Reference no: EM132370850 , Length: word count : 2000

Written Assignment – Nursing 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

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.

3. In the plan of care include:

I. Identify relevant assessment (e.g. vital signs, renal, respiratory, etc.)

I. Based on your assessment, propose three (3) potential patientclinical issues.

II. Based on your assessment and three (3)potential clinical issues, develop prioritised interventions (including monitoring). These interventions should include nurse initiated and collaborative interventions.

4. The scope of your prioritised interventions may include both physical and psychosocial aspects of care.

5. 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 Data	Past Medical History	Social 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. Observations Medications Post-operative orders

Observations	Medications	Post-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