Case Study of Total Knee Replacement

RUNNING HEAD: TOTAL KNEE REPLACEMENT 1
Case study of total knee
replacement (nursing the
surgical patient)
Student details:

TOTAL KNEE REPLACEMENT 2
Introduction
This paper is grounded on the situation study of Frank Wright, 76 years old man who has
recently experienced right total knee replacement and has remained reverted to the ward at 2100
hours where the paper emphases on the post-surgical plan, influence of co-morbidities and
overall anesthetic on post-operative operation sideways with discharge planning of the persistent.
An operating process in which the disorderly knee joint gets substituted with the simulated
substantial is stated to as total knee replacement. Through a total knee replacement process, the
culmination of the femur bone is disconnected and replaced with a metal cover. The culmination
of the tibia (lower leg bone) is also disconnected and exchanged with a channeled plastic unit
with a metal trail. The simulated constituent is recognized as prosthesis. The greatest mutual
reason for knee replacement is osteoarthritis of the knees which repeatedly causes difficulty,
discomfort and abridged daily function which indicates to the replacement of knee. Therefore,
patients who experience such surgeries must comprehend the post-operative plan and retrieval of
the procedure (BA Basques, 2015).
Part A: Post-surgical plan
This unit includes of the post-surgical strategy of Mr. Wright who has lately experienced
finished right total knee replacement operation. The nurses are answerable for patient’s
assistance and obtain specialized nursing maintenance. Afterward the surgical procedure, four
shared post-operative proceedings are capacity reduction, blood loss, vomiting and discomfort.
The leading 24 hour post-surgical strategy maintenance is as monitors. A significant constituent
in leading 24 hour post-surgical maintenance is estimate of preoperative configuration
dysfunction and subsequent optimization of determination, which has been recognized to be
relevant, predominantly in patients who are complicated in smoking and rigidity. The basic tool
for an increased post-operative threat in patients with preoperative construction dysfunction is
the medicinal compression response connected with the procedure following in acquisitive
pressures on the before abridged soft tissue (E Thienpont, 2015). Additionally, an uneasiness
facility helps as an imperious obligation for overall request to achieve perfect pain relief.
Mobilization will be happening within six hours postoperatively, in maximum cases 2-4 hours
after operation as soon as the vertebral anaesthesia had impaired off. The nurses will attain the
main mobilization, and reliable physiotherapy will be continuing the day afterward process and
confined of different exercising activities once or twice each day. DVT prophylaxis will be
continuing 6-8 hours postoperatively and will last until release of the enduring. “Non-steroidal
anti-inflammatory drugs (NSAIDs)” will be used frequently (PK Edwards, 2016). “Postoperative
nausea and vomiting (PONV)” will be healed only when compulsory disadvantaged of even
prophylaxis. The existence of an emblazoned care plan mobilizing the many features of firm
recovery is obligatory and should include substantial on the deliberate small LOS in education to
stimulate the patient to grow an active supplier. An effectual care plan protects the surgical
observers the patient expansion execution to the planning; written prescription is compulsory for
technique of deliberation and availability of resources to the patient. Regional analgesia is

TOTAL KNEE REPLACEMENT 3
superior to general anaesthesia as it reduces post-operative trouble by 30-60% (Han-Liang
Chiang, 2016). The catheters will be disconnected after 24 hours. The “blood pressure, heart rate,
respiratory rate, and somnolence score” adverse effects will be reported in first 24 hour care plan
after surgery. Somnolence will be measured with a five-point scale varying from conscious and
concerned with to not arousable (Olayinka Eyelade, 2016). The likely adverse effects are
“pruritus, sickness, urinary holding and eruptions”. Local gentamicin organization later total
knee replacement will be accepted for the illusion of adverse effects associated to renal as it is a
gentle and actual procedure related with the worldwide practice of aminoglycosides. Moreover,
“smoking, hypertension, hypercholesterolemia, diabetes” in males increases with the phase and
these are communal in males who practices such operations (J Cox, 2016). Suggestive tests like
“serum cardiac markers, RCG, and imaging technique” are recommended. Clinical presences
like augmented body temperature, amplified breathing emissions, cough and dysponea can occur
after the process. Consequently, if the patient demonstrates these risk issues, dimension for the
anticipation of PPCs can be accepted, which comprises, engagement of neuraxial anesthesia as
an alternative of general anesthesia, initial mobilization after operation, inspiration for deep
inhalation, alteration of low serum albumin and constraint of fluid transfusion (NL Ramos,
2014). Conceivable difficulties include glitches with wound therapeutic, infection, bleeding,
profound venous coagulation, irritation, rigorousness and resolute pain. Nursing maintenance
comprises nursing and wound valuation, neurovascular valuation, observing of wound bleeding,
pain administration, anticipation of contamination, and promotion of initial ambulation. Though,
ordered nursing interferences are reflection of bandage and draining, neurovascular examination,
drugs for pain, detecting CAC in wound pressure drainage, practice of continuous inactive
motion scheme and initiation of physical rehabilitations. Through the procedure, the nurse and
the anesthesiologist are answerable for the organization and therapeutic care of the patient after
post-surgery and anesthesia (MC Rosal, 2011)
Part B: Impact of co-morbidities and general anesthetic on post-operative recovery
The incidence of co-morbidities in operational patients is significant effects in preoperative
illness and transience risk assessment. The male cigarette smoker requires additional opiate
analgesics through the principal 72 hours of process as they ought to progressive pain absorption
when touching and 1 day rest after the process. Hypertension is the highest common (48.8%)
comorbidity in this team of patients with post-operative operation. Hemodynamic variations
throughout anesthesia for the enduring with hypertension are obligatory. Moreover, amlodipine
which is usually approved calcium channel blocker antihypertensive agent (JB Stambough,
2015). Diabetes mellitus is added comorbidity documented to be connected with hypertension.
Furthermore, continuing with OSA (obstructive sleep apnoea) has an unusual risk of
postoperative difficulties. Male, smoking and liquor incorporation, obesity and aging are
documented effects connected with a progressive incidence of OSA. Anesthetic drugs harm the
arousal response, which is a self-protective defense method in contradiction of sleep apnoea
which helps to overcome the air system obstacle. “Anaesthetic, opioids, hypnotics, and