Patient Assessment and Postoperative Complications
You need to write a 1500 word essay in which you discuss the assessment of a post-operative client (Mrs Grace Potter; see below) and develop a comprehensive care plan to address the nursing care priorities including ONE priority which is EITHER Post-operative wound infection OR Post-operative deep vein thrombosis (DVT).
Acute conditions of a patient often demand a specialized and integrated care plan that will address each and every concern of the patient effectively. Often the postoperative complications represent the acute care needs in the patients demanding effective and patient centered immediate care interventions and hence there is need for targeted and advanced post operative assessment (Aletaha et al., 2010). The aim of this essay is to demonstrate the understanding of evidence based and patient centered care for a patient in an acute post surgical condition. This essay will have a clear outline of the risk factors and pathophysiology of the heath concern of the patient, detailed postoperative assessment, care priorities, intervention and a reflection.
The case study represents a 67 year old patient named Mrs Grace Potter who had presented to the health care facility with rheumatoid arthritis, which has recently deteriorated with worsening pain and decreasing mobility. This has been the primary health concern of the patient and as a result she had been recommended total hip replacement surgery. Now, it has to be mentioned, rheumatoid arthritis (RA) is a very common medical concern for the patients and is a prevailing health adversity affecting the elderly patient population (Smolen et al., 2010). Considering the risk factors of this particular disease, gender, age and family history is the most important factors. The women are more likely to develop RA than the men and the age group of post 60 is the most affected population for Rheumatoid arthritis. Other risk factors for the disease includes Smoking, environmental exposures and obesity. It had to be mentioned that health conditions such as high cholesterol and diabetes is often linked with obesity and hence they can also act as indirect risk factors for RA as well (Singh et al., 2012).
Considering the pathphysiology of the condition it has to be mentioned that rheumatoid arthritis is a systemic auto-inflammatory disease and it is mainly facilitated by synovitis and joint destruction. Although the exact pathophysiology of the disease is unknown it has been discovered that cytokines are known to play a crucial role in the perpetuation of synovial inflammation. In case of the patient however, the link between the type 2 diabetes and RA needs to be highlighted; Hyperglycemia and hyperlipideamia both has been discovered to be affecting cumulative joint loads, systemic inflammation, and abnormal lipid metabolism which are key contributing factors to arthritis symptoms (Singh et al., 2010).
Care Priorities for Intervention
Patient assessment is a very important aspect of care planning and delivery and it incorporates patient situational analysis and collecting cues from the patient that will aid in identifying the care needs and sorting the care priorities. In this case Grace had been exhibiting a few signs of abnormality while being in the post operative ward and hence there is need for a thorough post operative assessment for the patient. First and foremost, the nursing professional will have to undertake primary assessment of the vital signs of the patients to explore whether the patient is under any immediate risk of metabolic dysfunction after the surgery. According to the Langton et al. (2010), the vital sign assessment is very effective tool that helps in the identification of any changes in the metabolic functions by the effect of anesthesia or post operative infection. Followed which, the nursing professional will have to undertake a surgical site infection assessment to check whether the patient has any chances of infection or bleeding. Infection assessment is very important after a surgical procedure as there is a heightened chance of infection in the first 24-48 hours of the surgery. Moreover, as the patient had bleeding from the surgical site, the need for infection assessment is much more enhanced for Grace. In this case the patients will need to be checked effectively for the temperature changes to check for infection severity and need for antipyretics (Sukeik et al., 2011). The patient had mild bleeding from the surgical site hence the next possible assessment for the patient will be to assessment whether the patient has any pain and utilize a pain score assessment to check whether Grace has pain sensation even after the patient controlled analgesia. As it is very common to have pain exacerbated by infection and inflammation, pain score assessment is very important. Lastly as the surgical site vacuum drain that Grace had been suffering with had been a Redi-vac drain in situ that contains 50 mLs of frank coloured blood, her surgical drain will need to be assessed to check whether the drain is securely attached and if there is a possibility of rectal bleeding (Langton et al., 2011).
As per the assessment carried out by the nurse it is crucial for the nursing professional to be able to focus on particular care priorities for the care intervention plan that is going to be given to the patient. In this case, Grace has been suffering from two major post operative complications, infection site bleeding which had high chances of being infected due to the bleeding. It has to be mentioned that in post operative setting a hemorrhage can easily be caused due to erosion of the blood vessels nearby, facilitated by a possible onset of an infection. And as a result there is need for the care priority focus to be on surgical site infection prevention management. Second care priority would be the pain management as surgical site pain is a very common manifestation of post operative complications, and it can be further exacerbated by infection. As the pain score of the patient had been 7/10, her next care priority will be pain management (Bolland et al., 2011).
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Nursing diagnosis |
Nursing goal |
Intervention |
Rationale |
|
Wound infection prevention |
The patient will be free from the risk of infection |
The nursing professional will maintain five minutes of hand hygiene diligently. Utilization of strict aseptic techniques for dressing changes and while handling drains (Bosker et al., 2012). Maintaining the patency of drainage devices such Redivac when present, and noting the characteristics of the wound drainage. Monitoring the temperature of the patient and noting the presence of chills (Langton et al., 2010). Encouraging fluid intake and administering the patient on high protein diet with roughage. |
Five minutes of hand hygiene is a WHO approved technique for infection control most importantly in case of hospital acquired infections (Bolland et al., 2011). Following the aseptic protocol has been proven to prevent contamination and risk of wound infection by 25%. Maintaining the patency of the Redivac drain will help in preventing blood accumulation and joint space secretions which can act like a medium for bacterial medium. Consistent elevation of temperature can be indicative of onset of infection hence monitoring will lead to better diagnosis of possible infection and immediate intervention Maintaining the fluid and nutritional balance will help in supporting tissue perfusion and will facilitate cellular regeneration and tissue healing (Bosker et al., 2012). |
|
Pain management |
Grace will be free from the acute pain and will be able to understand how to control the patent controlled analgesia on her own. |
Taking assessment of pain for the Grace and grading it in a range of 0-10 periodically using any common pain assessment scale. Changing the posture of the patient and changing the patient into a position of operated extremity. Providing comfortable nonpharmacological measures of pain management to the patient like the frequent repositioning and back rubbing or different relaxing diversional activities such as progressive relaxation, guided imagery, visualization, meditation (Bosker et al., 2012). Assessment of the patient control analgesia, under the discretion of the physician, change the dosage of the analgesic and if need be administering narcotics. Investigation of the impact of analgesic treatment on the pain sensation and assessing reports of sudden, severe joint pain with muscle spasms (Langton et al., 2011). Educating Grace regarding the operation of patient controlled analgesia and how to change the dosage when necessary depending on her pain sensation. |
It will help in providing information on which to base and check the effectiveness of interventions. It will help in reducing muscle spasm and reduce tension on new prosthesis and surrounding tissues. It helps in decreasing m muscle tension, refocuses attention, promotes sense of control, and may enhance coping abilities in the management of discomfort or pain, which can persist for an extended period (Sidhu et al., 2010). Narcotic or opioid based medication helps in relieving surgical pain and reducing muscle tensions and spasm, which contributes to overall discomfort. It will help in assessing the impact or effectiveness of the analgesic administered and along with that early recognizing of Early recognition of developing problems, such as dislocation of prosthesis or pulmonary emboli will provide opportunity for prompt intervention and prevention of more serious complications in the future (Langton et al., 2010). It will help in empowering the patient and providing sense of value and control in the pain. |
Nursing Diagnosis, Goals, Interventions, and Rationale
According to the Gibbs reflection, the patient situational analysis and collection of cues helped in post operative assessments and the processing of information led to the stage of post operative care priority identification. The care plan was designed on the basis of the care priorities identified and the two care priorities chosen were pain management and infection prevention. This assignment provided a perfect opportunity for me to understand the post operative acute care design and implementation and it can be hoped that it will help me in the future practice.
Conclusion:
On a concluding note, his assignment had been a great opportunity for me to understand the acute care needs of post operative scenario and the complications that may arise in the post operative scenario. The care priorities identified had been pain management and infection control and from the care strategies outlined, the patient could be hoped to be relieved of the complications.
References:
Aletaha, D., Neogi, T., Silman, A. J., Funovits, J., Felson, D. T., Bingham, C. O., … & Combe, B. (2010). 2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis & Rheumatology, 62(9), 2569-2581.
Bolland, B. J. R. F., Culliford, D. J., Langton, D. J., Millington, J. P. S., Arden, N. K., & Latham, J. M. (2011). High failure rates with a large-diameter hybrid metal-on-metal total hip replacement: clinical, radiological and retrieval analysis. J Bone Joint Surg Br, 93(5), 608-615.
Bosker, B. H., Ettema, H. B., Boomsma, M. F., Kollen, B. J., Maas, M., & Verheyen, C. C. P. M. (2012). High incidence of pseudotumour formation after large-diameter metal-on-metal total hip replacement: a prospective cohort study. J Bone Joint Surg Br, 94(6), 755-761.
Langton, D. J., Jameson, S. S., Joyce, T. J., Gandhi, J. N., Sidaginamale, R., Mereddy, P., … & Nargol, A. V. F. (2011). Accelerating failure rate of the ASR total hip replacement. The Journal of bone and joint surgery. British volume, 93(8), 1011-1016.
Langton, D. J., Jameson, S. S., Joyce, T. J., Hallab, N. J., Natu, S., & Nargol, A. V. F. (2010). Early failure of metal-on-metal bearings in hip resurfacing and large-diameter total hip replacement: a consequence of excess wear. Bone & Joint Journal, 92(1), 38-46.
Liska, W., & Dyce, J. (2016). Total Hip Replacement. Complications in Small Animal Surgery, 778-833.
McInnes, I. B., & Schett, G. (2011). The pathogenesis of rheumatoid arthritis. New England Journal of Medicine, 365(23), 2205-2219.
Sidhu, A. S., Singh, A. P., Singh, A. P., & Singh, S. (2010). Total hip replacement as primary treatment of unstable intertrochanteric fractures in elderly patients. International orthopaedics, 34(6), 789-792.
Singh, J. A., Christensen, R., Wells, G. A., Suarez-Almazor, M. E., Buchbinder, R., Lopez-Olivo, M. A., … & Tugwell, P. (2010). Biologics for rheumatoid arthritis: an overview of Cochrane reviews. Sao Paulo Medical Journal, 128(5), 309-310.
Singh, J. A., Furst, D. E., Bharat, A., Curtis, J. R., Kavanaugh, A. F., Kremer, J. M., … & Bridges, S. L. (2012). 2012 Update of the 2008 American College of Rheumatology recommendations for the use of disease?modifying antirheumatic drugs and biologic agents in the treatment of rheumatoid arthritis. Arthritis care & research, 64(5), 625-639.
Smolen, J. S., Aletaha, D., Bijlsma, J. W., Breedveld, F. C., Boumpas, D., Burmester, G., … & Emery, P. (2010). Treating rheumatoid arthritis to target: recommendations of an international task force. Annals of the rheumatic diseases, 69(4), 631-637.
Sukeik, M., Alshryda, S., Haddad, F. S., & Mason, J. M. (2011). Systematic review and meta-analysis of the use of tranexamic acid in total hip replacement. Bone & Joint Journal, 93(1), 39-46
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