Which postoperative intervention is essential to ensure adequate tissue integrity following hip arthroplasty?

Choice A rationale

Sudden onset of bilateral lower extremity edema often indicates a systemic failure rather than a localized integumentary issue, necessitating an evaluation of cardiac function. Normal central venous pressure ranges from 2 to 8 mmHg, and elevations can lead to peripheral fluid shifts. Heart failure screening is the priority to identify if the heart is failing to pump effectively, causing venous congestion and increased hydrostatic pressure that forces fluid into the interstitial spaces.

Choice B rationale

Assessing the ability of the patient to move their limbs or checking deep tendon reflexes provides information about the neurological system but does not address the immediate physiological cause of acute fluid accumulation. While motor function is important for overall health, it is not the most life-threatening concern when a client presents with rapid-onset bilateral swelling. The nurse must first stabilize or identify the primary circulatory or systemic deficit before performing detailed musculoskeletal or neurological exams.

Choice C rationale

Analgesics may provide symptomatic relief for the discomfort associated with skin stretching or inflammation, but they do not treat the underlying pathophysiology of the edema. Focusing solely on pain management ignores the potential for systemic complications such as pulmonary edema or renal failure. Scientific nursing practice dictates that the practitioner must address the etiology of the altered tissue integrity to prevent further deterioration of the client’s hemodynamic status and overall clinical stability.

Choice D rationale

While topical dressings are useful for open lesions, the primary issue described is systemic edema and redness, which suggests an internal fluid shift rather than a primary external wound. Using saline dressings without addressing the cause of the swelling would be an incomplete intervention. The nurse must recognize that bilateral symptoms usually point toward a central cause like cardiac or renal insufficiency, requiring a comprehensive assessment of the patient's fluid volume status.

Increased Heart Rate: A rise in heart rate can be seen in both fluid overload and dehydration. In dehydration, tachycardia is a compensatory mechanism: the body increases heart rate to maintain cardiac output despite reduced circulating volume. In fluid overload, the heart may also beat faster because of increased workload and stress on the cardiovascular system, especially if fluid shifts impair effective circulation. In burn patients, tachycardia is often more strongly associated with hypovolemia from fluid loss, but it can signal either condition depending on the broader context.

Decreased Urine Output: Low urine output is a hallmark of dehydration, as the kidneys conserve water in response to reduced circulating volume. In burn patients, this is particularly concerning because it reflects inadequate perfusion and possible progression toward shock. However, decreased urine output can also occur in fluid overload if renal perfusion is compromised by third spacing of fluids or if acute kidney injury develops. Thus, while it most commonly points to dehydration, it is not exclusive to it.

Elevated Blood Urea Nitrogen (BUN): An elevated BUN is strongly consistent with dehydration. When fluid volume is low, renal blood flow decreases, leading to impaired clearance of nitrogenous waste products. This results in a rise in BUN levels. In fluid overload, BUN is not typically elevated unless there is underlying renal dysfunction. Therefore, in this patient, the elevated BUN is a clear indicator of hypovolemia and dehydration.

Decreased Hematocrit: A low hematocrit suggests hemodilution, which occurs when excess fluid dilutes the concentration of red blood cells. This finding is consistent with fluid overload rather than dehydration. In dehydration, hematocrit usually rises due to hemoconcentration. In burn patients, decreased hematocrit may reflect aggressive fluid resuscitation or ongoing capillary leak with fluid shifts back into circulation, leading to dilution of blood components.