(PDF) Postoperative care - Desklib

Running Head: POST OPERATIVE CARE 1
Post Operative Care
Name of the Student
Name of the University
Author’s Note

POST OPERATIVE CARE 2
Post Operative Care
This report will be giving an overview of the health condition of Sarah Blake and her
postoperative care plan. She has just been through a right total hip replacement, and her
postoperative clinical assessment shows hypotension, which is not preferable for her health due
to her past medical history. This could be considered as a hypovolemic shock, which common
after a surgery as there is blood loss (Ugbeye et al., 2017). This paper will give an explanation
about Sarah Blake’s condition after the surgery including the clinical issues related to surgical
procedure of total hip replacement, her medical history that will influence the deterioration of her
condition, and the stress that affects the blood pressure. It will also include the nursing
interventions for her safety, three clinical problems of the highest priority and the relevant
nursing goals that will help in improving her condition. The pre and postoperative clinical data
will be assessed to find accurate solutions that will enhance her health status.
Part A
Total hip replacement is an appropriate measure for people who suffer from hip pain and
have difficulties in their daily activities. Similarly, Sarah, who is 76-year-old woman, is also in
her postoperative stage after her hip replacement surgery. Sarah is suffering from postoperative
hypovolemia after the surgery, as evident from assessment, which shows that her blood pressure
is 100/54 mmHg and her estimated blood loss was 400 ml. This could lead to a hypovolemic
shock, and that is a life-threatening condition, which happens when the body has a loss of more
than 20% of the total body fluid or blood (Le Manach et al., 2015). The body has to compensate
for the blood loss physiologically such as the cardiovascular system gets affected during the
maintenance of blood circulation. It tries to move the fluid of the body to different organs within
the cells to the bloodstream so that it can help to balance the blood pressure that gets affected
during blood loss. The body also increases the sympathetic tone that leads to elevated heart rate,
which results to peripheral vasoconstriction and cardiac contractility. The diastolic blood
pressure increases during a hypovolemic shock with a narrowed pulse pressure. The volume
status decreases and the systolic pressure drops, which leads to the obstruction in oxygen
delivery to different parts of the organs and that causes the inadequacy in meeting the oxygen
demand. Aerobic metabolism in the body is exchanged with anaerobic metabolism and that
causes lactic acidosis. The sympathetic drive increases and the blood flow diverts to the other
organs, which happens so that the blood flow is preserved for the heart and the brain. This is the

POST OPERATIVE CARE 3
cause of the propagation of tissue ischemia and the deterioration of lactic acidosis. If this
condition is not treated then it can worsen the hemodynamic compromise and that can lead to
death (Kalkwarf, & Cotton, 2017). However, Sarah is going through hypotension, which is
evident from the pathophysiology.
Several clinical issues occur after a total hip replacement surgery such as blood clots
forming in the legs, infection in the site of incision due to unsterilized equipment, fracture and
dislocation during surgery, change in the length of the leg due to the new hip being attached and
nerve damage when the implant is not connected properly cause the injury of nerves in the hip
area. The major health issue is blood loss that could be fatal. These clinical issues need serious
medical interventions immediately for the wellbeing of the patient (Berstock et al., 2014).
Sarah has a medical history of hypercholesterolemia, hypertension, osteoarthritis that
affects her knees and hips, obstructive sleep apnea, and myocardial infarction that happened in
2007, including a left coronary artery stenting. She takes medication for all these health
complications. Her family history shows that her father died of heart failure and her mother died
due to pancreatic cancer. It is seen that she has a history of cardiovascular diseases such as
hypertension and hypercholesterolemia, and she also had coronary artery stenting due to
myocardial infarction (Olsson et al., 2014). She already has abnormal blood pressure and
hypovolemic shock can lead to more complications in her blood circulation by decreasing the
cardiac output and elevating the peripheral vascular resistance. The venous volume that is
reduced due to blood loss and the nervous system that is sympathetic attempts to maintain or
increase the low blood pressure through systemic vasoconstriction. This will deteriorate Sarah’s
condition if correct intervention is not applied.
Physiological stress during surgery is the reason for several metabolic changes. Adrenal
insufficiency or the crisis of adrenal leads to catecholamine resistant hypotension, including
hypovolemic shock in patients that do not suffer from adrenal insufficiency or patients who have
no medical condition that requires them to take doses of glucocorticoids (Marrelli et al., 2014).
Adrenal insufficiency is also known as insufficient cortisol response to stress, which occurs in
people who have normal serum cortisol levels without any prior history of adrenal insufficiency.
Surgery causes the stress level to increase, which leads to the elevation of the blood pressure.
The use of anesthesia during surgery is also the reason for blood pressure to drop as it is a form