This essay is going to discuss about knee replacement surgery in a 76 year old man 2022

Running Head: NURSING CARE
NURSING CARE
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Introduction
This essay is going to discuss about knee replacement surgery in a 76 year old man
and is going to highlight the post-surgical plan of care, various co-morbidities and their
impact on the patient and the discharge planning (Skou et al., 2015). As osteoarthritis is more
prevalent among the older population, thus, the total knee replacement is a very common
process among the elderly (Alshryda et al., 2013). Total knee replacement is a type of
surgical process where the knee joint which is not working properly is changed with an
artificial material. During the replacement surgery of knee, there is removal of the end of
femur bone and after the change it is replaced with a shell that is made with metal (Kremers
et al., 2015). It is very important to identify the co-morbidities that are experienced by the
patient during or after the surgery and thus, this essay will highlight the impact of the co-
morbidities on the patient. After this the essay outlines the discharge care plan for the patient
so that it will help the patient for the management of the disease (Weinstein et al., 2013).
Part A
Frank has undergone an uncomplicated unilateral left total knee replacement. As per
the Clinical Reasoning Cycle it is very important for the nurses to know the condition of the
patient after the surgery. As Frank is 76 years old and lives all alone in the house with his
wife who is a dementia patient there is no one in their house to look after them. Thus the
nurse has to make a post-operative care plan for Frank that will involve the self-management
of the disease and also will help Frank to know about their condition (Han et al., 2013).
Within the first 24 hours after the surgery the blood pressure of the patient is 100/54, heart
rate was 106, respiratory rate was 12BPM, SaO2 was 95%, temperature 37.6°C and the
estimated blood loss (EBL) in the OT was 200ml. The nurse who was at the night shift for
taking care of the patient was given direction so that there is no lack of care for Frank. The
nurse identified the three potential issues about Frank that involves DVT prophylaxis, wound

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management and finally the pain management with the help of cryotherapy (Chen, Chen &
Lin, 2014). The doctors has prescribed normal diet for the patient after the surgery and was
also prescribed to take 100mg of Aspirin daily. Aspirin is given to the patient so that there is
prevention of the formation of blood clots that starts after five days of the knee replacement
surgery. The recent studies have shown that the switch from the rivaroxaban which is an
anticoagulant to the low-dose of the aspirin was equally effective (Oatis et al., 2014).
The other post-surgical care for Frank includes the management of the wound by the
nurse that is done by keeping an eye on the radius of the wound or the surgery cut. This will
help the nurse to analyse the condition of the cut and to detect whether the cut is healing or
not. The doctors also prescribed Frank that he should wear TED stockings whenever he is
going to travel for more than 3 hours (Han et al., 2013). These stockings are prescribed by the
doctors for the patients who develop DVT or Deep vein thrombosis which is a blood clot that
is formed inside a deep vein, and the most common site for the formation of the clot are the
pelvic veins and legs. The patients who are being admitted to the hospitals have a higher
tendency to develop the disorder after any surgery or if they are unable to move due to certain
medical issues. DVT can be prevented with the use of the drugs or certain compressions
(Donec & Krisciunas, 2014). As the use of the drugs can cause bleeding which is very
prominent among the patients who have undergone surgery thus, it is recommended by the
doctors to wear the TED stockings which are Graduated compression stockings or GCS that
will help Frank to prevent the formation of blood clots in the legs by the application of
varying degree of pressure at different parts of the legs.
The most common methods for the relief of the post-operative pain in the patients
who received the knee replacement surgery are the oral, intramuscular and intravenous
analgesics (Skou et al., 2015). As, most of the patients have reported that they suffer from
poor appetite and dizziness that usually results from vomiting and nausea after analgesics

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were administered. Thus, the process of wound healing was affected due to poor absorption
of the food nutrients. Along with this, the patients refused mobilization as they suffered from
dizziness that resulted in the decrease in the improvement of their condition (Chen, Chen &
Lin, 2014). Cryotherapy is a non-pharmacological method that helps to reduce the
postoperative pain or swelling. In this therapy there is a decrease in the temperature of the
surface of the skin by the use of the ice bags or cold water that is being applied on the tissues
that are injured. The decrease in the temperature of the inner structures and conduction of the
nerve signals, there is suppression of the signals that are harmful as well as the suppression of
the inflammatory response. Thus, the sensation of the pain and swelling will be lowered. In
addition to this, the process of cryotherapy is a very safe and cost effective way for the
management of the postoperative pain (Oatis et al., 2014).
The most important aspect of the post-operative care plan includes the education of
the patient after the surgery as Frank lives all alone with his wife and has to learn the ways of
managing the symptoms of the post-operative pain (Duivenvoorden et al., 2013). After the
total knee replacement surgery there can be incidences of chronic pain that is usually due to
the surgery or the severe preoperative pain. There are a number of reasons for the occurrence
of the pain after the surgery that also involves the psychological factors. Thus, it is the
responsibility of the nurse to educate the patient about the various ways that he can
implement for management of the pain and swelling after being discharged from the hospital
(Ward et al., 2015).
Part B
Within the 24 hours of the post-operative period there are a high risk of the co-
morbidities like smoking, high cholesterol, sleep disorder and hypertension. If the patient
smokes, then their lungs and heart don not work the way in which they should work. The

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patient might experience breathing problems at the time of surgery or even after the surgery.
This puts the patient at a higher risk of developing pneumonia (Everhart, Altneu & Calhoun,
2013). Along with this, smoking in patient also reduces the rate of blood flow that reduces the
healing process and can be a major cause for the development of infection after the surgical
incision. It is very important to carry out the assessment of the patients who are hypertensive
and will undergo surgery by measuring the blood pressure by using the correct technique.
The blood pressures of the patient before the surgery which is more than 180/100 mmHg
have the grounds for the deferment of the surgery for a later time (Lin, Kuo & Takemoto,
2013). The obstructive sleep apnoea or OSA is a very common sleep disorder that affects the
anaesthesiologists as it is linked with the increased rate of the morbidity and mortality after
the surgery. The main concern among the patients who are suffering from OSA are the
obstruction of the upper-airway, the difficulty in the tracheal intubation and the depression of
the respiratory pathway after the surgery and the obstruction of the air passage. The sleep
apnoea takes place when there is development of the negative air pressure at the time of the
inhalation is more than the pressure of the muscular distension that causes the collapse of the
air passage (Pugely et al., 2014). After the surgery there is disturbance of sleep process. Thus,
within the 24 hours of the surgery the pain scores are very high and deep. The higher levels
of the pain results in the more need of the analgesics and that increases the risk of the sleep
apnoea at the time when the patient is having a sleep which is drug-induced.
The nursing interventions that should be implemented on the patients is that the nurse
should place the patient in anon-supine positions which means that the head of the patient
should be placed at the end of bed that is being raisedat 30° through the entire process of
recovery. The nurses should also involve continuous monitoring of the patient as long as the
patients are at high risk (Noiseux et al., 2014). When the nurse observes that certain factors
such as the BMI, pulmonary disease and the use of the narcotic or sedative are all mild, then

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the patient might go to an unmonitored environment and when these factors are severe, then
the patient should go into ICU.
The nursing interventions for other comorbidities like high cholesterol and
hypertension involve the performance of exercise and normal diet. The regular exercise will
help in the decrease of the cholesterol and will make Frank active. This will also help in the
management of weight in Frank and thus ultimately reduce the burden of the weight on the
knees that will reduce the pain in legs experienced by Frank (Skou et al., 2015). The intake or
consumption of normal diet by Frank or die that contains less fat and more fibre will be
beneficial. As the diet will control the amount of sodium that is taken by Frank that will be
helpful to lower the high blood pressure. The other intervention which is necessary involves
the cessation of smoking in Frank. As smoking is the main cause of a number of diseases
among the patient like cardiac diseases, respiratory diseases and other health issues.
Part C
The discharge planning for Frank will involve the better pain management as it is that
aspect of patient which is poorly managed after discharge. Thus, the discharge planning for
Frank will focus on the ways to improve the condition. This is important as the patients are
generally discharged after 4-5 days of the surgery (Liao et al., 2013). The pain can be
managed both by the use of the pharmacological and the non-pharmacological approach that
includes the use of medicines such as the opioid analgesics along with other antileptic and
antidepressants medicines and the use of the psychological therapies. These therapies can be
very useful for the effective pain management. The knee joint is lined with a cushioning
called cartilage and is backed by muscles and ligaments. As the cartilage wears away over
time, this can make the knee feel painful and rigid. Frank is permitted to shower; there are no
showers until after he has cured your incision. The dressing should be waterproof so that

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the incision will be protected. The nurse should give instructions to Frank about shower by
sitting on stool or chair to prevent from falling. The nurse should educate Frank to take his
medication as directed by your doctor for blood thinner (Artz et al., 2015).
Conclusion
Thus, the conclusion is that the patient suffers from the knee pain and has undergone a
total knee replacement. As the patient is all alone and also has to take care of her wife who
suffers from dementia, it is important for the patient to learn about the self-care as well as it is
important part of the nursing interventions to teach the patient the ways for pain management.
The nursing interventions will also include the cessation of smoking in the patient, along with
restriction on the diet, and regular exercise. These interventions will be helpful as they help
Frank to take care of himself and will also prevent the further deterioration of his health.

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