Nursing Assignment: Case Study of Bilateral Knee Osteoarthritis

Running head: NURSING ASSIGNMENT
NURSING ASSIGNMENT
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NURSING ASSIGNMENT1
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).

NURSING ASSIGNMENT2
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