NUR2203: Acute Care Report on Post-Op Knee Replacement Care

This report focuses on the acute care of a patient, Frank Wright, who underwent a right total knee replacement. It applies clinical reasoning to assess and manage post-operative complications, co-morbidities, and implement appropriate nursing interventions. The report discusses essential aspects of post-operative care, including vital sign monitoring, prevention of blood clots, pain management, and dietary considerations. It addresses Frank's pre-existing conditions like hypertension, hypercholesterolemia, and osteoporosis, incorporating strategies for medication management, lifestyle modifications, and self-management techniques. The report also highlights the negative effects of smoking on post-operative recovery and the importance of a rapid response system for deteriorating patients. Finally, it provides a detailed discharge fact sheet with self-management strategies, wound care instructions, and lifestyle recommendations to promote optimal recovery and long-term health. The report emphasizes the role of nurses in providing comprehensive care and patient education to ensure positive outcomes following knee replacement surgery.

Running head: ACUTE CARE ACROSS LIFESPAN A
ACUTE CARE ACROSS LIFESPAN A
Name of the student
Name of the university
Author’s name

1ACUTE CARE ACROSS LIFESPAN A
Introduction
Knee replacement surgery has shown its prevalence in the older adults and it has been
found to successfully improve the patient’s condition provided they are given proper care and
kept under observation monitoring post-surgery complications (Bayliss et al., 2017). Patients
should be supervised to verify every vital after a full knee replacement operation. The majority
of people are kept in hospitals for several days to monitor the vitals, depending upon the
operation carried out and the overall patient's health. Following surgery, if patients suffer from
shortness of breath, chest pain and increased swelling or redness in the lower portion of leg, they
must immediately seek for treatment as these may lead to severe complications worsening the
patient’s condition. The paper, therefore, focuses on the post-operative care in patients for the
above surgery (Knee replacement), the nursing interventions related to it and self-management
strategies to manage the same following an incident shown in the case scenario.
Part A
Clinical reasoning cycle must be used by the nurse to devise intervention strategies for
the patient by collecting all the subjective and objective data through assessments that will help
to guide the treatment process suitable for the patient. After a complete knee replacement
surgery, patients must be monitored in order to check every vitals. Depending on the surgery
performed and overall health of the patients, most people are kept in the hospitals for several
days to follow up with the procedures.

2ACUTE CARE ACROSS LIFESPAN A
One of the most common post-surgery complications in these patients is the formation of
blood clot in the lower extremities. Therefore, therapies are given to prevent blood clots in these
patients. The therapies include-
 Compression boots that are wrapped around the lower leg and expands and contracts
when gentle pressure is applied.
 A continuous passive motion machine that moves the legs when the patient rests in bed.
 Moving the foot and ankle while taking rest in the bed.
 Medications for thinning the blood.
 Elevating the leg for a short period of time.
After knee replacement, patients must be given a proper and healthy diet. It usually takes as
much as 6 weeks for the patients to get steady and able to walk on their own feet. They may also
be given with a walker or crutches to assist them while walking. If the patients begins to use the
stairs, they must use the handrail. In order to reduce the stress on the knee which is replaced,
patients must lead with or start walking with their old knee while going up from stairs and lead
with the knee that was replaced while coming down from the stairs.
Before discharging the patient after operation, a physical therapist must provide the
patient guidance and recommendation that are needed to be followed after surgery (Losina, et al.,
2016). Exercise and daily movement can help these patients to regain their strength and get
started with daily activities (Losina, et al., 2016).

3ACUTE CARE ACROSS LIFESPAN A
After the knee replacement surgery, the patient should be given anticoagulant medication
to thin the blood, reducing the risk of developing harmful blood clots forming in the blood
vessel. These drugs are administered in the mouth or by injecting them (Franchini et al., 2016).
After surgery, it is also important to monitor the patient’s pain intensity in the operative
site, to monitor whether there is a new drainage from the incision (Losina, et al., 2016). The
patients are also examined to see whether the operative site is swollen or have become warm.
Managing the blood sugar level is important especially for patients who have undergone
surgery. After the surgery monitoring blood sugar level is extremely essential to decrease the risk
of health issues after the surgery like infection and the related comorbidities. Surgery affects
blood glucose level in a variety of ways, therefore, there is a need to monitor and manage the
blood glucose level post-surgery. After surgery, stress can cause the body to release hormones
that makes the body more difficult for managing glucose level in the blood. Surgery also affects
dietary habits of an individual and therefore, diabetes must be managed throughout the course of
the surgical process including pre surgery as well as post-surgery of the patient.
The clinical issues found in the patient includes-
Hypertension: Since, the patient has hypertension he must make some lifestyle choice to control
his hypertension. He must quit smoking and consumption of alcohol.
Hypercholesterolemia: Frank also has high cholesterol along with hypertension. Therefore, he
should be prescribed with a therapy for lowering lipid along with statins that helps in decreasing
the blood pressure through a pleiotropic effect. When blood pressure-lowering and lipid lowering
therapy are given in combination, it affects the blood pressure regulation and cholesterol levels

4ACUTE CARE ACROSS LIFESPAN A
in patients with both of these conditions (Egan et al., 2013). Thus, Frank Wright must be given a
combination of these drugs to manage his condition. Statin and renin-angiotensin inhibitor
therapy advantages not only by improving hemodynamics and reducing the cholesterol level, but
also by their pleotropical intervention and possible mutual interaction (Ivanovic & Tadic, 2015).
These two conditions upturns the risk of developing cardiovascular diseases, therefore, the
patient should be given medications for improving both of these conditions.
Osteoporosis- Knee replacement increases the risk of lowering bone density leading to an
increased risk for fracture, osteoarthritis and osteoporosis that results into the loss of mobility
and function (Gundry, Hopkins & Knapp, 2017). Since Frank has osteoporosis affecting legs and
hips, he must be made aware of the self-management strategies to promote his health. Although
the disease does not have a remedy, several medicines are authorized by Food and Drug
Administration for osteoporosis prevention and treatment. Additionally, a diet wealthy in
calcium and vitamin D, frequent exercises in weight-bearing and healthy lifestyles can help
prevent or decrease disease impacts (Nih.gov, 2019).
Part B
1. Smoking has become the most cause of anesthetic morbidity. In spite of such a dreadful
effect on the health, smoking patterns are continuously rising. Smoking after the post-
operative period of anesthesia will effect the cardiovascular system because of a high
consumption of oxygen by the sympathetic-adrenergic system activation. Similarly, there is
also a decrease in the supply of oxygen due to high COHb levels and a greater resistance in
coronary vascular system (Castori et al., 2017). Smoking is the primary risk factor for
coronary vasospasm and arterial thromboembolism through multiple ways that includes

5ACUTE CARE ACROSS LIFESPAN A
direct endothelial and hematological damage, biochemical and metabolic abnormalities.
Inveterate smokers have COHb levels of 5% to 15%, which may mean oxygen saturation
below 15% indicated by pulse oximetry. Smokers have a higher risk of perioperative
respiratory distress and of transfer to intensive care. After a general anesthetic within 24
hours of postoperative period if the patient smokes then it will increase the repetitive
occurrence of co-morbidities like hypertension, high cholesterol and obstructive sleep apnoea
(OSA) which will deteriorate the health and decrease the quality of life (Rabin & George,
2015).
2. One of the mechanism involved in the smoking effect on OSA is a disturbed sleeping pattern
including a deprived and fragmented sleep. Smoking also causes damage to the upper airway
neuromuscular protective reflexes leading to sleep apnea. Certain researchers conducted an
experiment on the newborn lambs (Singh et al., 2015). It was found that passive smoking
resulted in high inhibition in the respiratory system with laryngeal stimulation and a higher
chance of developing more apneas. Arousals due to sleep associates with the pathogenesis of
smoking and OSA. Smoking impacts the arousal threshold, but the indication is
contradictory.
3. Generally there are certain factors contributing to failure to recognize and respond to a
patient who is deteriorating. Issues which lead to failure in the identification of deteriorating
patient are–
 Failing to monitor and interpret the vital signs or detecting the changes occurring in
the vital signs
 Lack of knowledge regarding the indications that can rise to signal deterioration

6ACUTE CARE ACROSS LIFESPAN A
 Not able to recognize the implication of apparent deterioration (Edwards, Mears,
Stambough, Foster & Barnes, 2018).
 Confusion regarding whether help is needed or not
 Delaying in notifying the senior medical workforce of the signs of deterioration
 Staff members delaying to respond to the signs of deterioration
 Lack of knowledge and skills to on managing the patients with chronic and acute
conditions.
 Failure of staff of the medical ward to quickly seek out management and supervision
or recommendation.
 Lack of communication with other health workers or staffs about the issues of
concern, including failure of vital equipment.
 Lack of clarity and awareness about the roles and responsibilities to care for the
patients.
There are certain steps or features for a rapid response system –
 Event recognition and response trigger device: It helps to form a rapid response
system for detecting patients with deteriorated condition and activate an alarming
response.
 Crisis response: It involves a system of rapid response providing resources for
addressing the patients’ needs who are critically sick, in a timely manner.
 Process improvement: It establishes a system with the aim to collect information and
data thereby providing feedback to the healthcare providers, patients and their
families in order to improve responses that helps in the prevention of such events in
future.

7ACUTE CARE ACROSS LIFESPAN A
 Administration: An administrative organization is required that will help in
coordinating these activities. The main aspects include establishment of sufficient
resources, imparting knowledge and facilitate training of the staff and support the
organization in carrying out these measures (Azhar et al., 2016).
Part- C
The discharge fact sheet should have every detailed information regarding the health of the
patient.
General measures taken:
 After he reaches home, he should walk with the help of a walker or crutches.
 He should not be involved in any sports like football that needs heavy body movements
(Iorio et al., 2016).
 He should avoid or prevent himself from any falls.
 While lying in bed, he should comfort himself with the help of a pillow on his leg
(Nichols & Vose, 2016).
Wound Care:
 The dressing (bandage) on the incision should be clean and dry.
 While removing the dressing, he should not pull it hard rather he can soak it with the help
of saline or sterile water.
 He must check his wound for the signs of infection like swelling, redness and drainage
with a bad odor. He should immediately report to the doctor incase these symptoms
appear.

8ACUTE CARE ACROSS LIFESPAN A
 He can remove his stiches after about 10 days of surgery (Halawi et al., 2015).
Self-strategies
 He must be must be made aware of his condition and take the medicines as prescribed.
 He must be recommended to have a healthy and high nutritious diet.
 He must be encouraged to quit smoking (McLawhorn et al., 2017).
 He should be recommended for a healthy diet, including the DASH diet (eating more
fruits, vegetables, and low fat dairy products, less saturated and total fat)
 Since, he has a high blood pressure; he must reduce the amount of sodium in his diet to
an amount less than 1500 milligrams in a single day.
 He should be advised in getting a regular aerobic exercise.
 He should also stop consuming alcohol (Keswani et al., 2016).
Conclusion
Patients are supervised for 1–2 hours after a complete knee replacement until they wear
out anesthesia. The vast majority of the patients stay in the hospital several days post operation
depending on the particular sort of surgery done and the general safety and recovery.
Postoperative pain is generally relieved by pain medications. In many cases, the day after the
surgery, a physical therapist checks the patient. Patients should be aware of the symptoms and
signs that may indicate blood clots or other potential severe complications before getting
discharged from the hospital. After a few weeks of rest and enhancing workouts, postoperative
pain is generally reduced. Knee replacements can last 10-20 years with adequate follow-up
treatment. Willingness of the patients to follow the direction of healthcare suppliers will
determine their continued healthy functioning after the knee replacement surgery. In order to

9ACUTE CARE ACROSS LIFESPAN A
prevent any complications from occurring after the knee replacement surgery, patients must
continue following up with the procedures as per the health expects and physiotherapists advice
and seek immediate treatment in case they face any such complications.

10ACUTE CARE ACROSS LIFESPAN A
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