Nursing: Acute Care Essay 2022

Acute Care

Table of Contents
Introduction.................................................................................................................................................3
Part a)..........................................................................................................................................................3
Part b)..........................................................................................................................................................5
Part c)..........................................................................................................................................................7
Conclusion:..................................................................................................................................................7

Introduction
Post knee replacement surgery requires intensive care treatment for the first 24 hours to
recover from the pain and anesthetic effects. Skilled and experienced nursing care is essential for
the patient with knee replacement surgery. The key objective of this nursing essay is to
demonstrate the augmented skills that are essential for making clinical decisions by analyzing
the required information of the patient with knee replacement surgery. This study will
also highlight the key roles of the nurses in terms of monitoring and implementing necessary
care interventions as per the needs of the patients. Clinical reasoning cycle is currently used by
the nurses to collect the patient’s information, case history to come to an understanding of the
present situation of patient. The present study will also use clinical reasoning process in order to
understand the past and present clinical issues of Frank Wright, a 76 year old man to evaluate
better outcomes.
Part a)
Clinical reasoning is a process through which nurses collect and process the information of the
patient in order to understand the present problem or situation and make a care plan for health
recovery of that patient (Hunter & Arthur, 2016). Clinical reasoning is vital at the time of
surgery and it contains eight steps that are patient situation consideration, past and present
information collection, comparison of normal and abnormal symptoms in the patient, evaluating
the facts to make definitive diagnosis decisions, explanation of the desired outcomes, course of
action selection, evaluation of the process outcomes and last but not the least, learning
reflection("CLINICAL REASONING", 2019).
The present study deals with a case of post operative nursing care of Frank Wright who have
undergone through a knee replacement surgery in his right leg. The height and weight of frank is
170 cm and 92 kg respectively. He has normal heart, respiratory rate and high blood pressure rate
before operation and there was no sign of fever as the body temperature was normal. His

urination was normal before and after the surgery. According to the past medical history, Frank
was diagnosed with hypercholesterolemia, hypertension, and osteoporosis that affect his hips and
knees. Frank is addicted to cigarettes at take 10 cigarettes a day but not addicted to alcohol. His
mother died due to pancreatic cancer and his father died due to heart attack. Frank has undergone
an uncomplicated knee replacement surgery and his physical condition after operation is stable,
though he is still in a certain level of drowsiness due to anesthetic treatment. The physical
condition of frank Weight after knee replacement is stable though the blood pressure rate has
decreased lower to the normal which is due to the administration of simvastatin 40 medicines to
him. The other signs and symptoms like respiration rate, renal condition etc can be considered as
normal ("Total Knee Replacement Postoperative Procedures - Orthopedic Surgery -
HealthCommunities.com", 2019).
Based on the pre and post operative observation of physical condition of Frank Wright, there
are chances of three consecutive clinical issues in Frank’s case (Vera, 2014). According to the
assessment of his family background, Frank’s mother had been suffering from cancer disease. It
has been known to all that cancer is a genetic disease and it is caused due to the certain
mutation in genes which may be inherited by the future generations. Thus, there is a chance
of presence of the mutated genes in Frank inherited from his mother. Smoking and anesthesia are
the deadly combination for any individuals. Frank is a chain smoker even at his age of 76.
Smoking may increase the chances of risk of heart disease, cancer, blood vessel disease, and
chronic bronchitis. Based on his age and height the ideal weight must be around 70 to 75 kg
which is not the case of Frank. Preexisting Overweight, hypercholesterolemia and hypertension
may be the reason for Frank’s obstructive sleep apnoea. These diseases must be considered as an
alarming bell of risks in heart blockage and other complications in the near future.
Nurses need to constantly monitor the physical and mental condition for Frank for minimum 24
hours after his knee surgery in the right leg (K.C. Owsley, 2019). A systematic review of the
evidence is important during the post operative nursing care for the effective recovery of the
patient. Post anesthetic care tool (PACT) may be a useful process for the documentation of the
evidence of the physical changes of the patient. This tool also reduces the postoperative risk
factors by proper monitoring technique. It reduces the human errors and enhances the positive
responses in the intensive care procedure (Street, Phillips, Kent, Colgan & Mohebbi, 2015).

After documenting the issues and possible health related outcomes in the postoperative situation
of Frank with the help of PACT nurses can easily go for the further recovery procedures. This
will help them to determine the dosage of the medication to the patient after 24 hours. There are
three phases of nursing care in the post anesthetic situation ("An Overview of Postoperative Care
| Nursing Review [Video]", 2019). Phase 1 indicates the period immediately after the surgery
and anesthesia. In this phase the nurses of post anesthesia care unit (PACU) assess the rate of
consciousness, heart rate, blood pressure, respiration rate, muscle strength and oxygen uptake
capacity (Street, Phillips, Haesler & Kent, 2018). After one to two hours the patient is then
transferred to the intensive care unit and here nurses continue to monitor the rate of recovery by
assessing the functions of pulmonary and finally shifted to the phase three or extended care
unit. In this phase dose of medication, a healthy diet chart, various physical training and therapy
procedures of knees must be determined by the nurses. Cryotherapy process has been attended
by the patient in this phase (William C. Shiel Jr., 2019). In this Cryotherapy process health
professional uses the freezing temperature to the knees in order to activate the nervous system
there. This process helps to reduce pain and swelling in the joints and hips (Ming et al., 2017).
Part b)
It is known to all that smoking is harmful for health, especially when the age is more than 60
years. Smoking is associated directly to the cardiovascular, heart, lungs and cancer diseases.
People who smoke more than five cigarettes daily have higher rate of heart stroke and lung
cancer. Cigarettes contain nicotine which increases the heart rate and decrease the oxygen flow
through blood("Health Effects of Cigarette Smoking", 2019). Smoke increases the amount of
mucus which forms clogging in the air passage. During anesthetic condition sensitivity to
airways clogging increases and decreases the oxygen delivery into the body which is fatal for the
body. Surgical wound complications may be increased due to excess smoking. Thus it is
important to cease smoking for Frank for 24 hours after surgery ("Smoking and anaesthesia -
ANZCA", 2019).
Obstructive sleep apnoea disorder is a sleeping disorder which is directly linked with age and
obesity. It is associated with co-morbidity and mortality during anesthetic condition and thus
anesthetics must be aware of this disease and control the dose of anesthesia. Nurses need to

monitor constantly to the patient with OSA for 24 hours after surgery. Some difficulties that may
observe due to OSA are post operative depression of respiration, problems in tracheal intubation,
and obstruction in the air passages (Kumar et al., 2008).
High Cholesterol indicates the clogging of blood and increases the chances of cardiovascular
diseases which ultimately results towards the heart attack and stroke of a patient. At the time of
anesthetic condition high cholesterol may increase the risk of mortality. This is because; the
blood pressure and heart rate changes during anesthetic condition if a patient suffer from high
cholesterol. Thus, it is important to administer simvastatin and captopril before and after the
surgery to reduce the risk of heart attack. Frank need to be advised with proper and healthy
diet and food habits long with minimum smoke inhalation in order to control the blood pressure
and other related diseases (American Society of Anesthesiologists, 2015).
Hypertension may directly involve with the higher level of blood pressure which increases the
risk in surgery. Heart and kidney failure, stroke can be the fate during and after the surgery
because of hypertension. Administration of anesthetic injection may be a risk attempt if a patient
suffers from hypertension. Thus it is important for the anesthesiologist to clarify the health
related histories of Frank Wright in order to determine the anesthetic dosage. At the post
operative situation the patient may be in the drowsiness which may lower the activity of
brain and decrease the intensity of hypertension of the patient (Weber, 2019).
Nursing intervention is an important part of treatment procedures after knee replacement surgery
of Frank Weight. Mental, physiological and comprehensive interventions are the three major
parts of the overall nursing intervention procedure. After surgery first 24 hours is a crucial time
and nurses must be vigilant for this time period and monitor each and every physical or mental
changes of the patient. Though knee replacement is not a complicated surgery but because of the
age and other physical obligations of the patient nurses need to follow the strict instructions of
medication by the doctors. The dosage of simvastatin and captopril must be given as per the
doctor’s direction in order to control the blood pressure and hypertension. Aspirin along with
paracetamol must be addressed through the intravenous injections to avoid post operative
infections in right knee and to treat pain, inflammation and fever (Ming et al., 2017). Because of
his smoking habits he has higher nicotine level in his lungs and blood which decreases the
oxygen flow in the blood. Also, because of anesthesia, he might face lower oxygen consumption

after operation. Thus it is important to administer oxygen via nasal prongs. It is important to give
morphine to the patient to reduce the post operative pain in the right knee (Ming et al., 2017). All
the medicinal dosage should be decided based on the physical and mental condition, age and
capacity to uptake by the patient. As Frank has been given oxygen externally through nasal
prongs, food supplements must be administered through saline and medicines must be injected
intravenously for the first 2 to 3 hours after that normal diet should be given to Frank. It is
important to use compel for dressing the surgical place after five or six hours to heal and protect
the wound.
Part c)
Knee replacement is an easy and well known surgical procedure where patients are released
within two days after successful surgery. But the case of Frank is little bit different from others
as he has some preexisting complications. Thus it is necessary to monitor his physical conditions
for at least 72 hours. Based on the physical conditions medication and other health practices will
be determined. One of the major processes which frank need to continue for at least one month is
cryotherapy where cold temperature is used for the recovery to the pain and wounds (William C.
Shiel Jr., 2019). Frank need to use crepe bandage and graduated compression stockings for pain
relief. Graduated compression stockings help to reduce the deep vein thrombosis and make a
gentle pressure on the leg to normalize the blood flow in the right leg ("Preventing Deep Vein
Thrombosis - ACOG", 2011). Comfeel has been suggested by the nurses to the patient to get
faster relief from pain and wounds. Frank can now follow normal diet but with lower fat
content. Aspirin should be continued to reduce the risk of inflammation. General physician
follow-up has been fixed after two days and OPD follow up with Dr.mcmeniman has been fixed
after six days of discharge. As Frank has higher risk of cardiovascular diseases and cancer, he
need cease cigarette smoking in order to reduce health risks.
Conclusion:
After evaluating the post operative nursing care treatment procedure of Frank Wright overall
recovery can be achieved. Nursing intervention is an important aspect in order to determine the
post operative treatment procedures. PACU system has been useful in this regards. In order to

assess the treatment of knee transplantation nurses have also used the clinical reasoning methods.
Based on the pre and post operative health condition of the patient, the medication and other
physical exercise procedures have been determined in this nursing assessment study.

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