NUR2203: Post Operative Care Report for Sarah Blake

This report focuses on the post-operative care of Sarah Blake, a 76-year-old patient who underwent a right total hip replacement. The assessment reveals postoperative hypotension, prompting an in-depth analysis of her condition, considering her medical history of hypercholesterolemia, hypertension, osteoarthritis, obstructive sleep apnea, and a myocardial infarction with stenting. The report explores the clinical issues arising from the surgery, including blood loss, and physiological stress. It identifies priority clinical problems such as hypotension, tachycardia, and pain, and proposes relevant nursing goals and interventions, including medication, fluid management, and pain relief strategies. The report also outlines a comprehensive discharge plan, emphasizing wound care, mobility guidelines, medication adherence, and follow-up care to ensure a smooth recovery. The report highlights the importance of monitoring and addressing Sarah's specific health challenges to prevent complications and promote optimal health outcomes. The report also covers the nursing interventions for tachycardia and pain management post-surgery.

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

POST OPERATIVE CARE 4
of antihypertensive therapy. This might be another reason for the complication of hypotension in
Sarah as all these physiological reasons are relevant to her condition (Dogu et al., 2014).
Part B
The three priority clinical problems for Sarah are hypotension because her blood pressure
is 100/54 mmHg, her pulse rate is 116 as it could be tachycardia, and her pain score is 6 on the
scale of 10. Hypotension is a common phenomenon after a surgical procedure due to several
reasons such as physiological stress, anesthesia or antihypertensive therapy, or past medical
history of cardiovascular diseases (Helwani et al., 2015). The systolic pressure decreases due to
blood loss, which also leads to hypovolemic shock. It is necessary to treat hypotension because if
the blood flow to the heart and brain stops then, it can lead to cardiac failure. Sarah already has
issues with her cardiovascular system due to hypertension and stenting, which makes her more
vulnerable to hypovolemic shock leading to cardiac failure. The second clinical issue is her high
pulse rate of 116, which could be a symptom of tachycardia (Ulla, Anna & Årestedt, 2015). It
happens due to the release of catecholamine, which occurs due to anemia or stress, and in
Sarah’s both reasons might be possible as she is having a blood loss and stress due to surgical
procedure. It is necessary to look after tachycardia with the help of suitable interventions. In this
condition, the heart rate has an abnormal rhythm, and the pace is higher than a normal situation
even at rest. Physiological stress or trauma can lead to a change in heart rate, which has to be
monitored if her condition has to be maintained. The third clinical priority is her pain, which is 6
on the scale 10 and it shows that it is a little high than the moderate pain. It might be due to nerve
damage during the surgery or a dislocation (Dargel et al., 2014). The scale of 6 shows that it
might difficult for her concentrate, and due to her age, it might be more difficult to ignore the
pain as she is already weak. Her pain has to be controlled and it is a priority because the
underlying reason for the pain might be the root cause of other health complications.
The nursing goal for maintaining low blood pressure is to hydrate the patient as much as
possible because hypovolemic shock and hypotension also occur due to fluid loss. Maintenance
of fluid balance is an essential goal for the nurses in such a situation (Singh, MacDonald &
Ahghari, 2015). The nursing goal for tachycardia is to examine the patient’s heart and lungs if he
has a clear airway and has the tendency of breathing properly. The cause of tachycardia has to be
identified as a nursing goal, which can lead to the correct intervention. The nursing goal for the
pain of 6/10 is to identify the reason for pain, which could be due to nerve damage or dislocation

POST OPERATIVE CARE 5
in the hip area. Pain is a normal symptom after surgery, but if the pain is still there after two
weeks, then it might need serious medical intervention such as surgery (Song et al., 2015).
The appropriate nursing intervention for low blood pressure is medication, such as
fludrocortisone and Midodrine. Fludrocortisone helps in elevating the blood volume leading to
normal blood circulation, and Midodrine is used to elevate the blood pressure, which can cure
hypotension (Kuipers et al., 2016). One of the nursing interventions for tachycardia is
medications, vagal maneuvers, and cardio-version. Cardio-version is a shock therapy given to
people who have a fast heart rate. The shock is delivered through paddles, which is an automated
external defibrillator (AED). The effects of the current impact the electrical impulses of the
heart, and that allows the heart rate to become normal. This will help to control her fast heart rate
and reduce the chances of a major cardiac issue. The suitable medications for this condition is an
anti-arrhythmic drug such as calcium channel blockers, beta-blockers, and amiodarone as it
allows the heart to beat at a normal speed. The intervention used for pain management post-
surgery is to examine the area of pain and identify the cause, which could be nerve damage in
total hip replacement surgery. Analgesics are given to patients with severe pain as it is a pain
killer such as paracetamol, morphine, and NSAIDs such as salicylates. This medication blocks
the pain signals to the brain or changes the brain’s interpretation of the signal, which leads to the
feeling of pain (Meissner et al., 2015). They are classified as opioid or non-opioid and are
prescribed according to the medical history of the patient. Other interventions could be a hot or
cold treatment that relieves the muscle pain but for Sarah, heat treatment is more appropriate
because it will help in relaxing her muscle and it also promotes the blood flow.
Part C
The discharge plan for Sarah will be made according to her condition because she has a
medical history of chronic diseases, and she has also gone through total hip replacement surgery.
This is a total hip replacement surgery, so she must take care of her sitting position so that there
is no fractures or issues with her wound because it is still healing. The pain killers have to be
taken when necessary, or heat treatments have to be given. There are support stockings given to
people postoperative, so she should also follow the advice and wear that when she is walking.
Her wound or incision has to be examined every day to check if there are any infections or there
is any swelling or redness. She should not be allowed to sit for more than 30-45 minutes because
it will increase pressure in her surgical wounds, and she should not cross her legs while sitting.

POST OPERATIVE CARE 6
Her movement has to be monitored, such as the movement should be calm and slow without any
jerks that can affect the hip area (Vetter et al., 2017). A follow up for her after one week is
essential so that the health providers can check her wound and enquire about any pain so that
immediate measures can be taken. As she has suffered from hypotension, she should hydrate
herself often and maintain her diet, but due to her medical history of hypertension, she should
monitor her blood pressure daily.
Conclusion
In conclusion, this report has given a major insight to Sarah’s postoperative condition.
Her clinical data assessment to the clinical issues, nursing goals, and nursing intervention are
explained. Sarah’s clinical assessment showed that she had hypotension, which needed to be
treated immediately as it could lead to a critical condition or even death. Total hip replacement
surgery is a crucial surgical procedure that causes blood loss, and it could lead to a hypovolemic
shock, which needed to be observed and monitored. The pathophysiological reasons are also
mentioned that show low blood pressure causes due to blood loss, which is true in Sarah’s case.
The nursing interventions are for her betterment and has been proven beneficial for the clinical
issues in the medical field.

POST OPERATIVE CARE 7
References
Berstock, J. R., Beswick, A. D., Lenguerrand, E., Whitehouse, M. R., & Blom, A. W. (2014).
Mortality after total hip replacement surgery: a systematic review. Bone & joint
research, 3(6), 175-182. https://doi.org/10.1302/2046-3758.36.2000239
Dargel, J., Oppermann, J., Brüggemann, G., & Eysel, P. (2014). Dislocation Following Total Hip
Replacement. Deutsches Aerzteblatt Online. https://doi.org/10.3238/arztebl.2014.0884
Dogu, B., Oksuz, H., Senoglu, N., Yavuz, C., & Gisi, G. (2014). Postoperative Sudden
Hypotension Due to Relative Adrenal Insufficiency. Turkish Journal Of Anesthesia And
Reanimation, 42(5), 283-287. https://doi.org/10.5152/tjar.2014.33254
Helwani, M. A., Avidan, M. S., Abdallah, A. B., Kaiser, D. J., Clohisy, J. C., Hall, B. L., &
Kaiser, H. A. (2015). Effects of regional versus general anesthesia on outcomes after total
hip arthroplasty: a retrospective propensity-matched cohort study. JBJS, 97(3), 186-193.
https://doi.org/10.2106/JBJS.N.00612
Kalkwarf, K. J., & Cotton, B. A. (2017). Resuscitation for hypovolemic shock. Surgical
Clinics, 97(6), 1307-1321. https://doi.org/10.1016/j.suc.2017.07.011
Kuipers, J., Oosterhuis, J. K., Krijnen, W. P., Dasselaar, J. J., Gaillard, C. A., Westerhuis, R., &
Franssen, C. F. (2016). Prevalence of intradialytic hypotension, clinical symptoms and
nursing interventions-a three-months, prospective study of 3818 haemodialysis
sessions. BMC nephrology, 17(1), 21. https://doi.org/10.1186/s12882-016-0231-9
Le Manach, Y., Collins, G., Bhandari, M., Bessissow, A., Boddaert, J., Khiami, F., ... &
Winemaker, M. (2015). Outcomes after hip fracture surgery compared with elective total
hip replacement. Jama, 314(11), 1159-1166. https://doi.org/10.1001/jama.2015.10842
Marrelli, M., Gentile, S., Palmieri, F., Paduano, F., & Tatullo, M. (2014). Correlation between
Surgeon's experience, surgery complexity and the alteration of stress related
physiological parameters. PLoS One, 9(11). https://doi.org/10.1371/journal.pone.0112444
Meissner, W., Coluzzi, F., Fletcher, D., Huygen, F., Morlion, B., Neugebauer, E., ... &
Pergolizzi, J. (2015). Improving the management of postoperative acute pain: priorities
for change. Current medical research and opinion, 31(11), 2131-2143.
https://doi.org/10.1185/03007995.2015.1092122
Olsson, L. E., Karlsson, J., Berg, U., Kärrholm, J., & Hansson, E. (2014). Person-centred care
compared with standardized care for patients undergoing total hip arthroplasty—a quasi-

POST OPERATIVE CARE 8
experimental study. Journal of orthopaedic surgery and research, 9(1), 95.
https://doi.org/10.1186/s13018-014-0095-2
Singh, J. M., MacDonald, R. D., & Ahghari, M. (2015). Post-medication hypotension after
administration of sedatives and opioids during critical care transport. Prehospital
Emergency Care, 19(4), 464-474. https://doi.org/10.3109/10903127.2014.995848
Song, W., Eaton, L. H., Gordon, D. B., Hoyle, C., & Doorenbos, A. Z. (2015). Evaluation of
evidence-based nursing pain management practice. Pain Management Nursing, 16(4),
456-463. https://doi.org/10.1016/j.pmn.2014.09.001
Ugbeye, M., Lawal, W., Ayodabo, O., Adadevoh, I., Akpan, I., & Nwose, U. (2017). An
evaluation of intra- and postoperative blood loss in total hip arthroplasty at the national
orthopaedic hospital, Lagos. Nigerian Journal Of Surgery, 23(1), 42.
https://doi.org/10.4103/1117-6806.205750
Ulla, W., Anna, S., & Årestedt, K. (2015). Development and validation of an arrhythmia-specific
scale in tachycardia and arrhythmia with focus on health-related quality of life. Journal
of Cardiovascular Nursing, 30(2), 98-108.
https://doi.org/10.1097/JCN.0000000000000149
Vetter, T. R., Barman, J., Hunter, J. M., Jones, K. A., & Pittet, J. F. (2017). The effect of
implementation of preoperative and postoperative care elements of a perioperative
surgical home model on outcomes in patients undergoing hip arthroplasty or knee
arthroplasty. Anesthesia & Analgesia, 124(5), 1450-1458.
https://doi.org/10.1213/ANE.0000000000001743