The monitoring patients intake and output important

NURS3001 2020

Assignment 4: Critical Analysis

 Haemorrhage

 Hypovolaemic Shock

 Pain

Provide a rationale/reason for this concern:

anaesthetic (Mashour, et al., 2015).

 Neurovascular impairment: Neurovascular impairment, such as compartment

(Swearingen, 2016).

 Nausea and vomiting: Postoperative nausea and vomiting (PONV) are some of the

loss, and electrolyte imbalance, as well as delaying recovery and mobilisation for postoperative patients (Hambridge, 2013). PONV can also cause the individual anxiety and can place tension on the surgical site, venous hypertension, and increase the risk of haemorrhage (Swearingen, 2016).

 Haemorrhage: A common postoperative complication is a haemorrhage.
Haemorrhage is an extreme loss of blood and can cause death (LeMone, et al., 2017).

 Deep Venous Thrombosis: This complication most frequently occurs in the lower extremities of a patient postoperatively. It can develop as a result of trauma that occurred during surgery, a pressure that has been applied under the knees, and reduced blood flow post-op, as well as, reduced mobility (LeMone, et al., 2017).

 Fat Embolism: According to Caricato, et al., (2017) patients who have undergone trauma or surgery to their lower extremities (legs) to suffer from a fat embolism. The emboli can block blood vessels in the lungs, skin, or brain and can be fatal.

List all the appropriate interventions in order of priority (be specific):

 Complete a head-to-toe postoperative assessment

level of consciousness, and motor reaction.

 Assess the patient’s neurovascular function of the operative sites at regular intervals,

 Monitor for signs of haemorrhage from the surgical wound, any intravenous or

indwelling catheters, and/or gastrointestinal tract.

 Ensure that patient maintains appropriate positioning. Keep the patient in a semi-

fowler’s position and elevate the legs of the patient.

 Record bilateral calf or thigh circumference each shift.

 Assess the patient’s wound using an aseptic technique.

 Educate the patient about the risks of immobility and neurovascular compromise.

 Encourage the patient to ambulate as soon as appropriate.

 Educate the patient regarding the need for maintaining adequate immobilisation of

the fracture and the importance of scheduling post-discharge care reviews.

the patient’s general appearance, level of consciousness, dressing sites, wound

drainage sites, and urinary output (LeMone, et al., 2017).

inability to deliver adequate blood supply to the body’s extremities (Perry, 2013).

 A change in vital signs (e.g. increased heart rate, or respiratory rate) can alert nursing

trauma/surgery as the nervous system significantly overlaps with the musculoskeletal

system (Maher, 2016). The neurological assessment includes evaluation of the central

 A neurovascular assessment detects signs and symptoms of potential complications, such as compartment syndrome (NSW Government, 2018). It involves the evaluation of the vascular integrity of a limb and the sensory of the motor function of an individual (Blair & Clarke, 2013).

 The monitoring of a patient’s intake and output is important, especially in critical trauma patients as it is a reliable marker of possible hypovolaemia (Brotfain, et al., 2017). Trauma-associate haemorrhage is a leading cause of intravascular volume shock (Brotfain, et al., 2017).

 Pathology can influence up to 70% of critical decisions involving patient care (McCaughey, et al., 2016). Pathology results can be obtained from blood, urine, faeces, and/or sputum (LeMone, et al., 2017). Nurses must be aware of any changes in the patient’s pathology results as it directly correlates to the care provided to the patients (LeMone, et al., 2017).

 Monitor bilateral calf circumference to assess signs of possible DVT. An increase greater than 1.5cm or more in 1 day is a significant sign of DVT and may also indicate signs of compartment syndrome in a postoperative orthopaedic patient (Swearingen, 2016).

 Encouraging and educating the patient when appropriate about early ambulation will aid in preventing the risk of developing DVT. The risk of the patient developing DVT ranges between 15-40% as he is a postoperative patient from major surgery (Talec, et al., 2016). A further complication of DVT is pulmonary embolism, which can be fatal, hence the importance of early ambulation in the post-operative period (Talec, et al., 2016). Early ambulation will also promote peristalsis and will improve bowel elimination (Swaeringen, 2016).

 Proper alignment of the patient’s body decreases the risk of contracture
complications and formations, which may affect the patient’s mobility (Swearingen, 2016).

assessments of the device will ensure immobilisation of the fracture is maintained (Swearingen, 2016).

References

patients. World Journal of Emergency Surgery,12(1), 41.

Caricato, A., Russo, G., Biasucci, D., & Annetta, G. (2017). Fat embolism syndrome. Intensive

Australian ed., Always learning).

Maher, A. (2016). Neurological assessment. International Journal of Orthopaedic and

T., Westbrook, J.I., & Georgiou, A. (2016). Enhancing the quality of pathology test requesting

and test result management in Australian general practice. Macquarie University, Sydney.

maternity, and psychiatric-mental health (Fourth ed.).

8