Nursing Assignment: Case Study of Bilateral Knee Osteoarthritis

This essay discusses the case study of an old man diagnosed with bilateral knee osteoarthritis, highlighting the risk factors and pathophysiology. It also covers post-operative assessment, nursing priorities, and a care plan for wound dehiscence.

Running head: NURSING ASSIGNMENT
NURSING ASSIGNMENT
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The essay includes the case study of an old man named John Grant, 63-year-old, who
was diagnosed with bilateral knee osteoarthritis. The general practitioner planned a right total
knee replacement for John due to his worsening pain (Li et al., 2018). The left knee
replacement was also included in the plan after the successful completion of first surgery that
comprise of right total knee replacement. He had a medical history of hypertension, angina,
depression, type 2 diabetes mellitus and hyperlipidaemia. The essay will highlight the risk
factor and the pathophysiology that resulted in the condition of bilateral knee osteoarthritis.
Post-operative assessment is conducted for the patient that includes post-operative wound
dehiscence and post-operative pain management (Twiggs et al., 2018). Nursing Priority of
care is highlighted for the post-operative assessment and accordingly a care plan is generated
for the identified nursing priority. The essay concludes by using a Gibb’s Reflective Cycle
that will explain the process of management of patient health condition and post-operative
assessment.
The primary risk factor that is responsible for the onset of bilateral knee osteoarthritis
in the patient is his advanced age. The condition of knee osteoarthritis is more prevalent in
people who are more than 45 years of age (Oboirien, Agbo & Ajiboye, 2018). The elder
people experience thinning of cartilage and wear and tear that result in reduced flexibility and
mobility as the glycosaminoglycan’s are lost from their cartilage that result in lower osmotic
pressure hence, making the cartilage softer and fragile with reduced resistance from any
external compressive force therefore making the patient more prone towards the condition of
osteoarthritis (Hulshof et al., 2019). The inflammatory proteases and cytokines are highly
expressed in the elder people resulting in enhanced catabolic activity that leads to degradation
of cartilage. Other associated risk factors includes obesity, genetic predisposition, past knee
injury, reduced muscle control and strength and limb malalignment (Han & Gellhorn, 2018).

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Post-operative assessment is defined as the type of assessment that is crucial for the
patient who have undergone a surgery and requires assessment to reduce any further chances
of surgical complication. Registered nurse is responsible for undertaking post-operative
assessment of the patient with right total knee replacement (Who.int, 2019). The two
components of initial post-operative assessment includes pain assessment and joint
aspiration. Pain assessment was the most important component of post-operative assessment
as the patient was suffering from severe pain that was increasing day by day and therefore he
was referred for total knee replacement. Pain assessment tool, performance measure and
patient-reported questionnaires are generally used to assess the level of pain in the patient
with osteoarthritis condition (Akin et al., 2018). Using pain assessment tool, the level of pain
is marked on the scale of 1 to 10 and accordingly care plan is devised that aim to reduce the
pain in patient. In case of patient-reported questionnaires (PROs), pain is assessed based on
the perspective of the patient’s feeling and performance measures estimate the level of pain
by assessing physical action of patient like walking. These pain assessment methods will
enable the registered nurse to assess the level of pain in the patient and to construct an
appropriate care plan based on the pain assessment (Trouvin & Perrot, 2018). The second
component of post-operative assessment includes joint aspiration assessment. The patient
with osteoarthritis who have undergone total knee replacement surgery are usually under the
risk of synovial fluid deposition in the knee that can result in extreme complication. Hence, it
is crucial to assess if any deposition of synovial fluid took place or not. This will also help in
differentiating if the arthritis is inflammatory or non-inflammatory in condition (Leung,
2018). Joint aspiration is considered as an inexpensive and relatively quick procedure that can
be conducted within the hospital and assess if any deposition of synovial fluid is present of
not. Assessment of synovial fluid deposition will help the registered nurse to understand his
daily activities of life and devise a care plan that would involve moderate physical activity

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and action. As John could undertake all his daily activities of life before surgery it was
crucial to measure his physical activity of life by assessing joint aspiration (Sandler &
Dunkley, 2018).
In this scenario the patient requires nursing care priorities based on his post-operative
assessment of total knee replacement (Umuhoza et al., 2019). The first nursing care priority
will be post-operative pain management that will help the patient to reduce the intensity of
pain hence allowing the patient to breath effectively. In pain management, the registered
nurse will identify the sign and symptoms that can result in severe pain like allodynia,
dysaesthesia, hyperalgesia and other associated treatment for pain management (Goode et al.,
2019). Use of analgesics is considered as an important step in pain management as it will
control the level of pain that the patient will face after surgery. The respiratory condition of
the patient should be monitored by the nurse because in case of elder patient increased pain
can result in deep breathing and coughing hence leading to lung dysfunction. The nurse will
include different medication to reduce the severity of pain in the patient that is managed by
the nurse. In this scenario the patient was already suffering from gastro-oesophageal reflux
disease (GORD) and continuous severe pain can result in lower gastrointestinal function
hence increasing the complexity of patient health condition. Hence, effective pain
management using analgesic and medication is an important nursing priority for the
registered nurse to effectively manage the health condition of the patient (Cui et al., 2018).
The second nursing priority will be post-operative wound dehiscence. After the surgery it is
very important for the registered nurse to create a nursing strategy for managing the wound of
the patient. The aim of wound management is to permit the healing procedure of the wound
without any complication (Racgp.org.au, 2019). The main step in this management is to keep
the wound clean and free from any surgical-site infections (SSIs) that includes cleaning and
dressing the wound, antibiotic treatment, debridement and professional wound care facilities.

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The registered nurse must clean and dress the wound using aseptic technique. Sterile saline is
recommended to be sued by the nurse during wound cleaning and use of interactive dressing
method to reduce any chance of surgical site infection (Vakhshori & Lieberman, 2018).
Effective antibiotic must be given to the patient in case any slight possibility is seen of
infection. A structured method of approach is used by the registered nurse to improve the
healing of surgical wound and reducing the chances of any surgical site infection. The last
step in care priority for postoperative wound dehiscence is to use anti-microbial agent in
order to heal the surgical wound of the patient. Hence, the above mentioned nursing strategy
will help the registered nurse to meet with the needs of the patient’s identified assessment
method (Poultsides et al., 2018).
A comprehensive care plan is devised for the post-operative wound dehiscence that
comprise of various steps that has to be followed by the registered nurse during assessment
and management of patient’s health condition. The steps include din the care plan of post-
operative wound dehiscence are as follows (Vakhshori & Lieberman, 2018):
 Identification of risk factors that can result in wound dehiscence
 Identification of signs and symptom that can exhibit the condition of wound
dehiscence.
 Accurately assessing and categorising the wound dehiscence type that also includes
any ongoing valuation of the patient.
 Assessment of clinical indicators that result in surgical suite infection.
 Determine the care procedure for surgical debridement and healing of the wound.
 Appropriate preparation of the wound bed of the patient
 Managing the expectation of the patient
 Identifying the multidisciplinary team (MDT) approach
 Educating the patient reading their condition and treatment method

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 Continuous follow-up and post-discharge surveillance
As the patient was suffering from continuous pain and was recommended for right total
knee replacement it was possible that he could suffer from wound dehiscence. Hence, an
appropriate nursing care plan is created that will reduce the risk of wound dehiscence in the
patient and ensure delivery consistency from the devised care plan for sustained and timely
healing of surgical wound (Zwanenburg et al., 2018). In this care plan, ten different steps are
included that will help the registered nurse to reduce the complexity and chance of wound
dehiscence in the patient that can further result in future complication of the surgical site.
Based on the first surgery management he was recommended to take up another surgery of
left total knee replacement hence it was very crucial to follow a care plan and reduce any
future complication in the patient’s health condition (Sodhi & Mont, 2019).
I have understood from the care plan that it is very crucial to manage the symptoms and
risk factors of wound dehiscence as the chances of surgical site infection increases in the case
of any surgical wound. The care plan has also helped me to understand the indicators and
type of wound dehiscence that will affect the patient’s health condition (Saunders et al.,
2018). The use of multidisciplinary team to manage the condition of wound dehiscence is
also explained in the care plan. Hence, I have understood the overall concept of post-
operative assessment in case of total knee replacement surgery and devising the care plan for
effective assessment and management of the surgical wound.
It can be concluded from the essay the major risk factor of osteoarthritis is age and in
case of the patient his age was also responsible for osteoarthritis condition. The components
of post-operative assessment was explained in the essay by highlighting the major two
nursing priority to identify the need of the patient during post-operative assessment. A

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comprehensive care plan is devised for the post-operative wound dehiscence that will help
the nurse to reduce any risk or complication of surgical-site infection.

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