Postoperative Management

Running head: POSTOPERATIVE MANAGEMENT 1
Postoperative Management
Name
Institutional Affiliation

POSTOPERATIVE MANAGEMENT
2
Frank Wright, a 76-year-old man, married with four grown children and a retired architect,
was admitted for a right total knee replacement. He has a past medical history of obstructive
sleep apnea, hypertension, hypercholesterolemia, and osteoporosis affecting both hips and knees.
His father died of heart failure and the mother of pancreatic cancer. He smokes ten cigarettes per
day, drinks alcohol and the primary caregiver for the wife who has early-onset dementia. This
essay will critically discuss Frank's post-surgical plan of care, the input of commodities and
general anaesthesia on postoperative recovery and lastly discharge plan for the patient.
Post-operative care
Assessment data Nursing diagnosis Intervention Rationale
1. Vital signs
Blood pressure
100/54, heart rate
106 beats per
minute, respiratory
rate of 12 breaths
per minute, SAO2
95% and a
temperature of
37.6 .°C
a. Decreased cardiac
output related to acute
blood loss during the
surgical procedure as
evidenced by;
- Isolated diastolic
hypotension(100/5
4mm/Hg)
- Tachycardia
(106BPM)
Independent
- Record input and output by
measuring the amount of urine
hourly and observe a decrease
in production.
- Auscultate heart sounds,
observing for the presence of
S3 and S4, rate, rhythm and
lastly lung sounds.
- A decrease in cardiac
output may result in
decreased perfusion to
the kidneys, with
resulting reduced urine
output(John, 2017).
- Excessive bleeding
during and after surgery
can result in
hypovolemic shock. One
major complication of
hypovolemic shock is
heart failure. New onset

POSTOPERATIVE MANAGEMENT
3
- Monitor breath sounds,
respiratory rate, and rhythm.
Note any presence of
orthopnea and paroxysmal
nocturnal dyspnea.
Collaborative
- Monitor electrocardiogram
for ectopy, rate and rhythm.
of tachycardia, fine
crackles in lungs and
gallop rhythm may
indicate the start of heart
failure(John, 2017).
- Shallow and rapid
respirations show
decreased cardiac output.
Crackles is a
characteristic of impaired
left ventricular emptying
due to fluid buildup
(John, 2017).
- Cardiac dysrhythmias
are caused by hypoxia,
low perfusion and
acidosis. Tachycardia
and ectopic beats may
further compromise the
cardiac output, especially
in older patients(Abbott,
2016).

POSTOPERATIVE MANAGEMENT
4
- Monitor for Hct,
prothrombin time, platelet
count, Hgb and activated
clotting time.
- Administer blood products
and intravenous fluid as
needed (Sodium chloride
0.9% 100mls/hour).
- Administer supplemental
oxygen (Oxygen 2L via
nasal).
- Useful in recognizing
bleeding or clotting
problems related to the
surgery that may further
compromise the cardiac
output(Albert & Miracle,
2016).
- Red blood cell
replacement is usually
recommended to restore
and maintain enough
circulating blood volume
and increase oxygen-
carrying capacity to the
tissues(Abbott, 2016).
- Increases oxygenation
to the tissues hence
decreasing cardiac
workload and helps in
resolving
dysrhythmias(Albert &
Miracle, 2016).