Nursing Assignment: Clinical Reasoning Process

Running head: Nursing assignment
Nursing assignment
Name of the Student
Name of the university
Author’s note

1Nursing assignment
Clinical reasoning process
Patient situation
The patient is in the emergency ward and is experiencing pain of intensity 7/10 in her left knee as
she had underwent a total knee replacement surgery under general anesthesia.
Collect cues
The patient had a past history of osteoarthritis in both the knees, having a limited range of
movements and the pain on weight bearing in the left knee (Wylde et al., 2015). After prolonged
suffering from osteoarthritis, the patient might have opted for osteoarthritis, as it provides the
greatest improvement in the quality of life of the patient with functional impairment. She also
had a history of Type 2 diabetes, hypertension, and fatty liver and diabetic neuropathy in both the
feet with mild neuropathic pain, without any neurologic deficit (Wylde et al., 2015).
Mar is fully alert and her GCs is 15/15, her surgical wound is dry and her PCS has not
been assessed in the past hours. She had been suffering from pain at an intensity of 7/10 in her
left knee. Most of the patients who have undergone a hip replacement surgery experience chronic
pain after total knee replacement arthoplasty. Mary had been feeling lightheaded and had less
appetite for food. There is a 18 G IV catheter in the tight hand and 200 mL isotonic saline in the
IV bag, running at 80 mL per hour and the PCA circuit is attached to the line. Her BP 60 minutes
ago was 123/70, radial pulse was 55, RR20, SpO2 is 93 %, FiO2 0.21, T36.2, peripheral
capillary refill 2 seconds. The current vital signs were- BP- 105/56, RR20, radial pulse 66

2Nursing assignment
regular, SpO2 93%, FiO2 0.21, T36.4 tympanic. BGL11.5mmol/L, the peripheral capillary refill
is 2 seconds and pale cool digits.
Process information
Knee pain after a total knee replacement might occur due to the loosening of the implant,
infection, other palletofemoral problems or the alignment problems. Knee pain can also be
caused due to pinched nerve in the lower back (Wylde et al., 2015). The common peritoneal
nerve, the branch of sciatic nerve that courses from a knee over the top of the fibula bone , are
affected after a total knee replacement (Uesugi et al., 2014). This nerve is susceptible to injury
after the total knee replacement. It is evident from the case study that Mary is 85 years old and it
is normal to feel fatigued after a big surgery. Lightheadedness can also be caused due t the
prolonged intake of the medicines like metoprolol.
The patient had past history of hypertension but acute hypotension can occur after a total
knee arthoplasty (Zhang et al., 2015). It is clear that the BP of the patient had lowered suddenly
within a span of 60 minutes. The anesthetic drugs used at the time of the surgery can affect the
blood pressure. Again losing a large amount of blood at the time of the surgery can lead to
hypovolemic shock leading to a drop in the blood pressure levels. The factors responsible for the
increase in the post-operative hypotension is related to age, the pressure of the tourniquet and the
type of surgery conducted. According to Zhang et al., (2015), the elderly patients cannot regulate
the tension in the blood capillary bed after the surgery and the interstitial fluid cannot be
transferred to the blood vessel timely causing hypotension. Initially, the radial pulse was low
which became normal after 60 minutes. Again increased respiratory rate right after the surgery

3Nursing assignment
can be a sign of the advent of some major adverse events like the development of the sepsis
(King, Morton & Bevan, 2014)..
Again the normal blood glucose value is 5.6mmmol/L, hence 11.mmol/L is a quite high
value.
According to the case scenario, the patient had lack of appetite and hence the food intake
is too low. In such cases the patient might develop hypoglycemia and develop light headedness
(Rajamäki et al., 2015). The capillary refill time for the patient is also increasing as per the
standard value. A prolonged capillary refill time might indicate towards the development of the
sepsis or shock and might also indicate towards decreased peripheral perfusion.
Identify the problems
It can inferred from the symptoms, that sepsis might have occurred, which can be
understood by the prolonged capillary refill time, the pale skin and the increased respiratory rate.
The septic shock might also be caused due to infection or due to diabetes (Nielen et al., 2015).
Establish goals
 To increase her blood pressure level
 To increase her capillary refill time
 To increase her appetite to the food in order to prevent any chance of the occurrence of
the hypotension.
 To alleviate pain within 2 hours.