Nursing Care Priorities for Post-Surgical Recovery of a Patient with Total Knee Replacement

Running head: NURSING
Nursing
Name of the Student
Name of the University
Author Note

1NURSING
Introduction
The following paper is will focus on the post surgical recovery of Mr Frank Wright, a
76-year old man who has undergone total knee replacement surgery (TKS) of this right knee.
The assignment is divided into three parts. The first part of the paper will focus on the three
priorities of nursing care during the first 24 hours after surgery. The highlighting the clinical
priority will be done with the help of the clinical reasoning cycle. The second part of the
assignment will highlight the pathophysiology underlying smoking, hypertension,
hypercholesterolemia and obstructive sleep apnoea (OSA) in delaying the post surgical
recovery like coping up with the condition of general anaesthesia and nursing interventions in
order to overcome those complications. Third part of the assignment will elaborate the
discharge planning for the patient.
Part A
Effective management of the fluid volume of the body
According to the case study, the estimated blood loss for Mr Wright is 200 ml and the
Vacudrain in-situ is 50 ml in the bag and thus indicating further blood loss post surgery.
Significant blood loss post surgery leads to the generation of the hypo-volemia. Hypo-
volemia increases the vulnerability of developing cardiogenic shock. Hyppovolemia is a
pathological condition where haemoglobin concentration in the blood drops below the normal
range due to extreme blood loss. Decrease in haemoglobin concentration within the body
decreases the oxygen saturation leading to breathing trouble of shortness of breath (Faverani
et al, 2014). Mr Wright was fitted with external supply of oxygen (2L through nasal prongs).
Under this condition, collaborative intervention will be crucial. The collaborative
interventions for the management of hypovolemia resulting from blood loss will be

2NURSING
restoration of the blood volume by blood transfusion. It is the duty of the nursing professional
to match the blood group of the patient before initiation of the blood transmission.
Contaminated or mis-matched blood samples can give rise of anaphylactic medication (type 1
hypersensitivity reaction) leading of agglutination of the blood cells. The blood must be
stored under proper storage consideration and the blood transfusion guidelines must occur as
per the specification stated by the doctor. Documentation of the patients’ status like the
oxygen saturation level, fluid volume in the body and the blood pressure must be done in
order to estimate the prospective outcome of the intervention (El Ayadi et al., 2016).
Reduction in Pain
TKR surgery is associated with severe pain. Thus, in order to manage pain during
post-surgical condition, Mr Wright was administered different types of pain management
medication like Aspirin and morphine with PCA 1 mg bolus and 5 minutes lockout.
However, prolong use of the pain management medication can prove to be detrimental for the
patients who have hypertension or high blood pressure. Mr. Wright’s blood pressure during
post operative condition is 140/95 mm Hg (normal range: 120/80 mm Hg). Thus it would be
the duty of the nurse to strictly monitor the cardiac parameter like the heart rate, cardiac
output and blood pressure during the administration of the pain killers. The administration of
medication must be done by the nursing professionals by following six rights of medication
administration that is right client, right route, right drug, right dose and right time (Devereaux
et al., 2014). Apart from the pharmacological interventions, non-pharmacological
interventions must be used for the effective management of pain. The main non-
pharmacological intervention that will be suitable for Mr. Wright is cryo-therapy. The cryo-
therapy will be nurse initiated intervention that will include use of the cold pack in order to
reduce the temperature of the surface that is experiencing pain creating numbness and thus
reducing the sensation of pain. The cooling of the surface area of pain also increases the