Answer

Post-operative Care

A good nursing care is a very significant contributing factor for a better outcome after a major surgical procedure also known as post-operative care. By definition, postoperative care is the management of a patient after surgery. It includes care given during an immediate postoperative period, which may occur in both operating room and post anesthesia care unit. It also goes during several days after the surgery. According to Tomas et al. (2015), the goal of post-operative care is to prevent complications such as infections and promote the process of healing of the surgical incision and brings back the patient into a normal state of health.  Basically, it involves assessment, diagnosis, planning, intervention, and outcome evaluation. This essay, based on the case study provided, describes the risk factors of bilateral knee osteoarthritis and also looks at the postoperative care activities which are necessary after the patient has undergone knee replacement as a result of bilateral knee osteoarthritis.

The patient was diagnosed with bilateral knee osteoarthritis, a worsening disease of synovial joints which results from certain predisposing conditions, customarily trauma, which badly changes the articular cartilage or subchondral bones of the affected joints. Some of the risk factors are physical activities where too much duties, especially those that involves walking at work. Age also contributes to this condition as people who are 60 years and above are likely to develop the diseases as a result of low volume of the fluids within the joints (Noyes, 2016). Other risk factors include obesity, hypertension, diabetes, and genetic make-up. The pathogenesis of bilateral knee osteoarthritis involves the dilapidation of the cartilages around the joint and transformation of the bone because of the active responses of chondrocytes in articular cartilage and inflammatory cells (Barrington, Halaszynski, & Sinatra, 2014). The release of enzymes from such cells breaks down the proteoglycans and collagen which destroy the articular cartilage. An exposure to the underlying subchondral bone results in sclerosis, that is followed by reactive remodeling change which leads to the formation of bone cysts and osteophytes.

One of the components of an initial post-operative assessment that an RN would undertake for the patient is heart rate and blood pressure. According to the study conducted by Alshami (2014, there are certain factors which should be checked instantaneously after the operation. They include heart rate, rhythm and volume of pulse, blood pressure and capillary refill time to evaluate the circulatory status. A study conducted by Vulcano, Memtsoudis, and Della Valle (2013) reveals that particular attention should be given to the systolic blood pressure since a lowered systolic reading and tachycardia indicate hemorrhage or shock, although originally the blood pressure may not drop and remains within standard parameters as the body compensates. On the same note, tachycardia also indicates that the patient is suffering from pain, is anxious or has a fluid overload (Alshami, 2014). Generally, high blood pressure and abnormal heart rate are symptoms of other conditions such heart attack with can jeopardize the normal healing of the patient hence should be regularly checked.

Another component of an initial post-operative assessment that an RN would undertake for the patient is wound assessment. According to Metcalfe et al. (2015), wound assessment is a constituent of wound management which collects information of a patient and the wound before prescription of a treatment plan. Notably, wound assessment comprises of wound observation, surveying the patient, and identification of relevant clinical information from physical examination and history of the patient’s health. Clinical data noted in an initial assessment works as a standard for prescribing the suitable treatment. A study conducted by Hirschmann and Becker (2015) asserts that wound assessment is an all-inclusive procedure which considers the current state of health of the patient, factors which are likely to impede the healing of wound, and the duration, cause, and state of the wound. Wound assessment, therefore, assists in determination on whether the wound will heal as required or there are certain factors such as excess moisture which can prevent the normal healing process.

One of the nursing priority that has to be met in this case study is avoidance of compartment syndrome. Compartment syndrome is an excruciating condition which occurs when pressure within the muscles constructs to hazardous levels. That pressure is able decrease blood flow, which prevents oxygen and nourishment from reaching muscle cells and the nerves. According to Visser et al. (2015), during major surgery as this, it is important that the body gets enough supply of oxygen in all organs, however, compartment syndrome inhibits the supply of oxygen and nourishment which is important for the patient. According to Davis and MacKay (2013), without management of compartment syndrome in early stages, it can lead to Acute compartment syndrome which is a medical emergency that can lead to permanent muscle damage.

Another nursing priority in this case is pain management. The pain after surgery is known as post-operative pain which can subject a patient into acute pain. Nurses are in an inimitable position to evaluate pain since they have the most contact with patients and their families in the hospital. Notably, patients are frequently asked if they are in agony immediately the anesthetic wears off after the surgery. According to Vulcano, Memtsoudis, and Della Valle (2013), the more accurately the patient can describe the pain the better the treatment. According to Grosu et al. (2014), there three ways of assessing pain which should be applied in this case. The first one is self-report from the patient. In this case, the patient can report to the doctor if he is experiencing a lot pain or not. The second assessment method is behavioral. Here, health professional observes how the patient behaves or moves. Lastly, physiological means where nurses employ clinical observations.

Care Plan

The first diagnosis of this patent is acute diagnosis.  The desired out come in this case reduce the pain to normal the scale which is below 3 in a scale of 1-10. Nursing intervention for reducing pain that the patient will undergo is stress management techniques which are, guided imagery, progressive relaxation, and visualization, meditation). Basically, it reduces muscle tension, refocus attention, promote a sense of control. Another intervention of reducing pain is employment of psychotherapeutic means such as Tai chi and yoga. The programs fortify the muscles around the joint, increase the range of motion and lessen the pain. The last intervention of acute pain is medication where the patient shall be put under aceteminophen and Duloxetine. The medications are approved to treat chronic pain, including osteoarthritis pain. Therefore, it is likely to serve two purposes hence very effective.

The second diagnosis is risk of infection. In this case, the client will achieve an opportune wound healing, be free of infected erythema or drainage, and be afebrile. The nursing intervention in this case is ensuring good hand washing by patient and staff, use of strict clean techniques as designated to strengthen or change dressings, and assessment of incision color, integrity, and temperature. The rationale of these techniques is to prevent contamination and the risk of wound infections.

Last diagnosis is impaired physical mobility. The desired outcome in this case is maintaining a position of functions, as demonstrated by the nonappearance of contracture by the client. The nursing intervention demonstrates and assists with transfer techniques and use of mobility helps, such as trapeze, walker.

Application of Gibbs reflective cycle

The case of John is a sad one which can subject her in depression.  The bad thig in this case is that despite her condition, she does not get enough care even from family members, something that subjects her in more stress besides the pain she is undergoing.  This mad very unhappy. From this experience, I have realized that care is one of the most important part of healing and patient recovery. Other than pharmaceutical interventions, family support is an important factor of healing. In that regard, I have learned that psychotherapy is also an important therapeutic intervention alongside pharmaceutical therapies.

In conclusion, the care of the surgical patient requires an accurate understanding of the pathophysiological changes that occur preoperatively. For John Grant, the patient in this case study, two initial post-operative assessments which are important for the patient include heart rate and blood pressure and wound assessment. In order to ensure effective healing and positive patient outcome in this case study, some of the nursing priorities include avoidance of Compartment Syndrome and pain management. There are several ways of managing pain however, in this particular case medication using aceteminophen and Duloxetine are the most effective ones. A part from pharmacological means, pain can be managed using therapeutic means which include physical therapy and yoga.