Surgical Patients Face Various Challenges

Running head: NURSING
Nursing
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1NURSING
Surgical patients face various challenges in the post-surgical period as they are vulnerable
to various surgical complications. The complications may range from minor events which could
be managed by pharmacological intervention to serious events that may require multiple
interventions. To get better idea about the kind of challenges faced by surgical patient, this essay
will look at a patient with hip replacement surgery (Pinto et al., 2016). The essay will review the
case study of Sarah Blake, a surgical patient admitted to the hospital for a right total hip
replacement. The essay will look at the post-surgical vital signs and outcome of patient and
discuss about the pathophysiology of Sarah’s post operative hypovolemia. By the use of problem
solving and critical thinking skills, the essay will examine the three priority clinical problem,
nursing goals and nursing interventions for Sarah. In addition, based on the assessment of care
needs of Sarah post discharge, a discharge plan will be developed.
The case study is about Sarah Blake, a 76 year old retired pharmacist who has been
admitted for a right total hip replacement (THA). Based on the comparison of his pre and post-
operative assessment data, several changes in his vital signs was found. For example, his BP was
140/95 in the pre-operative period and post his operation, his blood pressure decreased to 100/54.
This form of decrease in blood pressure might be due to several causes such as bleeding, sepsis
or adrenal insufficiency. Relative adrenal insufficiency is another cause behind sudden
hypotension in the postoperative period. According to Doğu et al. (2014), decrease in systematic
vascular resistance (SVR) and arterial blood pressure is seen due to the induction of general
anaesthesia. Due to the stress conditions during surgery, inadequate cortical response takes place
which is defined as adrenal insufficiency. Thus, anaesthesia is one of the causeS behind
subsequent decrease in systematic vascular resistance. Patients who undergo THA are often
given spinal anaesthesia and one of the side effects of spinal anaesthesia is hypotension. There
are two main causes behind onset of spinal induced hypotension. One is the decrease in SVR and
other is the decrease in cardiac output (Hofhuizen et al. 2019). Hence, advanced hemodynamic
monitoring is crucial to detect post operative hypotension and reduce risk for Sarah.
The stress of surgery was clearly identified for Sarah as she was found to have an
estimated blood loss in the OT of 400 ml and this might be one of the causes behind hypolemic
symptoms in patient. There were many other symptoms that indicated that Sarah was suffering
from hypovolemic shock. This is evident from her vital signs observation post-operatively. His

2NURSING
pulse rate was 116 bpm which is greater than the normal value of 100 bpm. She had respiratory
rate of 12/min shallow. Her right leg was cool to touch. According to Taghavi and Askari (2019),
symptoms of hypovolemic shock includes rapid heart beat, shallow breathing, feeling weak, low
blood pressure and cool clammy skin. In case of Sarah, hypovelemia due to blood loss is most
likely. The pathophysiology behind hypovolemic shock includes depletion of intravascular
volume due to blood loss. In response to this change, the body compensates with increase in
sympathetic tone. This pathophysiological change is associated with increase in heart rate,
peripheral vascular constriction and increase in cardiac contractility. The first change that is seen
as a result of such change includes increase in diastolic blood pressure and decrease in systolic
blood pressure. This change adversely impacts the delivery of oxygen to the vital organs and
oxygen demand of the organ is compromised. At this point, it is very important to correct
hypovolemia because cells switch from aerobic metabolism to anaerobic metabolism resulting in
diverted flow of blood to the organs and disruption of blood flow to the heart and brain. Hence,
tissue ischemia may occur and patient may suffer from worsening hemodynamic shock which
may even lead to death (Taghavi & Askari, 2019; Gulati, 2016). Thus, to prevent any further
complications to Sarah, implementation of active intervention is necessary.
Sarah’s past medical history might also be the cause behind adverse effect on patient. For
example, from the past medical history, it was found that she was suffering from hypertension,
obstructive sleep apnea (OSA), myocardial infarction, hypercholesterolemia and osteoarthritis.
Her history of hypertension is one area of concern as she is at risk of poor wound healing and
prolonged wound discharge because of hypertension. Prolonged wound discharge was observed
in case of Sarah too as her hip dressing had serous ooze with mild swelling. This may increase
risk of infection rate. Ahmed et al. (2011) supports that hypertension may delay wound healing
following THA and active pharmacological prophylaxis may be required to enhancing wound
healing process. Sarah’s medical history revealed that she is suffering from OSA and this can be
one of the factors that can increase risk of post operative cardiovascular complications in Sarah.
Thus, peri-operative measures like assessment of cardiac troponins was necessary to implement
appropriate intervention that could reduce cardiovascular complications for patient (Lyons et al.,
2016). Based on the review of the pathophysiology behind hypovolemia post THA, it can be
concluded that it is necessary to treat hypovolemic shock in post operative patient because if it is
left untreated, it may lead to ischemic injury of vital organs and result in multi-system organ