TOTAL RIGHT KNEE REPLACEMENT

OSTEOARTHRITIS

Admitting Diagnosis

:right knee degenerati

ve joint disease

Pertinent History:Osteoarthritis (OA)

83 year old, Caucasian American female with chief complaint of pain

in her right knee

Past Surgical History:1946 – appendectomy1980s – sinus surgery1990s – cataract surgery1996 - CTR1998 - ankle surgery2005 - back surgery

Health History:Ocular: cataract, glassesHEENT: sinusitisMuscoskeletal: back pain, osteoarthritisCV: high BP, high cholesterol, heart disease - siblingGI: reflux disease, gall bladder disease – siblingOncological: renal cancer - sibling

OSTEOARTHRITISIt is the most common joint disorder. Risk Factors include: age, gender (female),

obesity, and occupations that have repetitive injury or physical trauma

Gender differences:MEN WOMEN

Men are more often affected than women before the age of 50.

Women are affected twice as often as men after the age of 50.

Hip OA is more common in men after the age of 55.

OA in interphalangeal joints and thumb base is more common in women after the age of 55.

Knee OA is more common in men before the age of 45.

Knee OA is more common in women after the age of 45.

OSTEOARTHRITISAlong with significant functional

impairment, there are signs and symptoms of pain, stiffness, and loss of mobility.

Most frequently affected areas are the hands, knees, hips and spine

Osteoarthritis is a disease of cartilage. OA can be either an idiopathic or secondary

disorder – trauma, stress, inflammation, joint stability, skeletal deformities

OA begins with tissue damage from mechanical injury (eg, torn meniscus), transmission of inflammatory mediators from the synovium into cartilage, or defects in cartilage metabolism.

The joint changes:Include a progressive loss of articular

cartilage and synovitisresult from the inflammation caused when

cartilage attempts to repair itself, creating osteophytes or spurs.

TOTAL KNEE ARTHROPLASTYEither part of or the entire knee joint may

be replaced with a metal and plastic prosthetic device.

Great emphasis is placed on postoperative physical therapy, and dislocation is not likely with a total knee arthroplasty.

http://www.youtube.com/watch?v=dqtOQ2WnYBM

CONCEPT MAP

DIAGNOSISAcute pain related to surgical incision as

evidenced by complaints of pain level greater than 8, tense and guarded body posture, restlessness, irritability, and facial grimacing.

Impaired physical mobility related to pain, stiffness, and surgical procedure as evidenced by limited joint movement, difficulty ambulating, and guarded movement.

Self care deficits related to surgical procedure and pain with activity as evidenced by inability to perform activities of daily living.

Risk for infection related to altered skin integrity, invasive instrumentation, and immobility.

CLIENT CENTERED OUTCOMEReport (verbalizes) satisfactory relief of

pain or is pain free.Participates in exercise therapy to increase

joint mobility by using the CPM machine for about 8 hours.

Demonstrates ability to transfer, walk with assistive device, and move with ease around the unit.

Perform activities of daily living to the maximum amount possible, but also determine when assistance is needed for performance of activities

Check incision site for signs of infection which may include redness, swelling, drainage and/or a foul smell.

INTERVENTIONS

Acute pain related to surgical incision as evidenced by complaints of pain level greater than 8, tense and guarded body posture, restlessness, irritability, and facial grimacing.

Encourage patient to

monitor own pain and to intervene

appropriately to increase patient’s

control over pain

management.

Medicate prior to activity to

increase participation.

Position in proper body alignment to

reduce pressure on nerves and tissues.

Impaired physical mobility related to pain, stiffness, and surgical procedure as evidenced by limited joint movement, difficulty ambulating, and guarded movement.

Determine limitations of

joint movement and effect on

function to plan appropriate

interventions.

Perform passive or assisted

ROM exercises.

Assist patient with initial

ambulation to promote mobility

according to patient’s abilities.

Self care deficits related to surgical procedure and pain with activity.

Inspect the incision site for

redness, swelling, or drainage to

detect infection.

Cleanse the area around the incision

with an appropriate cleansing solution to

reduce local pathogens.

Change the dressing at appropriate intervals to

reduce microbial

colonization.

EVALUATIONAt the beginning of the day, the patient reported a

pain level of an eight, which is when the nurse administered Toradol. By the end of the day, the patient was only complaining of a pain level of three, but also said that it was tolerable and no medication was needed.

Patient participated in exercise therapy to improve joint mobility and ambulation.

She was not able to do too much on her own and needed assistance.

Nurse from previous shift changed bandage at 2200 and reported that incision site looked clean, with very little redness, no swelling or drainage.