University Nursing Assignment: Nursing the Surgical Patient Report

This report presents a comprehensive analysis of the nursing care provided to Frank Wright, a 76-year-old patient who underwent right total knee replacement surgery. The report begins with an introduction to knee arthroplasty and its post-operative care, including pain management and wound healing. Part A details the plan of care, including vital sign monitoring, medication administration (morphine, aspirin, simvastatin, captopril), and cryotherapy. Part B identifies potential clinical issues related to Frank's comorbidities, particularly the negative impact of smoking on recovery, and the importance of nursing interventions based on the 5 A's model. Part C outlines a detailed discharge plan, focusing on Frank's ability to resume daily activities and the role of physical and occupational therapy. The report emphasizes the importance of addressing comorbidities and implementing effective nursing interventions to ensure a successful recovery and a smooth transition back to normal life.

Running Head: NURSING THE SURGICAL PATIENT
Nursing the Surgical Patient
Name of the student:
Name of the University:
Author’s Note:

1NURSING THE SURGICAL PATIENT
Introduction
The knee replacement surgery can also be defined as knee arthroplasty. It is defined
as a surgical process exploited to replace the weight bearing surfaces of the knee joint
(Namba, Inacio & Paxton, 2013). This facilitates relief from pain and disability of the
individual undergoing this surgery. Based on the evidence-based literature studies it can be
stated that post the knee replacement surgery individuals can get back to their routine life and
perform the required daily activities in almost six weeks gap (Healy et al., 2013). But it
should also be taken into account that the knee arthroplasty is a painful surgery that requires
effective wound healing and the healing process can encounter challenges like swelling and
inflammation and fever in an extreme level due to the pain (Lamplot, Wagner & Manning,
2014). An effective plan for the care after the knee replacement surgery promises successful
healing and has minimum complications involved.
This article is based on a case study of Frank Wright, 76 years of age who underwent
a right knee surgery and the subsequent care plans required by him to ensure fast recovery.
He has a past medical history of hypertension and hypercholesterolemia as well. He also has
sleep apnoea. He smokes cigarette and has a minimal alcohol intake that should be
considered. This article enlightens on the care plan for Frank and also discusses on the
negative health impact of substance abuse and also interfere with the healing process.
Part A: Plan of Care
The observable vital signs exhibited by Frank Wright post his knee replacement
surgery included low sedation score, low blood pressure and there was slight temperature.
The agitations due to pain can be the cause of the low sedation score of 1-2. His blood
pressure was also 100/54 mm Hg. Other vital signs that included the respiration rate was
normal of 12 breath per minute.

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Frank Wright has low sedation score and it has been observed that night pain is
common post the knee replacement surgery. Morphine is administered to Frank Wright to
reduce the pain. Morphine is a pain medication and this drug belongs to the opiate family.
Morphine is a drug that directly acts on the central nervous system of the individual to reduce
the feeling of pain. It works on the brain and modifies the feeling of the body and
consecutively responds to the pain. Cryotherapy was also exploited to manage the pain but
the tolerance level of the patient was also taken into consideration. This is a pain treatment
that exploits the method of localized freezing temperatures to soothe and deaden an irritated
nerve. He is prescribed comfeel dressing that is exploited to manage the low to moderate
level of exudation from the wounds post operation.
Frank Wright has been administered with100 mg of aspirin to prevent unnecessary
clot formation. This medication aids in thinning of the blood since Frank Wright had the
medical history of hypercholesterolemia. Thinning of the blood prevents clot formation at
unwanted places. Formation of blood clots deep inside the legs after the surgery is also called
as deep vein thrombosis (DVT). Injury and surgeries increase the probability of blood clot
formation. Formation of blood clot should be considered as a serious risk factor that should
be controlled and prevented at highest priority. When normal clots form the blood cells and
the factors aiding in the clotting process work together to form a protective scab on top of the
healing wound. But some of the clots form at unwanted places in the body leading to
blockage of the normal blood flow and increasing the chances of DVT formation. It is often
observed that deep vein thrombosis can occur without any observable symptom and it is
challenging to detect them in some cases. Hence, doctors resort to preventive measures
without taking a chance to prevent the occurrence of the deep vein thrombosis in case of
lower extremity surgery like total hip or knee replacement surgery. Simvastatin is also

3NURSING THE SURGICAL PATIENT
prescribed for Frank to combat his hypercholesterolemia thus promotes blood thinning by
preventing the lipid accumulation in the blood (Nordahl et al., 2014) (Lakshmi et al., 2014).
His blood pressure also required to be monitored at regular interval since he was
under the captopril medication that aids in hypertension and prevention of heart failure. A
decreased blood volume causes a drop in the blood pressure. It refers to a condition which a
heart is pumping less blood in comparison to its normal rate to the periphery. This may lead
to reduced perfusion of the organs. Frank Wright had low blood pressure post his knee
surgery. His pressure had been 100/54 mm Hg. A blood pressure below 90/60mm Hg is
considered to be low blood pressure that can have serious impact on the health. He might feel
dizzy and weak and this can lead to loss of consciousness. Extreme low blood pressures can
impact the heart and brain as well since low blood pressure causes oxygen deprivation in the
body that hinders the normal functioning of the human body.
Part B: Identification of the potential clinical issue in relation to the
comorbidities
As stated in the case study, Frank Wright used to smoke approximately 10 cigarettes a
day. Smoking is the chief cause of several health issues that can be life threatening like
cardiovascular disease, lung cancer and asthma. Smoking also interferes with the recovery
process thus making it challenging and difficult by promoting stress to the heart and that
impacts the blood pressure, reduces the oxygen in the blood as well as the tissues and it
promotes a damaging impact on the lungs. General anaesthesia makes a person lose their
consciousness and smoking causes the reduction of the blood flow rate that directly impacts
the healing by slowing down the pace. The surgical incision has a high probability of getting
infected. The tendency to get a heart attack also rises during or post-surgery (Nordahl et al.,
2014). Smoking promotes the risk of acquiring heart disease as well as perivascular disease.

4NURSING THE SURGICAL PATIENT
Smoking causes reduction in the high-density lipoprotein level. The high-density lipoprotein
aids in prevention of the heart disease (Lakshmi et al., 2014). Smoking increases the level of
low-density lipoprotein and a high amount of this low-density lipoprotein creates a toxic
environment in the blood vessels and hence promotes the deposition of the plaques in the
arteries as well as inflammation of the blood vessels. The phenomenon of plaque formation in
the blood vessel followed by inflammation of the blood vessels is called as atherosclerosis.
This causes an increased risk of blood clot formation in the blood vessels that can obstruct the
flow of blood and promoting the risk of heart attack (Leone, 2015).
Smoking also promotes sleep apnoea. This is widely prevalent and also causes
significant rates of morbidity and mortality. Obstructive sleep apnoea is a sleep disorder that
causes repetitive episodes of shallow breathing during sleep due to obstruction in the airway
which can be complete or partial. This can lead to substantial physiological disturbance as
well as the various clinical impacts. It is observed that this condition can impose adverse
effects that can lead to other comorbidities and can alter the existing therapies (Krishnan,
Dixon-Williams & Thornton, 2014). Sleep apnoea caused due to smoking alters the sleep
architecture, causes inflammation as well as arousal mechanisms and impact the upper airway
neuromuscular function also. Evidence based studies have also proved that smoking cessation
can promote improvement in the symptoms of sleep apnoea (Deleanu et al., 2016).
Nursing interventions have been observed to impose significant impact on the patients
they are interacting with and caring for in relation to the smoking habits of the patients.
Exploiting the TTUD 2008 guidelines for clinical practice it is observed that majority of the
patients prefer being enquired about their smoking status by their health care provider (Sarna
et al., 2014). It is observed that patients are more prone to quit smoking after being educated
and advised by the health care providers. The important rationale for this act is that the nurses
are the frontline interactors working and interacting with the patient on a regular basis

5NURSING THE SURGICAL PATIENT
therefore they have they greater probability to interfere with the smoking habit of their clients
(Rice & Stead, 2008). The intervention strategy of the healthcare providers exploits the 5A’s
intervention. The 5 A’s involved are ask, advise, assess, assist and arrange (Li et al., 2014).
The nurse should identify and document the tobacco use status of their clients on a regular
basis. The nurse should strictly and strongly advise their client to cease smoking. The
willingness to cease smoking of the client should also be assessed efficiently by the nurse.
The client who is willing to stop smoking should be guided with the help of pharmacotherapy
and counselling to help him to get rid of his addiction. The nurse should also take the
initiatives to arrange subsequent follow-ups (Vick et al., 2013).
Part C: Discharge Plan
It is observed that post a knee replacement surgery patients are able to resume to
normalcy and can be discharged one to five days after the surgery. They are seen to be able to
take care of themselves and resume their activities completely within six weeks of their
surgery. Evidences suggest that almost 90% of the patients recover after three months of the
surgery though some people might take six months. The main aim of the discharge plan is
based on the ability of Frank Wright to resume back to his routine life and perform the daily
activities that includes getting in and getting out of bed, executing the transfers independently
without help or with minimum help of an assistive device, ensure dressing up and bathing on
his own (Guerra, Singh & Taylor, 2015). He should be capable of bending his knees
successfully and with ease to a minimum of 90 degrees angle. He should minimally rely on
the assistance device. The discharge plan should ensure he walks a least distance of twenty-
five kilometres. He should also try to walk up and down the stairs with the help of crutches or
walker. He should also be guided for performing exercises and activities daily. Based on his
health progress the doctors can shift him from prescription strength to minimal dosage pain

6NURSING THE SURGICAL PATIENT
medicines. If required he might resort to help from the healthcare provider in execution of the
daily activities (Keswani et al., 2016).
An occupational therapist can also help in setting up a CPM, continuous passive
motion in his home. The Continuous Passive Motion (CPM) is a machine that is exploited to
move joints in a person incapable of doing so hence the patient does not have to exert any
effort. This machine keeps the knee in motion to decrease the risk of the scar tissue that can
build-up. It also prevents the development of stiffness as a cause of immobility (Boese et al.,
2014) (Harvey, Brosseau & Herbert, 2014). The physical therapist should exclusively engage
in bending as well as straightening the knee which has been operated that would lead to
flexing and extending the operated knee with the help of continuous passive motion.
Conclusion
It can be concluded from this article that effective and focussed care plan post a knee
replacement surgery can aid in quick recovery of the patient and help them to resume the
normal life. But the clinical issues intervene in the process of recovery making it challenging.
This article dealt with the case study centred on Frank Wright who had health complications
of high blood cholesterol, hypertension and sleep apnoea before he underwent a total knee
replacement surgery. He also used to smoke that aggravated his health condition. Thus, it can
be inferred that cessation of smoking promotes lowering of the lipid level in the blood, sleep
apnoea as well as high blood pressure. This aids in reduction of the probability of a heart
attack or a cardiovascular disease. Thus, nursing interventions have a crucial role in smoking
cessation.

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