Nursing Case Study: Total Right Knee Replacement and Osteoarthritis

This clinical case study focuses on a 72-year-old male admitted for a total right knee replacement due to osteoarthritis. The study encompasses the initial nursing assessment, post-operative care, nursing management, and discharge plan. It details the pathophysiology of osteoarthritis, emphasizing cartilage degeneration and its impact on joint function. The initial assessment includes pain evaluation, mobility assessment, and psychological status. Post-operative care involves vital sign monitoring, pain management, and the prevention of complications such as immobility-related issues. Nursing interventions include position changes, exercise encouragement, and patient education on diet, hygiene, and medication. Pain management techniques such as deep breathing and diversion therapy are implemented. The interdisciplinary team's roles are outlined, highlighting the nurse's role in monitoring, providing care, and making decisions for health promotion. The patient's outcome demonstrates reduced pain, the absence of infection, and improved mobility. The discharge plan includes monitoring for infection, medication adherence, exercise, wound care, and follow-up appointments. The study provides a comprehensive overview of patient care from admission to discharge, emphasizing holistic nursing care and patient education.

Clinical case study
Introduction
A 72 year old male is admitted for total right knee replacement in Greywalls nursing home
with the complaints of difficulty in mobilizing and climbing stairs. He is diagnosed with
osteoarthritis. He is unmarried and he was employed as driver and retired at the age of 65.
His past medical history states he is diagnosed with diabetes and hypertension in the year of
2003. His present history states that he is suffering from osteoarthritis since 2017. He is
proposed for the Total right knee replacement. The clinical case study includes Initial nursing
assessment, care of patient through the post-operative process, nursing management, and
discharge plan.
Pathophysiology of the Osteoarthritis states that the degeneration of cartilage which results in
modified bone structure. Osteoarthritis is common among aged people. Osteoarthritis also
affects the neighboring cells and tissues. An inflamed cell discharges an enzyme which is
produced due to the collapse of the collagen. The enzyme tears down the articular cartilage.
As the disease progress, the space between the cartilages is reduced; this causes friction in the
movement of joints. Osteoarthritis commonly affects the joints in hand and feet, hip and knee
joint (Mobasheri 2016).
Initial nursing assessment includes the collection of information during patient admission.
Assessed the level of pain using pain scale and the location, intensity, radiation of pain are
also assessed. Level of mobility and capability of performing his ADLs was included in the
assessment and the psychological status was also assessed. Impact of the disease has to be
discussed with the patient and his family (Kara 2018). Impaired mobility and pain are the
major impacts which have to be discussed with the patient and family. Immobility

significantly affects the ADL of the patient which may cause psychological distress. Patient’s
family history shows that the patient is a widower and has no children. Discussed the family
history and related psychological and health care issue with the registered nurse and the
health care team.
Care of the patient through the post-operative process includes patient care after the surgery.
Patient’s vital signs are monitored every half an hour for four hours because significant
changes in heart rate, respiratory rate and temperature are the indications of the clinical
deterioration (Bontempi 2017). The patient has to be continuous Spo2 monitoring because
Spo2 indicates the changes in oxygen concentration in the blood. Assessed the patient’s
consciousness and the sensation which indicate the recovery from the Analgesic. Any
changes in the vital signs were informed to the registered nurse and the concerned doctor.
Immediate post –operative monitoring and care were essential to ensure fast recovery and
prevent complications. Immediate post –operative care includes monitoring vital signs,
maintenance of airway and breathing, suctioning need to be done if the mucus blocks the
airway, and pain assessment (Bontempi 2017). Assess the surgical site for bleeding and signs
of inflammation. Since patient was on Nil per oral I started IV fluids to maintain the fluid
balance. IV antibiotics administration was started to prevent secondary infection.
The risk factors associated with immobility in post operative patients are bed sores, urinary
retention, pneumonia, decreased bowel movement, and respiratory infection. Nursing
interventions can prevent the patients from the post –operative complications that are related
to immobility (Hobson 2016). Patient’s position changed every two hourly, back care given,
encouraged the patient to do deep breathing exercise, monitored intake and output, perennial
care given, monitoring vital signs and steam inhalation is given. Neuro-vascular observation
done every 30 minutes, administered IV antibiotic Inj. Flucloxacillin every 6 hours,

analgesics administered for pain, Administered Inj. Clexane subcutaneous to prevent
thrombosis.
Patient’s social, cultural and psychological needs are considered in the nursing intervention
to ensure holistic nursing care. The patient is allowed for the visitation of his old friends,
psychological and moral support was provided. Discussed the psychological and social need
of the patient to his family and encouraged the family members to support the patient in the
therapy process (Kennedy-Malone 2018).Encouraged the patient to meet his need and
appreciated his simple efforts. Encouraged him to feed himself, allowed him to do simple
active and passive exercise, and encouraged to do deep breathing exercise. Educated the
patient about the complication of the disease condition, importance of well balanced diet,
personal hygiene, exercise and regular follow up.
Pain management is an essential nursing consideration for the patient undergone total knee
replacement. The pain was assessed using the pain scale. Periodical pain assessment is
implemented to rule out the contributing factors (Taylor 2017). Some of the pain
management techniques are deep breathing exercise, active and passive exercise, Diversion
therapy like music, any other art that the patient is interested. Hot and cold fomentation can
help to some extent. Nursing interventions involved positioned the patient comfortably,
educated the patient and family about the pain management technique and administration of
analgesics.
The interdisciplinary team involved in the care the patient includes the nurses, doctors, and
physiotherapist. The role of the nurse is monitoring, providing nursing care, meeting the
physical needs of the patient, prevention of further illness and make appropriate decision for
the promotion of health. Role of the doctor includes examining the patient, diagnosing and to
ensure right treatment for the patient. Physiotherapist helps the patient to improve the

mobility and provides physiotherapy. Past and present medical history of the patient assisted
in planning the nursing care and implementation. Clinical decisions are made with the
rationale for the speedy recovery and the well being of the patient. On the evaluation of the
patient outcome after the few episodes nursing care, patient verbalises that his pain is reduced
and he is implementing pain management techniques whenever needed(Skou 2018). Have no
signs and symptoms of infection. The surgical wound shows the signs of healing. The patient
is able to perform limited mobility and he is able meet his needs with assistance.
Discharge plan for the patient underwent a total knee replacement includes monitoring,
medication, exercise, nutrition, wound care and dressing and regular follow up. Advised the
patient to assess his surgical site for the sign of infection, unpleasant odour, inflammation,
swelling, and bleeding (Chen 2017). Advised the patient to take the medication regularly.
Encouraged him to continue the exercise for better muscle strength and independent mobility.
Demonstrated wound care and dressing and educated him about the importance of wound
care. Educated him about the usage of assistance equipment like toilet raiser, wheel walker,
and wedge pillow. Advised him to take diet rich in protein and calcium. Explained about the
importance of regular follow up
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