Dizzy After Breakfast: A Post-Op Hip Resident Who Wants to Walk
Mr. Tanaka, 78, is on day 12 of rehabilitation after a right total hip replacement. His orders are weight-bearing as tolerated with a walker, and ambulate 50 feet three times daily with a gait belt. At 8:40 a.m., ten minutes after finishing breakfast, you find him sitting on the edge of the bed. He is pale, his skin is cool and clammy, and he says the room is 'spinning.' His radial pulse is 112 and irregular and his respirations are 24. He took his blood pressure medication at 7:30 a.m. He wants to walk to the bathroom right now, because physical therapy arrives at 9:00. The charge nurse is at lunch and the only other aide is in the shower room with a resident.
1. What are your first actions in the next two minutes, and why is walking him to the bathroom the wrong choice even though he is asking for it?
Read the worked answer
Do not ambulate him.
- Stay with him and help him stay seated on the bed edge (or lie down if he cannot sit safely). Do not leave him alone and do not let him stand to 'walk it off.'
- Signal for help with the call light or call out to the other aide; the nurse must be located even though she is at lunch. A resident with these signs is not a 'wait until she gets back' situation.
- Get a full set of vitals if you can do it without leaving him: pulse (already 112 and irregular), respirations, and blood pressure lying, sitting, and standing if the nurse directs it.
Reasoning: new dizziness with a rapid irregular pulse, pale cool clammy skin and rapid breathing shortly after an antihypertensive dose points toward orthostatic hypotension or another acute change. Standing him converts a symptom into a fall with a fresh hip replacement. His request and the 9:00 therapy schedule do not change the risk. Deciding that he is 'fine to walk' is outside CNA scope; your job is to keep him safe, gather observations, and get a licensed nurse to him.
2. The nurse is still unavailable. What do you report, to whom, and how do you phrase it so nothing important is lost?
Read the worked answer
Report to the first licensed nurse you can reach (charge nurse, another RN/LPN, or the supervisor) - not to the other aide, and not only in the shift report at the end of the day.
Use a short, factual, time-stamped format:
- Situation: Mr. Tanaka, day 12 right hip, sitting on bed edge, pale, sweaty, says room is spinning, wants to walk to the bathroom.
- Background: BP medication given 7:30 a.m.; ambulates with gait belt and walker; PT due at 9:00.
- Assessment (your observations only): pulse 112 irregular, respirations 24, skin cool and clammy, no fall yet, he is fully alert.
- Request: someone come now and tell you whether he may get up, and how.
Say the numbers out loud rather than 'his pulse is a little fast.' If the nurse gives a telephone order, repeat it back. Afterwards, chart what you saw, the exact time, what you said to whom, and the response - not an interpretation like 'felt faint.'
3. Twenty minutes later the nurse says his BP is low but stable and he may get up with two staff. How do you proceed, and what do you watch for during the walk?
Read the worked answer
Get up slowly and in stages, with two staff and a gait belt, even though his order says one-person assist - the nurse's instruction for this episode takes priority for now, and you confirm that with her.
- Sit on the bed edge for a minute, check how he feels, then stand and pause before stepping.
- Gait belt on, walker positioned, one person at the belt on his weaker side, the other nearby.
- Stop the walk if he reports dizziness, turns pale, sweats, or his breathing changes; lower him to a chair or the floor-assisted position rather than trying to walk him back.
- Keep the distance short this time; do not push the full 50 feet to make up for lost therapy time.
Reasoning: the underlying problem has not been fixed, only assessed. Orthostatic symptoms often appear on standing, not while seated, so the first 30 seconds upright are the highest-risk moment. Report afterward whether he tolerated it and how far he walked, so the nurse and PT can adjust the plan.