TOTAL KNEE REPLACEMENT- NURSING MANAGEMENT

DR. RAJESH T EAPENATLAS HOSPITAL

MUSCAT

Q&A

Goals of Joint Replacement Surgery

• Relieve pain!!!

• Restore function, mobility

Evaluation Of Patient Before Surgery

• A Complete Medical History• Thorough Physical Examination• Laboratory Work-up• Anesthesia Assessment

Preoperative Evaluation• Soft tissue defects around the knee.

• Vascular status to the limb.

• Extensor mechanism.

• Preoperative range of motion.

• Standing (AP) view, a lateral view of the knee, and a skyline view of the patella.

• Extreme pain

• Limited range of motion

• Previous surgeries to the knee

• Muscle atrophy

• Locking/catching within knee

• Chronic inflammation

• Deformity

• Unable to kneel down

• Lack of function

• Limiting activities of daily living and/or hobbies

PREEXISTING FACTORS LEADING TO TOTAL KNEE REPLACEMENTS (TKR)

CONTRAINDICATIONS TO TKR

• Infection

• Severe vascular disease

• Neuropathic joint

• Obesity

• Skin diseases

Preparing for Joint Replacement Surgery

• Ease anxiety by mentally preparing with:– Breathing exercises– Meditation– Talking with friends and family

• Learn more about knee replacement surgery:– Brochures– Handouts– Websites– Videos

The Night Before Surgery

• Avoid medications, such as “blood thinners” (aspirin, ibuprofen, etc.).

• Do not consume any food or liquid after midnight.

• Make sure you have everything you’ll need at the hospital.

• Ask any questions you may have before surgery.

Nursing Process: The Care of the Patient Undergoing Orthopedic Surgery—

Assessment, Preoperative• Routine preoperative assessment • Hydration status • Medication history• Possible infection – Ask specifically about colds, dental problems,

urinary tract infections, infections within 2 weeks • Knowledge• Support and coping

Surgical Preparation

• Administer a dose of a 1st generation cephalosporin (or vancomycin, clindamycin)

• Avoid pressure on peripheral nerves.

Pre-op Care

• Educating Patient• Discharge planning• Evaluating patient risks

BEFORE & AFTER SURGERY• Before surgery:

• Begin rehabilitation to build up muscle and stability

• Knowing the exercises before hand will aid in a speedy recovery

• After surgery:

• Adhere to limitations set by doctor

• Attend and stick with rehab!!!

• Gradually begin light, low impact activities to tolerance

• Walking, swimming

• Avoid high impact activities

• Long-distance running, basketball, downhill skiing, impact aerobics

Procedure

Procedure

Procedure

Procedure

Procedure

Procedure

Postoperative Management

Post-op Care

• Monitor VS• Wound assessments• Neurovascular assessments• Monitor wound drainage• Pain relief• Infection/Osteomyelitis prevention• Promote early ambulation• Ensure physiotherapy is consulted

After Surgery

• Movement of knee determined by doctor.• Physical therapy is very important to regain

mobility and strength.

Post Operative Rehabilitation

– Rapid post-operative mobilization

• Range of motion exercises started• CPM• Passive extension by placing pillow under foot• Flexion- by dangling the legs over the side of

bed• Muscle strengthening exercises• Weight bearing is allowed on first post op day

Post-op Nursing InterventionsPost-op Nursing Interventions

• Observe dressing for bleeding/drainage• Ice as ordered• Neurovascular checks• Pain meds as ordered• Active flexion of foot q1h while awake• Observe CAC in wound suction drainage• Continuous passive motion (CPM) device• Early ambulation with knee immobilizer• Physical therapy as ordered

• Observe dressing for bleeding/drainage• Ice as ordered• Neurovascular checks• Pain meds as ordered• Active flexion of foot q1h while awake• Observe CAC in wound suction drainage• Continuous passive motion (CPM) device• Early ambulation with knee immobilizer• Physical therapy as ordered

Collaborative Problems/Potential Complications—Postoperative

• Hypovolemic shock • Atelectasis• Pneumonia• Urinary retention• Infection• Thromboembolism—DVT or PE• Constipation or fecal impaction

Position in bed

• A towel roll should be placed at the ankle to promote knee extension when patients are supine in bed.

• Nothing should be placed behind the operative knee, to promote maximal knee extension and prevent knee flexion contracture.

Nursing ConsiderationsTotal Knee Replacement

• Compression bandage & ice may be applied

•Active ROM of the foot q1h while patient is awake.

•Wound suction drain – 200-400 mL in first 24 hours is considered normal

•Continuous passive motion (CPM) device may be used

•Nurse assists patients in ambulating evening of or day after surgery

•Elevate knee while patient sits

Q&A1. What Activities should I avoid after surgery?

- Activities that require stop-start, twisting, or high impact loading

- Excessive or repetitive bending or squatting

- Heavy lifting

2. Will my new knee replacement set off a metal detector?

- It is unlikely that your implant will set off a a metal detector. However, if it

does, notify the security guard and they will pass a hand-held unit over your

knee to verify.

DOUBTS OF PATIENTS

Hospital Discharge

• You will be released from the hospital as soon as you can:– Get in and out of bed safely. – Walk up to 75 feet with your crutches or walker.– Get up and down flight of stairs.– Access the bathroom.– Demonstrate good muscle contraction of the upper thigh

muscle.• Hospital stay usually lasts 3 to 4 days.• May continue physical therapy at a rehabilitation center

or at home.

Thank You!!!