Study of Fred Brown Undergone Left Knee Replacement †Free Samples

Question: Discuss about the Case Study of Fred Brown Undergone Left Knee Replacement. Answer: Introduction The paper deals with the case study of Fred Brown a 72 year old man who has undergone left knee replacement. The patient history informs COPD, hypertension and depression. The patient lives alone and with no one to care. The paper presentsnursing assessments of the patient and risk factors associated with the condition. The paper providesnursing interventions for the patient along with rationale. The patient has vacuum drain insitu and a large dressing over his knee. The patient has PCA for pain relief and IVI Normal Saline running at 100mls per hour. Section 1 Assessment: After transferring patient to PACU Status of anaesthesia and monitor the level of consciousness in postanesthesia care unit Regular assessment of the vital signs and documentation for first hour until stable Rationale: The risk factors due to anaesthesia in Fred may include mild sickness and confusion. The risk is higher in case of Fred due to history of COPD. The side effects of anaesthesia include vomiting, sore throat, dizziness, shivering, drowsiness, aches and pains, allergic reactions (Lasater Mchugh, 2016). After transferring patient to unit (Abeles et al., 2017) After patient has returned to unit- monitor the level of consciousness after every shift Monitor sensation and circulation in the surgical site- to identify any blood clot Monitor the surgical site for any discharge to identify and prevent infection Monitor further need of intravenous fluids in patients Monitor range of motion, mobility, positioning and alignment of knee when resting one bed Identify the Pain level score Identify other symptoms such respiratory distress, vomiting and nausea as the patient as history of COPD Potential complications: complication may occur due to blood transfusion, which is evident from hives, fever, chills, and shortness of breath. Further, are the complications due to wound and bleeding. It is also associated with accumulation of fluid behind knee and inappropriate healing of skin. Wound infection is the potential complication after knee replacement (Palmisano et al., 2017). Nursing care plan: Nursinggoals Intervention Rationale Protection and safeguard of knee (Lasater Mchugh, 2016) Wound care- hand hygiene before dressing, Use of clean dressing, maintain dust free area and change patients clothes frequently. Administer blood thinners to prevent clotting. Oral amoxicillin can be administered to prevent bacterial infections. Keep the position of the leg elevated. Give knee support using continuous passive motion Wound care is necessary to prevent infection and allergy It is to prevent swelling due to accumulation of fluid. Offer knee support to reduce oedema and improve circulation. It will help in preventing deep vein thrombosis Ensure mobility (Piva et al., 2015) Ensure comprehension device is on the leg all time Assist in mobility to maintain active movement with the help of therapist or using walker. The patient can be taught ankle pump exercises such as up and down movement of the foot It will help in strengthening the increase the venous return and inc Appropriate pain management (Noiseux et al., 2014) Administration of medications for pain relief- that is opioid and NSAIDS The nonpharmacological approach to pain management: cold applications, musical relaxation, and have good sleep Small doses delivered at short intervals provide sustained pain relief. Use of both pharmacological and non pharmacological approach helps relieving pain more quickly Oxygen therapy (Uronis et al., 2015) Provide oxygen supply to maintain saturation level between 88-90% Since patient has COPD it is necessary to eliminate pulmonary complications such as hypoxia. Moreover shortness of breath and hypoxia are also related to high pain Health literacy (Omachi et al., 2013) Provide education to patient on hygiene, risk factors of illness and self management Educate patient on the signs of the infection that is redness, pain, swelling, tenderness and skin discolouration Educate patient on the signs of pulmonary embolism including hypotension, shortness of breath, chest pain Provide education materials to patient in preferred language to take pnemuoccocal and influenza vaccines prior to discharge. Health literacy is important to help patient understand the state of illness and take adequate precautions to prevent complications Improve activities of daily living (Lasater Mchugh, 2016) Provide patient with assistive device to walk reduce respirations and have controlled expirations as patient has COPD Assistive devices help in pacing activities. Narrowing of airway can be prevented by reducing respirations Improve mental well being- reduce depression and anxiety (Scott et al., 2016) Psychosocial intervention for Fred is necessary. These include psychiatric counselling where patient can share his emotion, fears and other concerns. Counselling or psychotherapy or motivational interviewing helps increase patients self confidence and techniques for relaxation and eliminate short term feelings of anxiety Mental well being is effected inpatients after major surgery due to medical complications, low mobility and lack of compassion and care from loved ones. Fred lives alone and has multiple comorbidities therefore he is depressed which mandates improvement in self confident, anxiety and stress to prevent worsening of health. Overcoming depression will help patient to involve in self-care and adhere to treatment procedure. Eliminate dehydration (Abeles et al., 2017) Maintain fluid balance to increase optimal functioning of the body. IVI Normal Saline at 100mls per hour should be maintained Lack of fluid balance will increase stress and irritation To eliminate complications due to medicines (Abeles et al., 2017) Some medication may result in constipation and use of NSAID may lead to leads to gastrointestinal tract upset and use laxative for stool softening. Side effects of medicines may increase wound complication and delay healing process Reduce hypertension (Levinger et al., 2016) Nurse will administer and titre vasodilator medications to meet the parameters for blood pressure. Until the parameters are met nurse must monitor the blood pressure until the parameters are met. Untreated hypertension may lead to cardiovascular diseases and even have risk of heart attack. Nutritional support (Hsieh et al., 2016) Fred must be put on high intake of carbohydrates, protein and intake of fluids Since patient has multiple comorbidities malnutrition should be avoided Section 2 The complications due to COPD in Fred include- risk of impaired ventilation, dyspnea, poor intestinal integrity and increase risk of infection. Fred may have high-risk pulmonary embolism due to blood clot that may travel to lungs leading to chest pain and breathlessness. The intervention to this complication includes oxygen therapy and use of blood thinning drugs to remove clot such as warfarin. The patient must have continued nasal prong @ 2L/min and maintain oxygen saturation between 88-92%. Patient must be educated to avoid smoking or other such behaviour if any. Medication for the patient may include Ipratropiumbromide and oral prednisone to impove lung function (Spencer Hanania, 2013). Patients after surgery have high risk of infection in the surgical site. The intervention includes administration of antibiotics either intravenously or orally. Further, the wound infection should be monitored till the infection is cleared so as to prevent septic shock (Petersen et al., 2015). In most cases after the surgery, patients undergo neurovascular damage. It involves numbness in foot. It may be due to damage of nerve or blood vessels that are associated with the foot muscles. The patient may experience knee stiffness. The intervention for this problem includes special exercises and physical therapy or adjustment of prosthesis inside the knee (Coolican, 2015). Risk of venous thromboembolism: According to Marsh, (2015) older patient have a high risk of venous thromboembolism or VTE following major surgery. Since patient is 72 years old and has history of COPD, there is even higher risk of VTE. With the increase risk of VTE there are other comorbidities associated which include coronary artery disease and cerebrovascular disease. Since the patient is depressed and hypertensive there is a greater risk of heart disease. The intervention to this complication include. The interventions for this problem include continuous passive motion therapy or by administering Dabigitran. Pharmacologic prophylaxis includes low molecular weight heparins along with newer classes of anti-thrombotic agent. However, the balance between clotting and bleeding must be considered. Section 3 Discharge Concerns of patients: The patient may not be ready for discharge Anxiety and stress in patient due to complications of discharge and comorbidities of COPD Risk of injury due to fall Side effects due to medication Discharge instructions to Fred Brown (Causey-Upton Howell 2017): Instruction on timely intake of medication and adherence Regular blood tests and follow up appointment with the patient after two weeks Immediate report on increase in calf pain, swelling on any part of leg, signs of blood clot Immediate report and visit in case of chest pain, shortness of breath and coughing blood Immediate report on signs of infection such as fever, incisional discharge, GI upset and increase in knee pain Educate on fall prevention and self care of the incision area such as dry dressing Maintain hydrated state of the body Provision of emergency contact numbers Maintenance of adequate diet to prevent malnutrition The patient must continue with the nasal prong @ 2L/min Maintain oxygen saturation between 88-92% The patient must abstain from intense physical activity Referral service for Fred Brown (Cunic et al., 2014): Referral to orthopaedic specialists Emphasise on continued care and rehabilitation- to regain and maintain mobility and knee function. 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