2803NRS Written Assignment

2803NRS Written Assignment

Introduction

This paper applies the doctrines of evidence-based and person-centered care to come up with a plan for adequate care for a client with bilateral knee osteoarthritis. Precisely, the paper will discuss the risk factors, pathophysiology, and assessment of th client a hand as presented int eh scenario and identify two priorities of postoperative nursing care. Additionally, the paper will discuss a potential complication (postoperative wound infection) and develop a plan to reduce the infection and reflect on the process of creating the plan of care.

The risk factors and pathophysiology leading to the presenting condition

Bilateral knee osteoarthritisencompassesdegradation of the cartilage along with bone remodeling as a result of an active reaction to chondrocytes within the articular cartilage as well as the inflammatory cells situated in the surrounding tissues (TeachMeSurgery, 2020).These cells often release enzymes, which in turn, break down proteoglycans and collage. Consequently, the articular cartilage is destroyed. Furthermore, after the underlying subchondral bone is exposed, sclerosis occurs, followed by reactive remodeling changes, which then give rise to osteophytes not mentioning subchondral bone cysts(TeachMeSurgery, 2020). Over time, the joint space is lost progressively. Age, angina, type 2 diabetes, depression, hypertension,hyperlipidemia, gastro-oesophageal reflux disease, taking antacids, and engaging in activities that strain the knees are all risk factors for the condition (Linet al., 2017and Singh & Terrell, 2019).

Priorities of postoperative nursing care

The postoperative assessments necessary includeTUG-test to assess Gant’s functional mobility andAVPU scale assessment. Hsiao et al. (2019) claim that the TUG test is often applied as an outcome measure after a surgical process and as a predictor of function and fall. Adding to this, Nygard, Matre, and Fevang (2016) supposed that the TUG assessment is used in evaluating a postoperative patient’s physical balance along with balance in elderly patients. This assessment is indeed necessary, considering that it will provide the registered nurse with a comprehensive understanding of Grant’s agility, strength, and dynamic balance. Consequently, as determined by Nygard, Matre, and Fevang (2016), the use of TUG assessment will allow the RN to know whether there has been any form of change or not following the initial surgical process..

AVPU scale assessment is essential as, according to Romanelli and Farrell (2020), it allows a medical practitioner to know the patient’s gross level of responsiveness, consciousness, and mental status. In particular, the assessment helps the RN to determine the patient’s alertness, verbal responsiveness, pain response, and the level of unresponsiveness. What this means, therefore, is that with the AVPU scale assessment, it follows that the RN will be in a better position to determine whether Grant is prepared for the postoperative care or not. If it is determined that he is not ready, the RN will apply the necessary interventions to increase the client’s readiness for care. Overall, the two assessments will go a long way in ensuring that the medical professional creates a comprehensive plan of care for the patient.

Potential postoperative woundand a nursing assessment to identify the complication

Azoury et al. (2015) relay thatpostoperative wound infections are detrimental as they necessarily complicate a patient’s course of recovery. The researchers add that the infections typically occur within 30days after an operation is performed and often occur at the site on which the surgical process took place. Alternatively, the postoperative wound infection occurs one year where an implant is left in place, and it follows that the infection s secondary to the surgical process. Azoury et al. (2015) suppose that bacterial colonization on the client’s genital tract, skin, and alimentary are the principal contributing factors leading to postoperative wound infections. The bacteria often hinder the healing process of the wound, which leads to wound dehiscence, anastomotic leaks, as well as superficial incisional infections. Larrea and Lund (2015) document that the bacteria outcompete the natural system of the postoperative patient. This leads to a series of systematic and local inflammatory responses.

Azoury et al. (2015) discuss the various risk factors that increase the chances of postoperative wound infections. As they pertain to the case study, these includetype two diabetes, open surgical process, and immunosuppression. The case study shows that Grant has a history of varied disorders ranging from type two diabetes to angina. This clearly shows that his immune system is suppressed. Grant’s gender is also a potential risk factor. Azoury et al. (2015) reveal that males are at an increased risk for postoperative wound infection, in part because of decreased deposition of collagen following surgery. Manifesting the impact of age as noted by Messier (2016), Azoury et al. (2015) claim that the decreased collagen deposition occurs mostly in aged people. To determine whether Grant is experiencing a postoperative wound infection, the registered nurse must focus on several things.

Foremost, he or she must establish where there are incisions with purulent drainage. Additionally, the RN must determine th presence of at least one of the following signs of infections, including tenderness or pain around the site of incision, heat, localized swelling, and redness. In addition to this, the registered nurse must establish the presence of organisms in a culture of tissue, which is aseptically obtained, or in fluid attained from the superficial incision. The other assessment need is a determination of whether the surgical site has experienced delayed feeling. The RN must also establish whether the client has experienced vomiting, malaise, and nausea.

A plan of care to reduce the risk of postoperative wound infection

Once the RN testspositive for thepostoperative wound infection, he or she must take steps to manage the infection. According to Medline Plus (2020), one of the options for managing the condition is the use of antibiotics. In most cases, the patient is started with IV antibiotics and then change to pills at a later date. The RN must ensure that the patient takes the full dose of the prescribed IV antibiotics, even where he feels better. In the case that there is drainage on the wound, it is best for the RN to perform a test to determine the most suitable antibiotic. If antibiotics do not seem to work, Medline Plus (2020) recommends the use of invasive surgical treatment. Foremost, the RN has to open the wound by withdrawing the sutures and staples. Next, the medical professional has to perform a test on the tissues or pus in the woundto establish whether there is an infection as well as to determine the kind of antibiotic drug should be administered. The RN should then rinse the wound with a saline solution, which is typically saltwater. Next, the RN should drain the abscess or pocket of puss where present. This should then be followed by the packing of the wound with saline-soaked dressing and a bandage.

Also, part of managing the infection is wound care. According to the Healthline Plus (2020), the postoperative wound infectionmight require cleaning and change of dressing on a frequent basis. While Grant might learn to perform this by himself, the RN might decide to facilitate the process. In any case, the procedure involves the removal of the old bandage and packing, cleaning of the wound, and replacing a new, clean packing material before then putting on a new bandage. To trigger faster healing of the wound, Healthline Plus (2020) holds out that a wound vacuum-assisted closure dressing could be administered.The essence of this dressing is to increase the degree of blood flowwhile assisting in the healing process. Healthline Plus (2020) documents that if the wound fails to close by itself, the RN should recommend a muscle flap surgery or a skin graft. Where the former is necessitated, the RN should take a piece of muscle from the client’s shoulder buttocks or the upper chest and put it over the wound. This should continue until the entire infection has cleared.

Application of Gibb’s Reflective Cycle

I decided that playing the role of an RN; I had to make my plan of care comprehensive. Therefore, I had to research deep and wide for best-practices. I feed satisfied with my plan and have high anticipation that my system will generate the most fulfilling effects for Grant. The thing that worked well was that I was able to apply my critical and problem-solving skills when developing the plan. I had to apply these skills primarily because I encountered some sources of information that were not credible.Besides, I was able to think “out-of-the-box,” which helped me to come up with an innovative plan.This outcome was due to the fact that I had the freedom to search through a myriad of distinctive resources. I learned that, for one to develop an appropriate care plan, he or she has to draw on the best practices documented by authoritative sources. I will use the plan I created in postoperative nursing care. Nevertheless, I will continue researching to find information that can enhance my plan.

Conclusion

This paper applied the doctrines of evidence-based and person-centered care to come up with a plan for effective care for a client with bilateral knee osteoarthritis. Grant’s condition is multifaceted as it is premediated by several disorders angina from angina to Type 2 Diabetes. A postoperative wound infection might occur, but with antibiotics, invasive surgical processes, and wound care, the wound will heal without any issues.

References

Azoury, S., et al. (2015). Postoperative abdominal wound infection—epidemiology, risk factors, identification, and management. Chron Wound Care Manage Res, 2, 137-48.

Hsiao, Y. H., et al. (2019). Early Postoperative Intervention of Whole-Body Vibration in Patients After Total Knee Arthroplasty: A Pilot Study. Journal of clinical medicine, 8(11), 1902.

Larrea, N., & Lund, K. (2015). Management of Postoperative Wound Infection. Topics in Obstetrics & Gynecology, 35(6), 1-7.

Lin, H. C., et al. (2017). The association between gastro-oesophageal reflux disease and subsequent rheumatoid arthritis occurrence: a nested case-control study from Taiwan. BMJ Open, 7(11), e016667.

Medline Plus (2020). Surgical wound infection – treatment. Retrieved from https://medlineplus.gov/ency/article/007645.htm

Messier, S. P., et a. (2016). Are unilateral and bilateral knee osteoarthritis patients unique subsets of knee osteoarthritis? A biomechanical perspective. Osteoarthritis and cartilage, 24(5), 807-813.

Nygard, H., Matre, K., & Fevang, J. M. (2016). Evaluation of Timed Up and Go Test as a tool to measure postoperative function and prediction of one-year walking ability for patients with hip fracture. Clinical Rehabilitation, 30(5), 472-480.

Romanelli, D., & Farrell, M. W. (2019). AVPU (Alert, Voice, Pain, Unresponsive). New York, NY: StatPearls Publishing.

Singh, P., & Terrell, J. M. (2019). Antacids. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK526049/

TeachMeSurgery (2020). Osteoarthritis. Retrieved from https://teachmesurgery.com/orthopaedic/principles/osteoarthritis/