University Nursing Assignment: Post-Operative Care of Surgical Patient

This case study examines the post-operative nursing care of Frank Wright, who underwent a left knee replacement. The assignment details a comprehensive care plan addressing his comorbidities, including hypertension, hypercholesterolemia, obstructive sleep apnea, and smoking. It highlights the importance of monitoring vital signs, neurovascular checks, and managing potential complications like infection and blood clots. The plan includes interventions such as pain management with morphine, preventing deep vein thrombosis with aspirin, and utilizing continuous passive motion to reduce stiffness. The study emphasizes the negative impact of smoking on healing and cardiovascular health, and the nurse's role in smoking cessation interventions. The discharge plan focuses on the patient's ability to perform daily activities independently and the need for follow-up care. The conclusion underscores the benefits of smoking cessation in reducing post-operative risks and the effectiveness of nursing interventions in improving patient outcomes. The article also references several sources to support the information provided.

Running Head: NURSING OF SURGICAL PATIENT
Nursing of Surgical Patient
Name of Student:
Name of University:
Author Note:

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Introduction
Knee replacement is also called knee arthroplasty which is a surgical process for replacing
the weight bearing surfaces of the knee joint to promote relief from pain and disability. It is
observed that majority of the patients resort to normal life performing daily activities
successfully within six weeks of operations (Barrington, Halaszynski & Sinatra, 2014). But it
should be noted that it is a painful process that involves wound healing, swelling and
inflammation even fever due to pain. Effective care plan post operation ensures successful
healing of the patient and also increases the rate of healing with minimal complications
(Dowsey & Choong, 2013). This article deals with a case study of an individual by the name
of Frank Writer, who underwent a left knee surgery and the post-operative care plan for him.
He has certain health complications like hypertension and high cholesterol. He also suffers
from sleep apnoea. And he is also into smoking. This article enlightens on the negative
impact of smoking on health especially intervening with the process of healing and also
causing other risk factors that impact the health of the patient.
Part A: Plan of Care
The recovery as well as the rehabilitation process of total knee replacement program is
complex and plays a crucial role in aiding the individual to get back to normal life resuming
his daily activity. It promotes the efficacy of the surgery and enhances the healing process
(Garson et al., 2014). The vital symptoms like the temperature, the level of consciousness of
consciousness of the patient as well as the neurovascular checks like pulses, capillary
refilling, movement and sensation should be monitored on the affected limb (Nam, Nunley &
Barrack, 2014). This provides the details about cardiovascular status and the initial
indications of complications like infection, fluid volume deficit and immense bleeding. This
should be done in the first 12 to 24 hours.

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Knee replacement surgery can cause certain complications like infections, blood clot in the
leg veins or in the lungs. Individual can be at risk of heart attack and stroke and nerve
damage as well. The symptoms of infection includes fever which is more than 100F, shaking
chills, drainage from the surgical site and enhanced redness, tenderness, swelling as well as
pain in the knee.
Pre-operative medical data of Frank Wright states that he was overweight,
hypercholesterolemia, hypertension and obstructive sleep apnoea. He was under medication
for decreasing the lipid levels in the blood by being administered simvastatin 40mg. He is
being administered atenolol 50mg to keep his blood pressure level under control. He is also
under medication of ranitidine to reduce acidity issues. He is also into substance abuse of
smoking 10 cigarettes a day.
Frank Wright shows to be agitated post the knee replacement operation as he has low
sedation rate of 1-2. He is also under the risk of acquiring cardiovascular disease post the
operation and proper precautionary measures should be taken. He has a normal respiratory
rate of 12 breath per minute. There is no observable respiratory issue of Frank Wright. He is
slightly feverish as the body temperature monitored is 97.6⁰C.
It is evident that Frank Wright would resort to help in getting out of bed in the first 24
hours post-surgery. The occupational therapist will ensure in setting up a continuous passive
motion (CPM) in the hospital as well as in the home. This machine aids in keeping the knee
in motion to reduce the risk of scar tissue build-up as well as stiffness due to immobility. He
can walk a short distance with assistance of the physical therapist. The physical therapist
should work on the bending and straightening of the knee which means flexing and extending
the knee exploiting the continuous passive motion (CPM).

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Night pain is frequently observed after the knee replacement surgery. The reason of the
pain may be technical flaws in the procedure, unrealistic expectations. To reduce the pain in
Frank Wright morphine is administered. Morphine directly acts on the central nervous system
to reduce the feeling of pain.
Frank Wright may have the risk of acquiring blood clots deep in the legs post the surgery
which is commonly termed as deep vein thrombosis (DVT). Clots in the lungs are known as
pulmonary embolism. Surgery or any kind of injury increases the risk of acquiring blood clot.
This blood clot is a serious risk factor which should be looked into and avoided at the highest
priority. Normally clots are formed by the blood cells and clotting factors working hand in
hand to create a protective scab over the healing wound but some blood clots are formed
abnormally in the blood vessels which may cause blockage of the normal blood flow thus
leading to the DVT (Okusaga et al., 2013). These clots can take place within few hours or
even in the operating room. To prevent this clot formation at unwanted places blood thinning
medications are prescribed for the patients. Frank Wright was administered with aspirin
100mg for the unnecessary clot prevention.
He is prescribed comfeel dressing in the first day post the knee replacement surgery. This
dressing is used to manage low to moderate exudating venous postoperative leg wounds.
Cryotherapy can be exploited for the pain management based on the extent to which the
patient can tolerate the therapy.
Part B: Potential Clinical issues in relation to the comorbidities
Smoking causes serious health issues like heart disease, asthma and lung cancer. Smoking
challenges the recovery process making it difficult and harder by stressing the heart affecting
the blood pressure, reducing oxygen in the blood and the tissues promoting a damaging effect
on the lungs (Peters et al., 2016). The main challenge with general anaesthesia is that it make

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the patient lose consciousness. Smoking reduces flow of blood which slows down the healing
so the surgical incision is at highest probability to become infected (Dawes et al., 2014). He
is at high of suffering a heart attack during or after the surgery. Smoking has a harmful effect
by enhancing the risk associated with heart disease and peripheral vascular disease. Smoking
lowers the levels of high density lipoprotein (Leone, 2015). This high density lipoprotein
promotes a protective effect against heart disease. It creates an environment that makes LDL
even more toxic to the blood vessels thus enhancing the deposition of plaques in the arteries
and promoting inflammation. This inflammation of blood vessels and build-up of fatty
plaques is called atherosclerosis. This enhances the probability of formation of unwanted
blood clots in the vessels obstructing the blood flow thus increasing the tendency for heart
attack (Deleanu et al., 2016).
Smoking and sleep apnoea is widely prevalent and is also associated with significant
mortality and morbidity (Krishnan, Dixon-Williams & Thornton, 2014). It is seen that these
conditions adversely affect the others which leads to comorbidities and alters the existing
therapies. It alters the sleep architecture, upper airway neuromuscular function and the
subsequent inflammation and arousal mechanisms. Literature studies reveal that reduction in
smoking promotes improvement in the sleep apnoea (Franklin & Lindberg, 2015).
Health care providers can have a significant impact on the patients they are dealing with
and their respective smoking habits. Based on TTUD 2008 clinical practice guidelines most
of the patients prefer their health care provider to enquire about the status of their smoking. It
is observed that patients are more likely to smoking cessation post being advised by their
health care providers. This is mainly because of the fact that nurses are the frontlines working
with and interacting as well with their patients on a daily basis hence they get a greater
opportunity to intervene with the substance abuse of their patient primarily smoking. The
health care givers implement the 5A’s intervention strategy. It mainly involves ask, advise,

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assess, assist and arrange (Stead et al., 2013). The tobacco use status of the patient should be
identified and documented at regular basis. The tobacco user should clearly and strongly be
advised to quit smoking (Vallis et al., 2013). The nurse should also assess the willingness of
the individual to quit smoking or resort to smoking cessation. The willing individual should
be guided accordingly with pharmacotherapy and counselling to aid him in the process of
smoking cessation. The follow-ups subsequently should be arranged (Williams et al., 2014).
Part C: Discharge Plan
The following things should be noted before successful discharge of Frank Wright which
includes that he should be able to bend his knee well preferably to a minimum of 90 degrees
angle. He should be able to resort to his daily activities like dressing and bathing on his own.
He should minimally rely on an assistance device. The goals by discharge enlists that he
should be able to perform basic daily activities like getting in and out of the bed and perform
the transfers independently or with minimum amount of help based on the assistive device.
He should also walk a minimum distance of 25 feet and should walk up and down the stairs
with the aid of crutches or walker. He should be assisted to perform exercises and activity.
The doctors will shift him from prescription strength to lower dose pain medication. He
might need a health care provider to be available to check on him and combat the daily
challenges during performing daily activities.
Conclusion
This article deals with a case study of Frank Wright who undergoes a knee replacement
surgery and enlightens on the clinical issues that he is at risk and the ways to combat that. He
had the complications of high cholesterol, hypertension and sleep apnoea. He had felt slightly
feverish post the operation and the relative medications for administered to combat the pain,
low sedation level and the fever. Blood thinning medication was also administered to avoid

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formation of unnecessary blood clots. It was observed that he was also into substance abuse
of tobacco. It can be concluded from the article that smoking cessation aid in reduction of
high levels of cholesterol, hypertension and sleep apnoea thus cumulatively reducing the risk
of post operation heart attack and related cardiovascular risks. It is also seen that nursing
intervention has been an effective way of smoking cessation in patients.

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References
Barrington, J. W., Halaszynski, T. M., & Sinatra, R. S. (2014). Perioperative pain
management in hip and knee replacement surgery. American journal of orthopedics
(Belle Mead, NJ), 43(4 Suppl), S1-S16.
Dawes, P., Cruickshanks, K. J., Moore, D. R., Edmondson-Jones, M., McCormack, A.,
Fortnum, H., & Munro, K. J. (2014). Cigarette smoking, passive smoking, alcohol
consumption, and hearing loss. Journal of the Association for Research in
Otolaryngology, 15(4), 663-674.
Deleanu, O. C., Pocora, D., Mihălcuţă, S., Ulmeanu, R., Zaharie, A. M., & Mihălţan, F. D.
(2016). Influence of smoking on sleep and obstructive sleep apnea
syndrome. Pneumologia (Bucharest, Romania), 65(1), 28-35.
Dowsey, M. M., & Choong, P. F. (2013). The utility of outcome measures in total knee
replacement surgery. International journal of rheumatology, 2013.
Franklin, K. A., & Lindberg, E. (2015). Obstructive sleep apnea is a common disorder in the
population—a review on the epidemiology of sleep apnea. Journal of thoracic
disease, 7(8), 1311.
Garson, L., Schwarzkopf, R., Vakharia, S., Alexander, B., Stead, S., Cannesson, M., & Kain,
Z. (2014). Implementation of a total joint replacement-focused perioperative surgical
home: a management case report. Anesthesia & Analgesia, 118(5), 1081-1089.
Krishnan, V., Dixon-Williams, S., & Thornton, J. D. (2014). Where there is smoke… there is
sleep apnea: exploring the relationship between smoking and sleep
apnea. Chest, 146(6), 1673-1680.
Leone, A. (2015). Smoking and hypertension. J Cardiol Curr Res, 2(2), 00057.

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Nam, D., Nunley, R. M., & Barrack, R. L. (2014). Patient dissatisfaction following total knee
replacement: a growing concern?. The bone & joint journal, 96(11_Supple_A), 96-
100.
Okusaga, O., Stewart, M. C., Butcher, I., Deary, I., Fowkes, F. G. R., & Price, J. F. (2013).
Smoking, hypercholesterolaemia and hypertension as risk factors for cognitive
impairment in older adults. Age and ageing, 42(3), 306-311.
Peters, S. A., Singhateh, Y., Mackay, D., Huxley, R. R., & Woodward, M. (2016). Total
cholesterol as a risk factor for coronary heart disease and stroke in women compared
with men: A systematic review and meta-analysis. Atherosclerosis, 248, 123-131.
Stead, L. F., Hartmann‐Boyce, J., Perera, R., & Lancaster, T. (2013). Telephone counselling
for smoking cessation. Cochrane database of systematic reviews, (8).
Vallis, M., Piccinini–Vallis, H., Sharma, A. M., & Freedhoff, Y. (2013). Modified 5 As:
Minimal intervention for obesity counseling in primary care. Canadian Family
Physician, 59(1), 27-31.
Williams, R. J., Masica, A. L., McBurnie, M. A., Solberg, L. I., Bailey, S. R., Hazlehurst,
B., ... & Stevens, V. J. (2014). Documentation of the 5 as for smoking cessation by
PCPs across distinct health systems. The American journal of managed care, 20(3),
e35.