Nursing Priorities within First 24 Hours of Total Knee Replacement Surgery

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

1NURSING
Introduction
The following nursing assignment is based on the case study of Mr Frank Wright, a
76 years old man who has undergone total replacement surgery of the right knee. The paper
will focus on the three nursing priorities within first 24 hours of surgery. This will
simultaneously cover the nursing interventions in order to address those clinical priorities.
Mainly in the first part of the assignment, post-surgical plan will be illustrated with the help
of clinical reasoning cycle. The second part of the assignment will cover the complication
that must be associated with pathophysiology of obstructive sleep apnoea and smoking and
how it affects post-surgical recovery and during general anaesthesia. This part will also focus
on co-morbidities associated with smoking and obstructive sleep apnea and nursing
interventions to overcome those complications. The third part of the assignment will discuss
the discharge planning of the patient, Mr Wright following the total knee replacement
surgery.
Part A
Management of Blood Loss
The estimated blood loss of Mr Frank Wright, a 76 year old man is 200 ml. Kaufman
(2015) stated that use of the vacudrain is done to drain the blood accumulated in the small
tissues after surgery. Mr Wright has Vacudrain in-situ 50 ml in bag and thus indicating
further blood loss. Taghavi and Askari (2019) stated that significant blood loss after surgery
leads to the generation of hypovolemia while increasing the vulnerability of getting affected
with cardiogenic shock. Under hypovolemia, the concentration of the haemoglobin in the
blood decreases leading to drop in the oxygen saturation level. Under this condition, it is the
duty of the nursing professional to work effectively under collaborative intervention.

2NURSING
Intervention for hypovolemia resulting from blood loss is blood transfusion. It is the duty of
the nurse to match the blood group of the patient before initiating transfusion. Blood
transfusion is associated with potential allergic reaction. Nursing professional must check the
blood products before initiation of transfusion. Blood vials must be stored as per the local
guidelines and transfusion must be administered following the guidelines of the doctor while
making detailed observance of the transfusion reaction. The evaluation of the outcome must
be done based on the blood pressure and haemoglobin level. Increase in blood volume
restores normal blood pressure and haemoglobin concentration in blood (Blandfort,
Gregersen, Borris & Damsgaard, 2017). The blood pressure will be monitored based on the
readings given by the monitor of the pulse oxymetry and haemoglobin must be monitored
with the help of blood test.
Management of Pain
Wylde, Beswick, Bruce, Blom, Howells and Gooberman-Hill (2018) stated that nearly
20% of the patient undergoing total knee replacement experience chronic pain. This pain has
a multifactorial aetiology guided by a wide range of biological, psychological and surgical
factors. Treatment of chronic pain with pharmacological interventions might incur harm to
the patients who have cardiac complications. Mr Wright has past medical history of
hypertension and his blood pressure under pre-operative condition was high (140/95 mm Hg)
(Adams & Urban, 2015). Thus a combination of both pharmacological and non-
pharmacological intervention must be used for the effective management of pain. The nurse
initiated intervention will include use of cryo-therapy for reducing pain. The cryo-therapy
(cold pack therapy) reduces the temperature of the muscle, removing the cold pack increases
the surface temperature of the area encountering pain. This leads to increase in blood
circulation and thus promoting pain relief (Sun, Li, Yuan & Zhou, 2015). Mr. Wright was
also given mild to moderate sedative, Aspirin in order to manage pain. Under collaborative

3NURSING
intervention, it would be the duty of the nurse to check the signs of petechiae, ecchymosis
and presence of occult blood in stool in order to reduce the over-dosage of aspirin and side-
effects associated with aspirin (Wylde et al., 2018). The overall outcome of the pain
management therapy will be ascertained based on the level of pain measure with the help of
the PQRST framework (Provocative, Quality, Radiation, Severity and Temporal) (Mejin et
al., 2019).
Wound Management
Comfeel is a form of hydrochloride dressing that is used during total knee
replacement (TKR). It is also used for the measurement of blood loss post-surgery from
tissues. Wound care is important for faster wound healing. In case of TKR, de-bulking of the
Comfeel crepe will help in faster wound healing, reduce post-operative pain while promoting
faster recovery. De-bulking must be done under proper examination of the amount of tissue
loss, the condition of the skin surrounding the tissue, appearance of the wound area, presence
of exudates along with the signs of pain. Nurse initiated intervention in this case will include
proper wound assessment followed by de-bulking. The de-bulking must be done under the
aspectic condition and this will be done via maintenance of the proper hand hygiene
principles. The site must be cleaned thoroughly in order to remove the debris and devitalized
tissue (Chowdhry& Chen, 2015).
Part B
Peri-operative hypertension occurs in 25% of the cases of total knee replacement
patients who have hypertension. The past reported history of Mr Wright showed that he had
hypertension and during peri-operative condition, his blood pressure was 140/95 mm Hg
(high blood pressure). Under the post-operative condition, his blood pressure is 100/54 mm
Hg (low blood pressure: diastolic pressure). This rapid change in the blood pressure increases