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Common postoperative complications and prevention strategies

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).

Postoperative complications can be related to the exact surgery one has had, but in most cases, the difficulties happen after any surgery (Hobson, 2012). Therefore the aim of the postoperative care is to prevent these complications and enhance healing of the surgical incisions and to ensure that the patient recovers fully. Common general postoperative complications include wound infection, deep vein thrombosis (DVT), fever, pulmonary embolism and small lung blockages. In this paper, we will be taking a look at Mrs. Grace Porter who has had a total hip replacement (THR) surgery due to a condition of rheumatoid arthritis of the right hip and after that had issues. This paper contends that postoperative care by the client in collaboration with their families is vital in the overall recovery of the patient with an acute medical/surgical condition.

Mrs. Grace Porter is a 67-year old woman who got diagnosed with rheumatoid arthritis that was previously well treated by total hip replacement surgery. The patient has had a history of hypertension, hyperlipidemia and Type 2 Diabetes which had been poorly managed. She was usually able to do her activities of daily living (ADLs), but recently she has been having difficulties with general mobility due to pain in her leg. The chief complaint on admission was the pain, but a small amount of blood oozing from the surgical dressing got observed.

According to Bozic (2014), found that patients, surgeons, health system and device factors play a vital role in the outcomes of a total hip replacement surgery. The patient factors associated with surgical site infection include chronic medical conditions, the female gender, and obesity as is the case of Mrs. Grace and the use of surgical elements could be the bilateral procedure (Namba, 2012).

According to Liddle (2013), nurses working in post-operative care must regularly update their clinical and theoretical knowledge. This can be achieved by depend less on electronic equipment and learning to implement assessment tools with excellent observational skills. As a registered nurse (RN) for Mrs. Grace, one of the components of the initial postoperative assessment undertaken was a systematic collection of subjective and objective data, described by the patient and observed by the nurse respectively. In the case of Mrs. Grace, she disclosed that she was a widow and lives alone, although she has a son who lives nearby and he regularly contact her. She also mentioned that her home has six steps at the front which up to now she was able to maneuver with ease. She is drowsy but routable, and her pain score is 7/10. The nurse’s observation was a little oozing of blood from the dressing on her right hip. Also from her vital signs on admission, the nurse observed that:  her blood pressure was 145/70, Heart rate 105bpm and a temperature of 35.9 degrees, SpO2 99% on 8 liters of oxygen via a Hudson mask. She had a Redi-vac drain that contains 50mls of frank colored blood and a Charnley pillow for patient-controlled analgesia (PCA). This first assessment component makes nurses have an understanding on the parameters of their observations and what may be affecting the patient.  

Case study of a patient with total hip replacement surgery


The second component is analyzing the data and using it to formulate a precise and understandable nursing care plan. It can get done by making use of the diagnoses made by the nurse to plan and have an evaluation on the patient-centered outcomes and nursing interventions. This assessment step ensures that respiration and oxygen saturation are adequate, the cardiovascular system is stable with no persistent bleeding, the pulse of the patient and blood pressure compared with normal pre-operative values and also that temperatures are within acceptable limits (Akhtar, 2013).This acts as a baseline of future assessment on the condition of a patient at a later date. Monitoring of the patient multiple times a day is another component which allows routine data to be collected and trends to be established, therefore making it easier for the nurse to detect any clinical deterioration (Schaaf, 2009). It also allows for evaluation of a patients response to treatment and the variables that got monitored are pulse rate, temperature, respiratory rate, blood pressure, urine output and pain scores.

During the initial post-operation assessment, two key nursing care priorities were identified about Mrs. Grace's condition that is, post-operative wound infection prevention and postoperative health-related quality of life. Surgical Site Infection (SSIs) following THR can lead to prolonged hospitalization, increased morbidity, and mortality, and high costs which will, in turn, can lead to a reduced quality of life. According to Van Kasteren (2007), the risk factors associated with preoperative wound infections got related with the environment, the surgeon and patient argue that SSIs are health-care-associated infections which are most preventable, therefore, patients and medical personnel should prioritize nursing and prevent the occurrence.

From the statistics, there are significant differences in patients' total, physical and psychological quality of life postoperatively compared to the situation before the operation. The good news is that this situation can be curbed sooner if a patient becomes an active participant in the healing process leading to a more successful outcome. According to Chou (2016), the optimal postoperative pain management began in the preoperative period and got made by initial assessment of the patient. Moreover, the development of a comprehensive care plan for the patient in question, the surgical procedure involved together with follow up assessments and adjustments, in this case by a registered nurse.

The care bundle approach is a recommended technique of packaging evidence-based measures into routine care to patients, and it is familiar to many procedures used in the prevention and significant reduction of SSIs (Leaper, 2014). Even though Mrs. Potter will be able to resume with her normal activities, she may need to change the way she did them in the past. For instance, Mrs. Potter may need to learn a new techniques of bending down and going up the stairs to keep the hip safe and avoid pain. Educating the patient is another care practice where the nurse discusses possible complications, and review with the patient the warning infection signs or a blood clot, from which the patient should notify the doctor immediately they develop these signs (Gulanick, 2013).

Nursing care plan for postoperative patients


For the follow-up recovery that will be taking place at home, the nurse would advise Mrs. Porter to arrange for the son to provide help at home. She would need help in rearranging furniture or temporarily changing rooms for ease of access and minimization of movement. She would need to place frequently used items such as phones, remote controls, and medications within easy reach. Thirdly, she would need to throw away any rugs that could cause her to trip and secure loose electrical cords around the perimeter of the room, and a good firm chair gets recommended. 

For person-centered care, Mrs. Porter will need to keep the wound area clean and dry and the dressing applied in the medical facility should be changed often when necessary as per the instructions by the RN. Home medication may include narcotic and non-narcotic pain pills, injectable or oral blood thinners, anti-nausea medication and stool softener. Constant consultation with the doctor is advised especially on over the counter drugs, supplements or even vitamins. Notifying your dentist that you've had a hip replacement before you have any dental work done is equally important. A diet rich in iron and vitamin supplements is highly recommended. These care practices will reduce chances of infection and allows the patient to live a comfortable, healthy life.

To critically explore this case study, Gibb's Reflective Cycle gets used, and it will ensure that we have covered and evaluated all aspects of the issue and created an understanding for future reference (Paterson, 2013).

Description

Action Plan

Conclusion

Feelings

Evaluation

Analysis

The nurse was appointed as Registered Nurse (RN) for Mrs. Grace Porter to administer postoperative care to her after her she developed complications after her hip replacement surgery (Lia, 2016).

When the nurse learned of Mrs. Grace's admission, I felt very motivated to do everything in my power as an RN to help her through in this situation.

 The role was to come up with nursing care that involves family and other health disciplines. It is important to note also that acting in the patient's best interests was also the nurse’s role.

The patient was cooperative and collaborative despite being an older adult, so transition after education was smooth.

Conclusion

 Having witnessed the complications caused by lack of education and knowledge of self-care, the nurse was aware of the importance of being more proactive if similar situations were to arise in future. There should also be the higher emphasis on establishing strong relationships between patients and clinical personnel to in turn increase the levels of effectiveness.

 The plan will involve prioritizing the welfare of patients in the nurse’s care by creating person-centered care for them.

Conclusion

It is important that the policies and procedures on postoperative care, and therefore should be patient education on how to prevent postoperative complications. Using evidence-based tools and person-centered care methods the nurse can make a stressful situation controlled, and eventually improve the quality of life. Furthermore, it is essential that the nurses update their skill and knowledge on their assessment on patients so that they may be up to date with the new medication, procedures and assessment tests which the patients are put through. Moreover, Gibb's Reflective Cycle enabled the nurse to further create safe and perfect care for Mrs. Grace Porter.

References

Akhtar, A., MacFarlane, R. J., & Waseem, M. (2013). Suppl 3: Pre-Operative Assessment and Post-Operative Care in Elective Shoulder Surgery. The open orthopaedics journal, 7, 316.

Bozic, K. J., Lau, E., Ong, K., Chan, V., Kurtz, S., Vail, T. P., ... & Berry, D. J. (2014). Risk factors for early revision after primary total hip arthroplasty in Medicare patients. Clinical Orthopaedics and Related Research®, 472(2), 449-454.

Gulanick, M., & Myers, J. L. (2013). Nursing Care Plans-E-Book: Nursing Diagnosis and Intervention. Elsevier Health Sciences.

Hobson, B.M., Hadjipavlou, N., Stephens R.CM, (2012). An Introduction to postoperative Complications. Retrieved from: https://www.ucl.ac.uk/anaesthesia/StudentsandTrainees/Intro_to_postop_Complications

Leaper, D. J., Tanner, J., Kiernan, M., Assadian, O., & Edmiston, C. E. (2015). Surgical site infection: poor compliance with guidelines and care bundles. International wound journal, 12(3), 357-362.

Lia, P., (2016). Learning Support Tutor: Using Gibb’s Reflective Cycle. Retrieved from: https://www.kcl.ac.uk/campuslife/services/disability/onlineresources/StudyGuides/USING-GIBBS

Liddle, C. (2013). Principles of monitoring postoperative patients. Nursing times, 109(22), 24-26.

Namba, R. S., Inacio, M. C. S., & Paxton, E. W. (2012). Risk factors associated with surgical site infection in 30 491 primary total hip replacements. J Bone Joint Surg Br, 94(10), 1330-1338.

Paterson, C., & Chapman, J. (2013). Enhancing skills of critical reflection to evidence learning in professional practice. Physical Therapy in Sport, 14(3), 133-138.

Van Kasteren, M. E., Mannien, J., Ott, A., Kullberg, B. J., de Boer, A. S., & Gyssens, I. C. (2007). Antibiotic prophylaxis and the risk of surgical site infections following total hip arthroplasty: timely administration is the most important factor. Clinical Infectious Diseases, 44(7), 921-927.

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