I worked in nursing home in sub acute unit . I have patient that was c/o a lot of pain on left leg . Pt has left hip replacement and on rehab for that . I noted patient was medicated with pain medicine at 9pm and that she was still on a lot of pain at 11pm . I worked 11-7 shift . So I went assessed patient , neurovascular check complete . Left hip surgical site was fine but noted increased swelling on left leg , faint pulse , and from knee down the extremity feel cool to touch , she's able to wiggle toes and denies numbness , movement was limited on that leg . Vitals was checked as expected HR and Bp was elevated . I called the doc and told him about my findings and that even though pt is medicated for pain medicine oxy and hydomorphone alternately per order she only have minimal relief and that I'm concern about it . Doc did not order X-ray . He just basically told me that he will see patient early on am . I also notified him about the vitals . No reported recent fall . So all throughout the night I just medicated pt with pain medications , reposition her , applied ice for comfort . In the am they did X-ray and found out it has dislocated hip . Patient was sent out to hospital . The problem now pt states that When CNA put her to bed she heard something puff out . She didn't not mention this to me . My question .. did I didn't do enough? I asked pt if she want to go to hospital she refused . So I'm not sure what else could I have done aside from notifying the doc and medicating her ? Now my facility want me to write a written statement about the incident . So I'm going to write exactly this .