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Post-Surgery Care Plan after Knee Replacement

Written Assignment – Nursing the Surgical 

Task overview

Assessment nameNursing the Surgical Patient
Assignment Objectives
  1. Demonstrate the use of research evidence for nursing practice applied   to the care of a surgical patient
  2. Augment skills in clinical   decision making and reasoning through synthesising and analysing information   required to care for a surgical patient 
  3. Apply appropriate assessment,   problem solving, planning, prioritising of interventions to care for the   selected client scenario chosen
  4. Demonstrate the nurse’s role in monitoring and implementing   prioritised nursing interventions in response identified patient needs
  5. Demonstrate the ability to communicate specific patient care issues   succinctly according to scholarly writing and referencing conventions
Due DateSeptember 16,   2019 11.59 pm (week 9) 
Length2000 words +/-10% (including   headings) (word length includes in-text referencing and excludes your   reference list) 
Marks out of:
Weighting:
A total of 80 marks = 40 %
Task description
This assignment   requires you to consider the case scenario of Frank Wright. Frank Wright has undergone a right total knee replacement.
Applying your knowledge and understanding   of the post-operative patient, you will write an academic essay applying the   principles of surgery, consideration of patient co-morbidities and   implementing nursing actions that identify, assess and prevent potential   clinical issues.
Must   be written in the format of an academic assignment and in third person.
You   may use headings to differentiate the three parts. 
The assignment has three parts –
Part   A: Using the clinical reasoning cycle, devise a   post-surgical plan of care for a patient who has undergone a total knee   replacement 
Parts   B: Discuss the impact of co-morbidities and a   general anaesthetic on post-operative recovery
Part   C:  Discuss   discharge planning for the patient following a total knee replacement
1.   Provide an INTRODUCTION (approximately 150 words) 
 An   introduction should provide clear scope about the direction of your   assignment.
Part   A  Utilising the case scenario and considering the pre and post-   operative clinical data and academic   literature devise a plan of care (approximately 600 words)
  1. This section will concentrate on the        first 24 hours of post-surgical care.
  2. Analyse the case and formulate an        appropriate prioritised plan of care for Frank within the defined 24        hour period.


  1. In the plan of care include: 
  1. Identify relevant assessment (e.g. vital signs, renal, respiratory, etc.)
  2. Based on your assessment, propose three (3) potential patient clinical   issues.
  3. Based on your assessment and three (3) potential clinical issues,   develop prioritised interventions (including monitoring). These   interventions should include nurse initiated and collaborative interventions.
  1. The scope of your prioritised        interventions may include both physical and psychosocial aspects of        care.
  2. The care plan must involve        justification of your prioritised interventions and supported with        rationales derived from the literature.
Part   B: Analysing the case to identify potential clinical issues in relation to   co-morbidities (400-500 words)
  1. Discuss smoking, and the co-morbidity of hypertension, high   cholesterol and obstructive sleep apnoea (OSA) in the context of having a   general anaesthetic within the 24 hour postoperative period. 
  2. In your discussion, include the possible clinical issues related   to the smoking and OSA that could arise in this 24 hour period and how Fred   might deteriorate (You will need to reason explain the relevant pathophysiology).   
  3. Detail the nursing interventions   the nurse would initiate to decrease risk of clinical deterioration and   include your rationale for the nursing interventions. Justify your rationale with   reference to the literature.
Part C:   Discharge Plan (300 words)
  1. Identify and briefly discuss   discharge planning for Frank. Identify from the case the discharge planning   that would need to be put in place for Frank. Keep this section brief. 
Provide   an conclusion (approximately 150 words) 
 Your conclusion succinctly summarises the   main points of your assignment but this section is not an opportunity to   introduce new information.        



Case Study
Pre-operative
Frank Wright is a 76 year old man, retired   architect, married with two grown children and has been admitted for a right total knee replacement.   Frank’s wife suffers from dementia and Frank is her   main carer.  Consider the pre-operative   data in your discussion. 
Utilising clinical reasoning cycle and   referring to the post-operative data you will devise appropriate nursing plan   for Frank.  Your answer will be divided   into three parts with an introduction and conclusion. Ensure you refer to pre   and post-operative data to support your answer. 


Objective     DataPast     Medical HistorySocial     History
  • Weight 92kgs
  • Height 170 cm
  • BP 140/95
  • HR 86
  • RR 18
  • Temp 36/8
  • Urinalysis - normal
Current Medication
  • Simvastatin 40mg nocte
  • Atenolol 50mg daily
  • Ranitidine 150mg BD
  • Hypercholesterolemia
  • Hypertension
  • Osteoporosis affecting both     hips and knees
  • Obstructive sleep apnoea     confirmed with sleep study March 2019
  • Married with 2 grown children
  • Main carer for wife with who has early onset dementia
  • Retired 
  • Smokes 10 cigarettes a day
  • Minimal alcohol use
Family history
  • Father RIP heart failure 
  • Mother RIP pancreatic cancer
Postoperative
Frank has undergone a right total knee   replacement and returned to the ward at 2100 hours. You are the nurse looking   after him on the night shift.
ObservationsMedicationsPost-operative     orders
  • BP 100/54, HR 106,     Respiratory rate 12BPM, SaO2 95% FiO2 2 litres via nasal prongs,     temperature 37.6°C Axilla, 
  • Sedation score = 1-2
  • Vacudrain in-situ 50  ml in bag
  • Estimated blood loss (EBL)     in OT 200ml
  • Simvastatin 40mg nocte
  • Regular paracetamol 1G QID
  • Captopril 50mg BD
  • Ranitidine 150mg BD
  • Aspirin 100 mg mane
  • Morphine PCA 1mg bolus: 5     minute lockout
  • Oxygen 2L via nasal prongs
  • Intravenous infusion:     Sodium Chloride 0.9% (Normal Saline) (NaCl) 100mls/hour
  • Comfeel, crepe bandage to     be de-bulked day one
  • Apply cryotherapy as     tolerated
  • Normal diet
  • DVT prophylaxis –TED     stockings  
  • Aspirin 100mg daily 
  • Pain management
  • GP follow up 2/52
  • OPD appointment 6/52 with     Dr McMeniman

                        


Answer

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