Nursing Case Study: Total Knee Replacement Post-Operative Care

This case study analyzes the post-operative nursing care of a 76-year-old male patient, Frank Wright, who underwent a right total knee replacement. The paper explores the post-surgical plan, including pain management, mobilization, and DVT prophylaxis, emphasizing the nurse's role in monitoring and implementing interventions. It examines the impact of co-morbidities like hypertension and diabetes, and the effects of general anesthesia on post-operative recovery. The study also delves into discharge planning, covering the patient's activity level, medication, and potential complications. The case study highlights the importance of comprehensive nursing care, including wound assessment, pain management, and patient education to ensure a successful recovery, and provides a comprehensive overview of nursing interventions and strategies to optimize patient outcomes following total knee replacement surgery.

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

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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

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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

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benzodiazepine” might also basis breathing despair and therefore decreases tiny aeration (JF
Styron, 2011). Surgery and anesthesia are bases of sleep apnoea in the perioperative eternities
which might dominant in the increase of perioperative problems. The kind of process and the
type of anesthesia are independent risk subjects for the incidence of trouble in post-operations
(Kai Song, 2016).
Pre-existing circulatory co-morbidities in the senior and troubled enduring proposing for
total knee replacement supports in the upsurge of postoperative cardiac accounts which moreover
obscures retrieval of the process (PK Sculco, 2015). Multilayered pathophysiological devices
fund in the way of the pathogenesis of cardiovascular chronicles between the patients. It upsets
with the development of serious unwanted intrathoracic density as a importance of difficult
breathing possessions to overcome advanced airway catastrophe, understanding start through
events of apnea, sleep breakdown and amplified rapid eye movement, recurring hypoxemic
compression, deregulation in nuerohumoral, carotid augmented and shortened profession,
frustration, endothelial dysfunction, metabolic dysregulation and clotting (Tatiana Ambrosii,
2016). Additional, recurrent attacks in unwanted intrathoracic compression indicates to
augmented cardiac preload and left ventricular afterload, increased cardiac work load, ventricular
wall compression, and unmet myocardial oxygen appeal in the incidence of alveolar hypoxia and
hypercapnia and finally myocardial stress, ischemia, wound or infarction. Additionally,
augmented cardiac exertion transformed cardiac unit and cardiac mechanoreceptors, whole
hypoxemia, breathing acidosis (“from carbon dioxide retention”) and sympathetic hyperactivity
fund to decontrolled cardiac automaticity and arrhythmias. Augmented understanding
undertaking and REM movement also promote to blood compression streams, altering vagal
manner, reduced heart rate discrepancy, trouble in cardiac automaticity and arrhythmias (M
Botti, 2014).
The management interference in the recovery of the patient is divided into numerous groups.
The genuine interfering includes pre-habilitation workout, oral nutrition interference,
confrontation exercise, heelift postponement boot interference, jubilee dressing interference,
healing touch involvement and comprehensive intrusion. As per Suetta’s (2004) examination of
resistance training (RT) was self-governing rational exercise for the quadriceps control of the
operated leg. Furthermore, as per Topp’s examination in pre-habilitation test wherein the
supports achieve test like flexibility and step workout (MC Rosal, 2011). Hence, the prehab
group proves decrease in pain and development in serviceable tasks. In the heelift suspension,
boot intervention nurses usages venous bags, the density relief interruption boots useful to the
patient in the bed and extra pressure is applied. Furthermore, the liquid nutritious
supplementation is a beverage of 240 ml twice in a day. The oral nutritional supplement (ONS)
contains of 18-24g of protein in the interference collection. In the context of mental intervention,
Mccaffrey and Locsin implanted a CD player for the patients who were awakened from
anesthesia. The psychological problems of the patients improved after intervention and showed a
significant reduction in the number of pain in the patient. In healing touch intervention, the

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outcome designated that discomfort and nervousness level of long-suffering who had operation
was inferior in ST group (O Ayalon, 2011). Furthermore, the comprehensive intervention takes
program as essential and provides complete procedure complete high superiority, high efficient
and low cost services for the patient who undergoes surgery. Comprehensive care comprised of
sub-acute care plus health maintenance interventions for the management of depressive
symptoms, management of malnutrition and prevention falls. This intervention improves
physical function, physical role and in home rehabilitation. This intervention has better
development in physical utility, role physical, vivacity and social purpose than usual
maintenance group (M Melanie Lyons, 2016).
Part C: Discharge planning of the patient
The patient who receives focused rehabilitation achieves discharge criteria significantly
earlier and had short hospital days. As per Frank’s condition and assessment of the surgery, frank
must be able to walk on his own with the help of crutches. Frank has to use these walking aids
for up to three months. Frank should try to return to former level of activity. Frank should avoid
some sports like football and soccer but should start low impact activities like gardening, tennis
and golfing. Physical therapist will visit home weekly. As a precautionary steps do pivot the
body when using a walker, avoid climbing on a stepstool and do not kneel down, avoid carrying
heavy weights (M Melanie Lyons, 2016). Additionally, use ice on the knees after and before
physical activities, icing will help in the reduction of swelling. Furthermore, try to keep the
bandage clean and dry and change the dressing as per the instructions of surgeon, wash hands
properly, use sterilized equipment’s while dressing, perform drying and cleaning procedure in a
sterile manner, properly examine the wounds such as infection which will have odor, redness,
swelling and drainage. Removal of sutures will be after 10 to 14 days after the surgery. Patient
should take shower after 5-6 days. Patient should follow the prescription of pain management.
Patient should take use of special compression stockings which prevent blood clotting. Please
avoid sexual activities for days. Follow normal diet and ensure proper to consume proper sources
of nutrients. Call the doctor or physician when observe over bleeding, pain does not go away,
swelling or pain, cold foot or toes, yellowish release from score, redness around opening, chest
aching, chest blocking, shortness of inhalation. Furthermore, avoid smoking and alcohol use (M
Raphael, 2011).
In the valuation of post-surgical interferences of total knee replacement, we have
organized post-surgical plans with comorbidity interferences of smoking and OSA. Total knee
replacement operation might have mental and physical problems after the operation. Nurses must
take exact functioning intrusions for the development of fast recovery after procedure. Male
sexual category, smoking and liquor ingestion, corpulence and elderly are recognized influences
connected with an advanced occurrence of OSA Exertions for the development of healthier
release planning, adding of pre-emptive numbness, and sickness expectation operation results in
condensed regular extent of stay in hospitals. Furthermore, “smoking, hypertension,
hypercholesterolemia, diabetes” in males increases with the oldness and these are communal in
males who experiences such processes. Mr. Wright should avoid smoking as per the
pathophysiology discussed above in Part B. As per reflection and control, Mr. Wright will be

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capable to walk appropriately after 3 months of operation and will be accomplished to form daily
doings on his own.

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