David Douglas iHuman Case Study
David Douglas is a 74-year-old male presenting on post-operative day five following an elective left total hip arthroplasty. His hospital course has been uncomplicated, and he is being transferred to rehabilitation due to a lack of home support. He reports a pain level of 4/10 to the left hip and requires assistance with transfers and ambulation due to left hip pain. Notably, physical and occupational therapy recommended further strengthening prior to discharge to home because he lives alone.
In this comprehensive guide, we’ll walk you through how to approach his case, from initial post-operative assessment through systematic physical examination to the final nursing diagnoses of acute pain management and impaired mobility. You’ll learn the key clinical reasoning steps for post-operative hip replacement care, what the iHuman grading rubric expects, and a complete step-by-step solution to help you confidently navigate this essential post-operative nursing care simulation involving orthopedic recovery and rehabilitation planning.
David Douglas iHuman Case Overview (Doorway Information)
Patient Overview: David Douglas, a fictional patient, presents as a 74-year-old male on day five post-elective left total hip arthroplasty. He describes ongoing left hip discomfort with a pain level of 4/10, requiring ongoing pain management and mobility assistance. David requires assistance with transfers and ambulation and uses a front-wheeled walker for safe mobility. Additionally, he lives alone, creating unique discharge planning challenges that necessitate rehabilitation placement.
Key Background Information:
- Age/Gender: 74-year-old male
- Height/Weight: 6’0″ (183 cm), 165 lbs (75 kg)
- Procedure: Post-operative day 5 following elective left total hip arthroplasty
- Chief Concern: Post-operative pain management and mobility limitations
- Presenting Situation: Stable post-operative patient requiring rehabilitation placement due to lack of home support
- Associated Conditions: Lives alone, requires strengthening before home discharge
- Significant History: Uncomplicated surgical course, elective procedure
- Current Status: Stable vital signs, manageable pain levels, requires mobility assistance
- Risk Factors: Advanced age, living alone, post-operative complications risk
- Physical Findings: Stable post-operative condition, uses assistive devices for mobility
The patient appears stable but requires ongoing post-operative care including pain management, mobility assistance, and rehabilitation planning. His presentation with typical post-operative hip replacement recovery needs suggests standard orthopedic nursing care requirements with focus on safe discharge planning and functional improvement.
David Douglas (74 y/o male) – Adult Post-Operative Assessment
- CC: Post-operative pain and mobility limitations following left total hip arthroplasty
- MSAP: Acute Pain Related to Surgical Intervention – requiring ongoing pain management and mobility rehabilitation
- Associated symptoms: Left hip pain (4/10), impaired mobility, requires assistance with transfers
- History: Day 5 post-elective left total hip arthroplasty, uncomplicated course
- High-risk factors: Advanced age, living alone, post-operative status, mobility limitations
History Questions
- How are you feeling today, Mr. Douglas?
- Can you tell me about your pain level right now?
- Where exactly do you feel the pain?
- Can you rate your pain on a scale of 1 to 10?
- What makes your pain better or worse?
- How has your pain been since your surgery?
- Are you taking any pain medications? How well are they working?
- How are you managing to move around?
- Tell me about your living situation at home
- Do you have help at home when you’re discharged?
- How confident do you feel about going home right now?
- What concerns do you have about your recovery?
- Are you able to use the bathroom independently?
- How is your appetite and sleep?
- Have you been doing your physical therapy exercises?
- Do you feel safe when walking with your walker?
- Any nausea, dizziness, or other concerns?
- Do you have any questions about your medications?
- What are your goals for rehabilitation?
Physical Exam
Vitals: Blood pressure, pulse rate, respiratory rate, and oxygen saturation levels within normal limits for post-operative status
General appearance: Alert, oriented male appropriate for age, post-operative day 5, appears comfortable at rest
Post-Operative Assessment:
- Pain Assessment: Current pain level 4/10 to left hip, manageable with prescribed medications
- Surgical Site: Assessment of incision site for signs of infection, healing progress
- Mobility Assessment: Requires assistance with transfers and ambulation, uses front-wheeled walker safely
- Safety Assessment: Uses urinal and bedside commode appropriately for toileting needs
Cardiovascular Assessment:
- Heart rate and rhythm evaluation post-operatively
- Assessment for signs of DVT or other post-operative complications
- Circulation checks to affected extremity
Respiratory Assessment:
- Post-operative respiratory status evaluation
- Assessment for signs of pneumonia or other pulmonary complications
- Deep breathing and coughing assessment
Musculoskeletal Assessment:
- Range of motion within post-operative limitations
- Strength assessment of unaffected extremities
- Gait assessment with assistive device
- Transfer ability and safety
Integumentary Assessment:
- Surgical incision assessment
- Skin integrity evaluation
- Assessment for pressure areas from bed rest
Assessment Note
D.D. is a 74-year-old male on post-operative day 5 following elective left total hip arthroplasty with an uncomplicated hospital course. Physical examination notable for stable vital signs, manageable pain levels (4/10), and appropriate use of mobility aids. His presentation with typical post-operative recovery progress, combined with social factors requiring rehabilitation placement, indicates successful surgical outcome requiring comprehensive discharge planning and continued rehabilitation.
Diagnostic Testing: Complete blood count, basic metabolic panel, ESR/CRP if infection suspected, X-ray of surgical site if complications arise
Primary Nursing Diagnoses:
- Acute Pain Related to Surgical Intervention
- Impaired Physical Mobility Related to Hip Surgery
- Risk for Injury Related to Altered Mobility
Plan:
- Continue pain management with oxycodone/acetaminophen as prescribed
- Physical and occupational therapy for strengthening and mobility training
- Discharge planning for rehabilitation facility placement
- Patient education on post-operative precautions and safety
- Regular assessment of surgical site and overall recovery progress
David Douglas SOAP Note
Patient: David Douglas
Subjective Data
CC: Post-operative pain and mobility limitations following left total hip arthroplasty
HPI: 74-year-old male on post-operative day 5 following elective left total hip arthroplasty who presents with ongoing but manageable post-operative pain rated 4/10 to the left hip. Patient reports the pain is controlled with prescribed oxycodone/acetaminophen and describes the pain as aching and intermittent, worsening with movement and improving with rest and medication. Patient requires assistance with transfers and ambulation, using a front-wheeled walker for mobility. He reports feeling ready for rehabilitation but acknowledges concerns about eventual discharge home due to living alone.
Medications: Oxycodone/acetaminophen for pain management, prophylactic anticoagulation, other post-operative medications as prescribed
Allergies: No known drug, food, or environmental allergies reported
PMH: Elective left total hip arthroplasty 5 days ago, uncomplicated surgical course, no previous orthopedic surgeries
Social History: Lives alone, which necessitates rehabilitation placement, retired, limited social support system for immediate post-operative period
Review of Systems: Reports manageable pain levels, no signs of infection, appetite returning to normal, sleep somewhat interrupted by position limitations, no respiratory distress, bowel and bladder function intact with assistive toileting
Objective Data
General: Alert, oriented 74-year-old male in no acute distress, appears comfortable at rest, post-operative day 5
Vital Signs: Pulse rate, respiratory rate, blood pressure, and oxygen saturation levels stable and within normal limits
Physical Examination:
- Appearance: Appropriate for age and post-operative status, cooperative with care
- Surgical Site: Left hip incision healing appropriately, no signs of infection or complications
- Mobility: Requires assistance with transfers and ambulation due to left hip pain, uses front-wheeled walker safely
- Pain: Current pain level 4/10, well-controlled with current regimen
- Safety: Uses urinal and bedside commode appropriately for toileting needs
- Respiratory: Clear lung sounds, adequate respiratory effort
- Cardiovascular: Regular rate and rhythm, no signs of complications
Assessment
Primary Nursing Diagnoses:
- Acute Pain Related to Surgical Intervention (Priority)
- Impaired Physical Mobility Related to Hip Surgery
- Risk for Injury Related to Altered Mobility
Secondary Concerns:
- Discharge planning needs due to lack of home support
- Need for continued rehabilitation and strengthening
- Risk for post-operative complications
- Patient education needs for safe recovery
Differential Considerations
Acute Pain Related to Surgical Intervention: Most appropriate diagnosis given the patient’s current pain level of 4/10 related directly to the surgical procedure. The pain is manageable with current medications and is expected for post-operative day 5 following major orthopedic surgery.
Impaired Physical Mobility Related to Hip Surgery: Highly relevant given the patient’s need for assistance with transfers and ambulation, use of assistive devices, and overall functional limitations expected after hip replacement surgery.
Risk for Injury Related to Altered Mobility: Important consideration given the patient’s age, altered mobility status, and potential for falls or other injuries during the recovery period.
Readiness for Enhanced Self-Care: Potential positive diagnosis as patient demonstrates willingness to participate in rehabilitation and self-care activities within current limitations.
Primary Focus: Acute Pain Management and Mobility Enhancement with safe rehabilitation progression toward independent function.
Plan
Health Promotion:
✓ Post-Operative Education – Comprehensive instruction on hip precautions, activity limitations, and gradual progression of activities
✓ Safety Training – Proper use of assistive devices, fall prevention strategies, home safety assessment
✓ Rehabilitation Participation – Active engagement in physical and occupational therapy programs
✓ Pain Management Education – Understanding of medication regimen, non-pharmacological pain relief techniques
Monitoring:
✓ Surgical Site Assessment – Daily evaluation for signs of infection, proper healing progression
✓ Pain Assessment – Regular monitoring of pain levels and medication effectiveness
✓ Mobility Progress – Assessment of functional improvement and safety with activities
✓ Vital Signs – Continued monitoring for post-operative complications
Interventions:
✓ Pain Management – Administer prescribed oxycodone/acetaminophen for pain management, continuously monitor pain levels and assess medication effectiveness
✓ Mobility Assistance – Provide assistance for transfers and ambulation using front-wheeled walker, collaborate with interdisciplinary team including physical and occupational therapists
✓ Rehabilitation Support – Active participation in prescribed therapy sessions for strengthening and functional improvement
✓ Safety Measures – Ensure safe toileting with urinal and bedside commode, prevent falls and injuries during mobility
Long-term Management:
✓ Discharge Planning – Coordination with social services and rehabilitation facility for safe transition
✓ Rehabilitation Goals – Progressive strengthening and functional improvement toward home discharge
✓ Follow-up Care – Scheduled orthopedic follow-up appointments and continued therapy
✓ Home Preparation – Assessment and modification of home environment for safe eventual discharge
Complete Step-by-Step Guide to Writing the David Douglas iHuman Case Study
Completing the David Douglas iHuman case requires a systematic approach focused on post-operative nursing care and rehabilitation planning. This comprehensive guide will walk you through each section of the simulation, providing specific strategies and key points to ensure you achieve the required 70% score.
Step 1: Pre-Case Preparation and Initial Approach
Before diving into the case, review the doorway information and formulate your initial clinical approach.
Key Information to Note:
- 74-year-old male, post-operative day 5
- Elective left total hip arthroplasty with uncomplicated course
- Lives alone, requiring rehabilitation placement
- Current pain level 4/10, manageable with medications
Initial Clinical Mindset: Approach this case focusing on post-operative orthopedic nursing care. The priority concerns include pain management, safe mobility, and appropriate discharge planning for an elderly patient living alone.
Step 2: Conducting the History of Present Illness (HPI)
The HPI is crucial for understanding the patient’s current post-operative status and recovery progress.
Key Areas to Assess:
- Pain Assessment: Current level, location, quality, what relieves/aggravates
- Mobility Status: Current functional level, use of assistive devices, safety concerns
- Recovery Progress: Comparison to expected post-operative milestones
- Discharge Planning: Home situation, support systems, rehabilitation needs
Critical Questions:
- Pain level and management effectiveness
- Mobility limitations and safety concerns
- Understanding of post-operative precautions
- Concerns about discharge and home management
Step 3: Review of Systems (ROS)
Conduct a focused ROS paying attention to post-operative complications:
Musculoskeletal:
- Joint mobility, strength, function
- Pain patterns and relief measures
Cardiovascular:
- Signs of DVT, circulation to extremities
- Activity tolerance
Respiratory:
- Post-operative pulmonary function
- Risk for pneumonia or other complications
Integumentary:
- Surgical site healing, signs of infection
- Skin integrity from bed rest/immobility
Step 4: Social and Discharge Planning Assessment
Living Situation:
- Lives alone – assess safety and support needs
- Home environment and accessibility
- Available family/social support
Functional Assessment:
- Current ability to perform ADLs
- Safety with mobility and transfers
- Readiness for rehabilitation participation
Step 5: Physical Examination Strategy
Perform a comprehensive post-operative assessment:
General Assessment:
- Overall post-operative recovery status
- Pain levels and comfort measures
Surgical Site Examination:
- Incision healing and integrity
- Signs of infection or complications
Mobility Assessment:
- Transfer ability and safety
- Gait assessment with assistive devices
- Range of motion within restrictions
Safety Assessment:
- Fall risk evaluation
- Cognitive status for following precautions
Step 6: Developing Nursing Diagnoses
Propose appropriate nursing diagnoses with rationales:
Priority Diagnoses:
- Acute Pain Related to Surgical Intervention
- Impaired Physical Mobility Related to Hip Surgery
- Risk for Injury Related to Altered Mobility
Supporting Evidence:
- Current pain level 4/10
- Requires assistance with mobility
- Uses assistive devices for safety
- Advanced age and post-operative status
Step 7: Pain Management and Mobility Plan
Pain Management:
- Continue oxycodone/acetaminophen as prescribed
- Non-pharmacological interventions
- Regular pain assessment and medication effectiveness evaluation
Mobility Enhancement:
- Physical and occupational therapy for strengthening and mobility training
- Progressive activity advancement
- Safety measures and fall prevention
Step 8: Discharge Planning and Rehabilitation
Rehabilitation Placement:
- Coordination for rehabilitation facility due to lack of home support
- Goals for functional improvement
- Timeline for potential home discharge
Patient Education:
- Post-operative precautions and restrictions
- Safe use of assistive devices
- Signs and symptoms to report
Step 9: Interdisciplinary Collaboration
Team Coordination:
- Collaboration with physical and occupational therapists for rehabilitation planning
- Social services for discharge planning
- Orthopedic surgeon for medical management
Step 10: Documentation and Submission Tips
Writing Your Summary:
- Create a concise summary explaining your nursing care priorities
- Include clinical reasoning for nursing diagnosis selection
- Cite specific assessment findings and interventions
- Use professional orthopedic nursing terminology
Key Documentation Elements:
- Assessment of post-operative status and recovery progress
- Pain management effectiveness and ongoing needs
- Mobility assessment and safety considerations
- Discharge planning requirements and rehabilitation goals
Final Submission Checklist:
- ✓ Complete post-operative assessment with systematic evaluation
- ✓ Appropriate nursing diagnoses with clear rationales
- ✓ Evidence-based pain management and mobility plan
- ✓ Comprehensive discharge planning and rehabilitation coordination
- ✓ Professional documentation with proper nursing terminology
David Douglas iHuman Case Summary Grading Criteria
The David Douglas iHuman case will evaluate you across several critical domains to ensure comprehensive post-operative nursing care skills. Here’s what you need to focus on to maximize your score:
(1) Assessment Skills (Major Points): You must demonstrate thorough post-operative assessment including pain evaluation, mobility status, and surgical site examination. Essential components include: systematic pain assessment using appropriate scales, mobility and transfer evaluation, surgical site and healing assessment, vital signs and overall recovery status monitoring. The rubric specifically rewards students who conduct comprehensive post-operative evaluations.
(2) Nursing Diagnosis (High Weight): Focus on appropriate nursing diagnoses for post-operative orthopedic patients. Must-include diagnoses: Acute Pain Related to Surgical Intervention, Impaired Physical Mobility Related to Hip Surgery, Risk for Injury Related to Altered Mobility. Pro tip: The rubric awards points for accurate problem identification and appropriate prioritization based on patient needs and safety.
(3) Pain Management (Critical for Scoring): You need to demonstrate understanding of post-operative pain management principles. Expected interventions include: appropriate medication administration and monitoring, non-pharmacological pain relief measures, regular pain assessment and documentation, patient education about pain management strategies.
(4) Mobility and Safety Planning: You must address mobility limitations and safety concerns appropriately. Key components include: safe transfer and ambulation techniques, proper use of assistive devices, fall prevention strategies, progressive mobility goals.
(5) Discharge Planning (Heavily Weighted): The rubric expects comprehensive discharge planning including: assessment of home situation and support needs, coordination with rehabilitation services, patient education for safe recovery, interdisciplinary team collaboration for optimal outcomes.
(6) Patient Education: Demonstrate appropriate education for post-operative orthopedic patients. Bonus points for: explaining post-operative precautions clearly, teaching safe mobility techniques, discussing pain management strategies, providing discharge instructions and follow-up care.
Example of a High-Scoring Clinical Summary
Here’s how a top-performing student might document this case:
Patient Summary – David Douglas
Situation: 74-year-old male on post-operative day 5 following elective left total hip arthroplasty requiring ongoing pain management and mobility rehabilitation with discharge planning for rehabilitation facility placement.
Background: Uncomplicated surgical course with stable recovery progress. Lives alone, creating unique discharge challenges requiring rehabilitation placement for strengthening before home discharge. Current pain level 4/10, well-controlled with prescribed medications.
Assessment: Alert, oriented male demonstrating appropriate post-operative recovery with manageable pain levels and safe mobility using assistive devices. Requires assistance with transfers and ambulation, uses front-wheeled walker and bedside commode appropriately.
Primary Nursing Diagnoses:
- Acute Pain Related to Surgical Intervention
- Impaired Physical Mobility Related to Hip Surgery
- Risk for Injury Related to Altered Mobility
Recommendation:
- Continue prescribed pain management with oxycodone/acetaminophen and regular pain assessment
- Ongoing physical and occupational therapy for strengthening and functional improvement
- Safe mobility practices with assistive devices and fall prevention measures
- Coordination with rehabilitation facility for appropriate placement and continued recovery
- Patient education on post-operative precautions and safe discharge planning
Patient and Family Education Provided:
Explained post-operative recovery expectations and timeline, discussed proper pain management and medication use, taught safe mobility techniques and assistive device use, reviewed rehabilitation goals and discharge planning process, provided instructions for recognizing and reporting complications.
Conclusion
By following this comprehensive approach to the David Douglas case, you’ll demonstrate the post-operative nursing care skills that iHuman evaluates. Remember, success in orthopedic nursing cases requires understanding post-operative care principles: conduct thorough post-operative assessments including pain and mobility evaluation, develop appropriate nursing diagnoses focused on patient safety and recovery, implement evidence-based pain management and mobility interventions, and coordinate comprehensive discharge planning with interdisciplinary teams. The key is treating each iHuman simulation as you would a real post-operative patient encounter – be thorough, prioritize safety and comfort, and always focus on patient-centered care planning. With this guide, you’re well-prepared to excel in this essential post-operative nursing care simulation.
Frequently Asked Questions
Q1: What are the priority nursing diagnoses for David Douglas?
The primary nursing diagnoses for David Douglas include Acute Pain Related to Surgical Intervention (priority), Impaired Physical Mobility Related to Hip Surgery, and Risk for Injury Related to Altered Mobility. Students often struggle with prioritization, but remember that pain management is crucial for successful rehabilitation and recovery in post-operative orthopedic patients.
Q2: What are the critical assessment components I need to perform?
Essential assessment elements include comprehensive pain evaluation using appropriate scales, mobility and transfer assessment for safety, surgical site examination for healing progress, and vital signs monitoring for post-operative stability. Many students miss points by inadequately assessing discharge planning needs or failing to evaluate the patient’s understanding of post-operative precautions.
Q3: How do I address the discharge planning requirements effectively?
Focus on the patient’s living situation (lives alone), need for rehabilitation facility placement, and coordination with physical and occupational therapy for strengthening before home discharge. Include assessment of home safety, support systems, and functional improvement goals. The key is demonstrating understanding of safe discharge planning for elderly post-operative patients.
Q4: What pain management interventions should I include?
The comprehensive pain management plan should include prescribed oxycodone/acetaminophen administration with regular effectiveness monitoring, non-pharmacological interventions such as positioning and ice therapy, patient education about medication use and overuse prevention, and regular pain assessment using appropriate scales. Students often forget to address the importance of pain control for successful rehabilitation participation.
