Comprehensive Nursing Plan: Post-Knee Replacement & Comorbidities

This report presents a comprehensive post-surgical nursing care plan for a 76-year-old male patient with a history of osteoarthritis undergoing total knee replacement. The plan utilizes the Clinical Reasoning Cycle to address identified nursing issues such as risk of wound infection, acute post-surgical pain, and impaired mobility. The report also discusses potential risks and impacts of comorbidities like hypertension, hypercholesterolemia, and chronic smoking on general anesthesia and the surgical process. Furthermore, it details a discharge plan emphasizing patient and family education, medication management, physiotherapy referrals, and home care considerations to ensure a smooth transition and continued recovery after hospital discharge. This assignment showcases the importance of tailored nursing interventions and comprehensive care planning in optimizing patient outcomes following knee replacement surgery.

Contents
INTRODUCTION.....................................................................................................................................1
PART A...................................................................................................................................................2
NURSING CARE PLAN.........................................................................................................................2
PART B...................................................................................................................................................4
POTENTIAL ASSOCIATION WITH THE COMORBIDITIES......................................................................4
PART C...................................................................................................................................................6
DISCHARGE PLANNING......................................................................................................................6
CONCLUSION.........................................................................................................................................7
REFERENCES..........................................................................................................................................8
1

INTRODUCTION
Total knee replacement surgery is very common management and procedure for
joint degenerative diseases. The essay focuses on the post-surgical plan for the
individual that is a 76 years of male patient with history of osteoarthritis. The essay is
divided into three sections that will include the preparation of a post-surgical nursing
care plan for this patient by using Clinical reasoning cycle by Levett-Jones. This
section will enable the nursing professional to make appropriate decisions using
critical thinking power in order to address the identified nursing issues and the
requirements of the individual. The second section of the assignment focuses on
discussion of the potential risks and the impact of comorbidities on the general
anaesthesia and surgical process. The last section of the assignment includes
discharge planning that is supposed to be one of the most important aspects of
nursing practice and post-surgical care. The use of appropriate services and the
quality of services will be determined in the assignment by using the case of Frank
with the findings provided.
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PART A
NURSING CARE PLAN
Nursing profession is based on providing the health and social care requirements of
the individual with the main focus on the assessment, management and recovery of
the condition. Nursing interventions are the actions taken by the professionals in
order to provide adequate care and services to the individual to address their health
and social care needs. Frank is a 76 years old individual with history of osteoarthritis
and is treated for total knee replacement. He is married with two grandchildren and a
retired architect by profession. His wife is suffering from dementia and he is the
primary carer for her. The patient also presented with history of hypertension and
hypercholesterolemia as well as he is identified to be a chronic smoker with habit of
smoking 10 cigarettes per day. The post-surgical care plan for this patient is
developed after assessing his recent condition and for this the clinical reasoning
cycle and its stages are being followed.
The clinical reasoning cycle includes seven stages that are being followed by the
nursing professionals in order to develop appropriate nursing care plan and make
decisions for the patient in care. These seven stages includes considering patient
situation, gathering cues, process the information, identify the issues, establish the
goals, action plan and evaluate the outcomes. These stages were followed in
Frank’s case to evaluate the case and develop the nursing care plan as per the
recent conditions (Levett-Jones et al., 2009).
The very first step of preparing the nursing care plan includes nursing assessment.
Assessment is the examination of the patient’s condition using different tools that
allows the nurse to identify the current situation and prepare the care plan according
to it. The basic assessment done for Frank post-surgically includes assessment of
his vitals. While the vitals were assessed following findings were recorded- his heart
beat was high with 106 beats per minute that indicated acute tachycardia. Blood
pressure was recorded to be 100/54 mmHg that is reduced than the normal levels.
Oxygen saturation is 95% that shows reduced oxygen in body and the respiration
rate is recorded to be 12 breath per minute that is also low than the normal range.
These vitals are abnormal the cause can be due to the effects of surgical process
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and anaesthesia or it can be also due to comorbidities associated with the case. The
renal function was also evaluated by keeping close observation of the urine output
and the wound fluid drain was also observed for accumulation using vacuum drain.
The assessment included identification of three nursing issues that were priority to
be included in the nursing care plan and the interventions for these would be
planned to address these requirements. These priorities are 1) Risk of wound
infection, 2) Acute pain after surgery and 3) Impaired mobility and function.
Schug et al (2016), stated that around 41 to 57% of the patients undergoing total
knee replacement complaints of acute post-surgical pain. Pain is the discomfort and
an unpleasant sensation that cause individual to suffer both physically and mentally.
In case of Frank the intensity of pain can be verbally recorded by the patient using
the pain assessment scale. This helps in developing appropriate nursing intervention
as per the nature of the pain. To address the post-surgical pain in this case various
nursing interventions can be adapted (Oderda., 2012). The most potent intervention
includes administration of the narcotics and analgesics. NSAIDS are the first line
drugs that help in reducing the pain modulators in the body by acting on
prostaglandins and providing relief from pain (Golladay et al., 2017).
The non-pharmacological interventions using simple nursing actions are also helpful
in pain management post-surgically. These interventions include use of massages
and reflexology therapies to relieve the pain sensation for the individual. Smith et al
(2018), suggested that these alternative therapies are beneficial in providing pain
management post-surgically. Also it is indicated that appropriate posture and
alignment of the operated periphery helps in modulation of pain (Li et al., 2012).
The second priority includes prevention of risk of wound infection after surgery.
Considering the history of the patient the determined hypertension and
hypercholesterolemia as the aspects can enhance the risk for wound infection and
delayed healing. To prevent the wound has to be regularly inspected and assessed
for any infection and cleaned using aseptic measures. Proper cleaning guidelines
are used to clean and dress the wound on regular basis and administration of
antibiotics helps in better healing and prevention of any infection. Use of Vaccum
drain is also done to avoid any accumulation of blood or fluid around the wound area
that can be the medium for the bacterial growth and can aid in infection.
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The third nursing priority includes impaired function and mobility after surgery. As the
periphery is operated the area and muscles surrounding the operated area becomes
less toned and loses its functioning ability. The ligaments and muscles surrounding
the knee lose its resilience and functioning. To address this, the nursing intervention
that is suggested includes physiotherapy and basic exercises. Use of physiotherapy
during the rehabilitation phase after surgery proves to be a beneficial strategy to
recover the functional ability of the bone and muscle system. As suggested by
Henderson et al (2018), use of walking aids and basic exercises helps in regaining
the normal function after surgery.
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PART B
POTENTIAL ASSOCIATION WITH THE COMORBIDITIES
Comorbidities are referred to as health conditions that are interrelated to each other
with the overall impact on the functioning of the systems of the body. The current
case has some major comorbidity that has a significant impact on the surgical
process and the effects of general anaesthesia. Frank is suffering from hypertension
and hypercholesterolemia and both these conditions are interrelated with effects on
cardiac system of the body. The chronic smoking habit is also associated with impact
on general anaesthesia and its effects during and after the surgery.
According to Yıldız et al (2019), the smokers have higher risk of disturbed cardiac
function and monitoring during the surgery under general anaesthesia than
compared to non-smokers. The authors also suggested that around 40% of major
intra-operation complications occur due to the presence of smoking as the factor
preoperatively (Shorrock & Bakerly., 2016). Smoking acts on the function of cardiac
and respiratory system and this causes disturbed readings during surgery under the
influence of general anaesthesia that can lead to major complications.
Hypertension is another factor that affects general anaesthesia and its effect. The
agents used in general anaesthesia are mostly known for their vasodilator effects
that causes reduction in blood pressure. The administration of these agents to the
hypertensive patient may react abruptly and can cause increased heart beat and
tachycardia during or after surgery with severe reduction in blood pressure. Meidert
et al (2017), suggested that monitoring blood pressure during the surgery while the
general anaesthesia is working and even after the surgery is very crucial as it
provides reduced risk of stroke and other cardiac episode due to these drug
interactions.
Cholesterol imbalance mainly is associated with effects on healing and inflammation
after surgery. The patient is provided statin to avoid any delayed healing and
excessive bleeding during the surgery. This condition can lead to neutralize the
effect of general anaesthesia and result in excessive inflammatory changes during
surgery or after the surgery that can lead to complications.
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Other important factor associated in this case is the history of Frank regarding
obstructive sleep apnoea. This condition is characterized by the relaxation of the
throat muscles during sleep that can lead to intermittent breathing and can cause
severe complications. According to Fouladpour et al (2016), around 46% of the
cases of patient with obstructive sleep apnoea are not monitored appropriately
during and after the surgery and these cause severe fatal complications due to the
effects of general anaesthesia. General anaesthesia can be the trigger to enhance
the risk of OSA. To prevent this condition close monitoring of the patient’s breathing
during unconscious state and surgery is done and any changes in oxygen saturation
level should be acknowledged and the patient should be put on direct ventilator for
artificial breathing process (Kotecha & Hall., 2014).
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PART C
DISCHARGE PLANNING
After the evaluation and overall recovery of the patient the most important stage in
hospital services includes discharge of the patient. In older times discharge was not
considered as one of the crucial aspects of nursing or health care practice. In
modern times it is identified that discharge planning is a very crucial step to indicate
future recovery and care of the patient and should be done with appropriate in-sight
and skills. Discharge planning is the process where different allied health groups and
professionals come together to evaluate patient’s situation and certify the plan for his
discharge and care after discharge from the hospital setting.
This process sis guided by thorough evaluation of the patient by the team head but
the opinion and evaluation by all professionals is required. The current status of
Frank is evaluated and an appropriate plan for discharge is framed for better
recovery of patient and post-discharge care (Shepperd et al., 2013). This plan
includes interviews of the patient and the family regarding the post-discharge care
and the rehabilitation of the operated periphery. The discharge interview is a
counselling session where the patient and the family members are supported and
instructed regarding dos and don’ts of the process. The kit is also prepared where
the medication list and the way of administration of the medication are instructed, the
list for the different exercises and centres for service help is also provided. Referral
for physiotherapy or home care is also suggested (Artz et al., 2013). Frank was
processed and certified fit for discharge by the professionals and so his discharge
was well planned and referred by the nurse.
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CONCLUSION
Health and social care services in today’s world are mainly patient centred and
oriented and the nursing ethics and code of conduct also provides clear guidelines
on the process of providing high quality nursing care and interventions post-
surgically to the patient. The case in this assignment was dealt with appropriate
nursing care using the clinical reasoning cycle and the development of the adequate
and effective nursing plan was done for Frank. The discussion on the association
and risk of comorbidities with the effects of general anaesthesia was also
successfully done and the discharge planning was well focused and explained. Thus,
it can be concluded that appropriate nursing interventions and care planning is
required for better recovery of the individual after surgery.
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REFERENCES
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Perioperative complications in obstructive sleep apnea patients undergoing surgery:
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