The aim of the essay is mainly to explore the effective care plan for the patient. Other than this the aim is also to apply the principles of evidence based and person cantered care for the client so that the client recovers soon and also that the outcome is a positive one. The essay also explores the risk factors of the patient and tries to implement ways that helps in mitigating the risks or helps in reducing the risks. The aim of the essay is also to develop a care plan and set the priorities of post operative nursing care plan for the patient.
The present condition that John is having is mainly due to some factors and that needs to be mentioned here. Risk factors such as heavy workload, working 6 days a week then hypertension and angina have contributed towards the condition. Risk factor is also depression here which leads to sloth and lack of energy in the body and is also a contributing factor towards the present condition of John (Liu et al., 2017). Pathophysiology such as degradation of cartilages and also wearing out of tissues around the knee area leads to the condition of bilateral knee osteoarthritis and that is identified in this case as well.
Post operative nursing care for John includes pain management and vital signs assessment. The body system to be accessed here is intergumentary system wound assessment and this is all about the physical body signs recording and noting and is also about health history assessment. This intergumentary system wound assessment includes both the aspects such as pain management and signs assessment and they are important here. The pain assessment will mainly focus on the body system such as the knee and the cartilages of the leg. The pain assessment will focus on the knee area and also the capability of the knees in terms of standing and walking time. Both these are important and needs to be considered in this case so that These two are important and are apt for the given situation (Liu et al., 2017). John just underwent total knee replacement and thereby immediate comprehensive post operative care is required and is to be implemented. His condition is not stable and requires intensive nursing care and for that both pain management and vital signs assessment is very necessary. Pain management is all about controlling the pain so that some relief can be provided to the patient. The RN can use over-the-counter medicines to manage the pain. Medications such as acetaminophen, aspirin or ibuprofen can be used in this case and that will provide some relief to John.
Pain management is necessary here since John has rating of 7/10 for pain and with the pain management assessment the risk of cardiac arrest, pulmonary complications and others can be tackled. In this case sedatives can also be used since the patient is complaining of high pain rate (Liu et al., 2017). This is however one of the apt post operative nursing assessment for John. Besides this the other option such as vital signs assessment is also there. Vital sign assessment in this phase needs to be implemented and this gives knowledge about the patient’s condition and if the condition deteriorates then immediate measures can be taken (Ciani et al., 2017). This includes information on points such as blood pressure, pulse rate, temperature, urine output, oxygen input and others (Liu et al., 2017). The vital sign assessment is a post operative observation phase as well and needs to be taken into consideration in this case so that the entire condition can be known and also any kind fluctuations from the normal rate can be reported. In case of John it is seen that the pulse rate is a bit higher than the usual one which is 60 – 100 bpm. On the other hand sign of higher blood pressure- 145/70 can also be found and these are required to be noted.
In case of John there can be one potential complication and that is pulmonary embolism. He is already having history of hypertension, angina and hyperlipidemia and all these in the post operative stage can lead to pulmonary embolism (Ciani et al., 2017). With the developing condition of pulmonary embolism at this stage the overall condition of patient can deteriorate and the associated risks such as breathlessness, high blood pressure rate and others can be found. This complication is very serious in this case and needs to be handled carefully (Ciani et al., 2017). The past history of the patient states that he already has chest or artery complications along with signs of hypertension or anxiety and high blood pressure.
The past patient history also refers to the fact that there is high level of cholesterol in John’s blood and these gives rise to the complication such as pulmonary embolism. With the condition that John is having now, he is already complaining of pain and since he has history of angina the development of pulmonary embolism is quite evident and there are certain risk factors that are associated with the condition such as blood coming out through coughing, shortness of breath, clotting of blood in lungs, arterial blockage and others (Laredo et al., 2018). This complication in case of John will make the health condition all the more weak and that is not at all desirable for the patient. Complication such as pulmonary embolism is quite common in post operative phase if the patient is already having a history that is related to cardiac issue or chest pain. The risk identified such as breathlessness can be very risky since it can lead to stress on the surgery or on the surgical area and that is very important in this case. Spitting of blood is also very risk prone since that can lead to blood loss and that kind of issue post operation is unwanted (Ciani et al., 2017).
However the nursing assessment used to identify the situation or the condition is “vital signs assessment”. This assessment helps in getting a clear picture about the current patient status and also helps in knowing about health complications or the risk factors that can come up. The vital signs assessment technique is there to identify the growing health issue and the risks that the issue brings about in the case. This nursing assessment is the apt one here.
Pulmonary embolism is the potential complication here and the care plan for this condition is referred to in this context (Laredo et al., 2018). Oxygen therapy is one of the approaches to be considered here and this is all about providing oxygen from outside so that the issues such as breathlessness and short of breath can be managed. Plan of care here refers to intensive care of John and treating the condition, pulmonary embolism. Oxygen therapy is the most important here and needs to be provided at the earliest so that there are no potential risks and also no potential danger associated with the situation. However other than this plan of care also includes approaches such as thrombolytic therapy and anxiety relieving therapy (Ciani et al., 2017).
These approaches are one of the vital aspects of the care plan so that the potential complication can be reduced and also can be tackled to a good extent. Thrombolytic therapy is important and this will help in breaking down the blood clots that are actually formed in the blood vessels (Laredo et al., 2018). If this is done then the issue related with pulmonary embolism such as spitting of blood through cough can be averted or can be managed. This therapy will prevent any further complications associated with the pulmonary embolism condition and is helpful in this case. Medication can also be used in this case and that helps in fast and speedy action. Other than this the care plan for the complication also includes anxiety relieving approaches. Anxiety is also a reason of chest pain, high blood pressure and others. Anxiety relieving approach can be based on techniques such as medication, cognitive therapy and creating a stress free environment as well for the patient (Laredo et al., 2018). Once anxiety is managed then it can lead to a better health outcome and can also lead to a better result in terms of care plan for the identified complication. The care plan for the complication needs to be such that it helps in overall betterment and also in diminishing the associated risks of the issue. Evidence based practice also points out towards these steps as the effective ones since these have already yielded fruitful results and outcomes for patients having the same condition.
In developing the care plan I considered the issues predominantly and also my objective has been to better John’s condition. To develop the care plan the first area that I considered is description and this mainly refers the overall issue (Laredo et al., 2018). The issue here the medical condition, bilateral osteoarthritis and that gives rise to the complication such as pulmonary embolism in the post operative stage. I was feeling that a cure plan is very much necessary and required here. The good thing about the experience is that I got an opportunity to develop a care plan for John who is the patient here and the bad part about the experience is that I have to witness the suffering of the patient (Ciani et al., 2017). An analysis of the situation tells that pulmonary embolism can bring other associated risks as well and that needs to be averted (Laredo et al., 2018). It is however concluded that a care plan is immensely vital here and is considered as well. If the condition like this arises again then I will definitely act in the same way and will help the patient with a care plan.
The essay thereby illustrates the significant points related with bilateral osteoarthritis and also talks about the risk factors and other aspects that are there with it. The essay also talks about the intensive nursing care plan and nursing approaches. Complications as well as post operative care approach are also referred to in the given context.
Laredo, J. D., Wyler, A., Alvarez, C., Aout, M., Lequesne, M., & Vicaut, E. (2018). Diagnostic performance of bilateral false profile radiographs in early hip osteoarthritis. Joint Bone Spine, 85(1), 93-99.
Messier, S. P., Beavers, D. P., Herman, C., Hunter, D. J., & DeVita, P. (2016). Are unilateral and bilateral knee osteoarthritis patients unique subsets of knee osteoarthritis? A biomechanical perspective. Osteoarthritis and cartilage, 24(5), 807-813.
Ciani, O., Pascarelli, N. A., Giannitti, C., Galeazzi, M., Meregaglia, M., Fattore, G., & Fioravanti, A. (2017). Mud‐Bath Therapy in Addition to Usual Care in Bilateral Knee Osteoarthritis: An Economic Evaluation Alongside a Randomized Controlled Trial. Arthritis care & research, 69(7), 966-972.
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Liu, Y. H., Wei, I. P., Wang, T. M., Lu, T. W., & Lin, J. G. (2017). Immediate effects of acupuncture treatment on intra-and inter-limb contributions to body support during gait in patients with bilateral medial knee osteoarthritis. The American journal of Chinese medicine, 45(01), 23-35.
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