Nursing Care Plan for Total Knee Replacement: A Case Study

This academic essay examines the case of Frank Wright, who underwent a right total knee replacement. The essay is divided into three parts: post-surgical plans, the impact of comorbidities and general anesthesia, and the discharge plan. The post-surgical plan focuses on immediate care, monitoring vital signs, and pre-operative evaluations. The impact of comorbidities, such as smoking and hypertension, and anesthesia are discussed. The discharge plan covers outpatient physical therapy, home exercises, wound care, and activity limitations. The essay emphasizes the importance of following medical guidance for a successful recovery and preventing future complications. The conclusion stresses the need for adherence to post-operative instructions to ensure optimal outcomes for the patient.

Running Head: NURSING 0
TOTAL KNEE REPLACEMENT
AUSTRALIA
[DATE]
[Company name]
[Company address]

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Introduction
In this academic essay, the case scenario of Frank Wright will be taken into consideration
who had undergone surgery for total replacing of the right knee. The entire procedure covered
under this provision of this undergone surgery will be noted down basically under three heads.
Where the first head will postsurgical plans made for Frank. The second part will include the
impact of comorbidities and general anesthesia. The third part will cover up the entire
discharging plan made for Frank. Finally, there will be a concluding statement determining all
the recommendations or the suggestions given to Frank. Before proceeding further it is important
to understand the meaning of total knee replacement. It is defined as a surgical procedure where
the artificial material replaces the diseased knee joint. The joint of the knee is the one that
connects the thigh with the lower leg.
Source: (Hospita, 2018).
Part 1 Post-surgical plan
The surgery of the total knee replacement upon being successfully helped Frank to
increase his mobility and reduce the pain in and around the diseased knee. But to get the relief it
is very important to be very careful after completion of the surgery. Around one and a half to

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three hours is required for undergoing this operation. Then Frank was taken to the recovery
room. First 24 hours are very curtailed, where generally all the vital organs are to be monitored
and after recovering the stability in them, they are been taken to the rooms in the hospital by the
nurses and taken proper care off (Sun, Darnall, Baker, & Mackey, 2016).
Pre-operative period
Only those patients whose knee joints have been damaged either by progressive arthritics
or trauma or any other destructive disease in the joint and that results in intolerable pains and
decreases the daily functioning power of the patients. So deciding on undergoing surgery is not
an easy task. Before reaching any decision the patients must understand all the risks as well as
the benefits of undergoing knee replacement operations (William & Shiel, 2019). Before the
surgery, the joints along with the hip and the ankle are to be evaluated carefully, which is very
important to confirm the best outcome and retrieval after the completion of the surgery
(Ljungqvist, Scott, & Fearon, 2017).
Source: (Shiel Jr. & Wheeler, 2018)
Replacing a joint of the damaged knee may bring several pain if it is not done properly or
abnormally.24 hours before the conduction of the operation all the medicines that the patient is

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taking must be gone through properly and all the medicines which result in thinning the blood or
other anti-inflammatory pills must be discontinued prior to the surgery. All the routine tests in
regards with the functioning of the liver, kidney, and urine must be properly evaluated so that
anesthesia may be precluded for avoiding any upcoming signs of anemia or any other infection
in the significance of the heart or the lung disease (Goodman, et al., 2017). Measuring the weight
of the patient is very important, it must not exceed 200 pounds as the more weight may increase
the risk of recovery or dislocation or loosening after the surgery. The three potential clinic issues
may include the Clots of blood in the legs which may further travel up to the lungs, shortness in
breathes due to pulmonary embolism i.e. blood clots. Pain in the chest, symptoms of shock and
infections in the urine, etc. are some of the involved risks while undergoing the surgery of total
knee replacements.
Appropriate interventions must be provided which may be of nursing or collaborative.
Nursing means the proper care given to the patient and prevents him from all the incontinent
activities like smoking so to prevent the risk in the future after the success of the operation.
These priories intervention may prevent all the physical and psychological aspects of health care.
This scheme can help Frank in reducing the future risk of undergoing the operation of total knee
replacement ever again (Chou, et al., 2016).
Part B Impact of comorbidities and general anesthesia
For Frank, who has undergone surgery in a very recent period, smoking will highly ally
with the Risk of increased infectious complications which may further lead to the requirements
for repeat surgery (Daily, 2017). According to a literature, review hypertension is considered as
that means which tends to reduce blood loss and transfusions. Whereas the transfusions become
the major cause of the mobility for the patient and also the major source of expense. While the

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increased blood pressure within 24 hours of post-operation may give rise to increased blood loss
(Russo, Dasa, Duarte, & Beakley, 2012).
A study suggests that Frank may undergo with the merged risks of stains with a
standardized blood clot. The preventive theories may further fall in risk relating to venous
thromboembolic events all these are the major impacts of raised cholesterol immediately within
24 hours of the operation (Harrison, 2019). Obstructive sleep apnea (OSA) can have a very
diverse impact on Frank, it may lead to cardiovascular complications and sometimes even to
death. Recoveries can reach up to the negative level (Lyons, Bhatt, Keenan, & Pechar, 2016).
Hence it can be noted that if all these comorbidities are not taken proper care off then it may be
very risky for Frank and he may have to bear of ultimate cost for these mistakes.
Discharge Plan
After the total knee replacement surgery, for the better result, it is important for Frank to
a therapy which is called outpatient physical therapy program along with other home exercises
during the process of his healing. After giving due care for few days Frank was discharged and
was asked to continue exercising to prevent scarring and contracture and also for maintaining the
strength and stability of the joint. Proper exercise will reduce the time of recovery and provide
the required strength and stability (Inneh, Clair, Slover, & Iorio, 2016). The surgeon or any
appointed nurse will monitor the wound. And also examine whether there are any infectious
signs or any readiness of abnormality or swelling or any unusual pain. Any symptom recovered
at home is also needed to be reported to the doctor immediately.
Frank was suggested to limit those activities which were generating the risk of knee
replacement such as running sports. Swimming is considered as the best form of exercise as it
strengthens and enhances the muscles and doesn't even exert any pressure or stress on the n

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replaced joint. The physician who was treating Frank is required to prescribe all the antibiotics
before, during and immediately after the holdup of the procedure so to prevent any further risk of
infections, etc. (Keswani, et al., 2016)
Upon committing any infrequency in the replacing procedure or the prescribed exercises
then Frank may have to undergo a second operation even after years this becomes important so
to reduce the complicacies of joint loosening or fractures. Generally, the reoperations cannot be
considered as much success as that of the original ones as they may have many risks and
complicity factors (London, et al., 2016).
Conclusion
Precautions suggested by the doctors at the time of discharging to Frank are not to soak
knee in water unless asked by the doctor to do so i.e. no bathtubs or no swimming pools. Support
stockings must be worn which are provided by the hospitals and must be used in a way
prescribed by the doctors. All the items of the home which may cause a fall must be removed off.
Till the time of full recovery use cane, walker, crutches or someone for help for walking, etc.
Hence to conclude it can be said that the total replacement of knee is a very curtail
surgery undergone by Frank, so now onwards he needs to follow all the guidance provided by
the doctors very carefully and precisely for avoiding any risk in the coming future.

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References
Chou, R., Gordon, B. D., de Leon-Casasola, O. A., Rosenberg, J. M., Bickler, S., & Brennan, T.
(2016). Management of Postoperative Pain: a clinical practice guideline from the
American pain society, the American Society of Regional Anesthesia and Pain Medicine,
and the American Society of Anesthesiologists' Committee on regional anesthesia,
executive commit. The Journal of Pain, 17(2), 131-157.
Daily, S. (2017, February 16). After joint replacement surgery, smokers at increased risk of
reoperation for infection. Retrieved from Wolters Kluwer Health:
https://www.sciencedaily.com/releases/2017/02/170216103943.htm
Goodman, S. M., Springer, B., Guyatt, G., Abdel, M. P., Dasa, V., & George, M. (2017).
American College of Rheumatology/American Association of Hip and Knee Surgeons
Guidelines for the perioperative management of antirheumatic medication in patients
with rheumatic diseases undergoing elective total hip or total knee arthroplasty. The
Journal of arthroplasty, 32(9), 2628-2638.
Harrison, L. (2019, August 24). Statins May Lower Clot Risk After Joint Replacement. Retrieved
from Medscape: https://www.medscape.com/viewarticle/821863
Hospita, S. (2018). Joint Replacement Department. Retrieved from Movement is life, life is
Movement: https://www.sanchetihospital.org/joint-replacement-department/?
gclid=CjwKCAjwnf7qBRAtEiwAseBO_PNmRgzZPuhTsFO8nrAHET2kY5sKoDaAxj5t
dTNuvcrLsGH_uIC7VBoCrwwQAvD_BwE
Inneh, I. A., Clair, A. J., Slover, J. D., & Iorio, R. (2016). Disparities in discharge destination
after lower extremity joint arthroplasty: analysis of 7924 patients in an urban setting. The
Journal of arthroplasty, 31(12), 2700-2704.

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Keswani, A., Tasi, M. C., Fields, A., Lovy, A. J., Moucha, C. S., & Bozic, K. J. (2016).
Discharge destination after total joint arthroplasty: an analysis of postdischarge
outcomes, placement risk factors, and recent trends. The Journal of arthroplasty, 31(6),
1155-1162.
Ljungqvist, O., Scott, M., & Fearon, K. C. (2017). Enhanced recovery after surgery: a review.
JAMA surgery, 152(3), 292-298.
London, D. A., Vilensky, S., O'Rourke, C., Schill, M., Woicehovich, L., & Froimson, M. I.
(2016). Discharge disposition after joint replacement and the potential for cost savings:
effect of hospital policies and surgeons. The Journal of arthroplasty, 31(4), 743-748.
Lyons, M. M., Bhatt, N. Y., Keenan, B. T., & Pechar, J. (2016, February 29). Sleep apnea in
total joint arthroplasty patients and the role for cardiac biomarkers for risk
stratification: an exploration of feasibility. Retrieved from Biomarks in Medicines:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5493965/
Russo, R. R., Dasa, V., Duarte, R., & Beakley, B. (2012, December 26). Post-operative
hypertension after total knee arthroplasty and the effects on transfusion rates. Retrieved
from U.S. National Library of Medicine:
https://www.ncbi.nlm.nih.gov/pubmed/23300531
Shiel Jr., W. C., & Wheeler, T. (2018, September 11). Total Knee Replacement. Retrieved from
Medicinenet: https://www.medicinenet.com/pain_management_knee_pain/article.htm
Sun, E. C., Darnall, B. D., Baker, L. C., & Mackey, S. (2016). Incidence of and risk factors for
chronic opioid use among opioid-naive patients in the postoperative period. JAMA
internal medicine, 176(9), 1286-1293.

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William , C., & Shiel, J. (2019). Total Knee Replacement. Retrieved from MedicineNet:
https://www.medicinenet.com/total_knee_replacement/article.htm#total_knee_replaceme
nt_facts