What is the primary reason for encouraging early mobilization in a patient after total knee replacement surgery?

B) To prevent deep vein thrombosis

C) To reduce surgical site pain

What is the primary reason for encouraging early mobilization in a patient post-total knee replacement surgery?

B) To prevent deep vein thrombosis

A) To increase the range of motion in the knee

B) To prevent deep vein thrombosis

C) To enhance the patient's comfort and pain relief

D) To ensure the surgical site remains clean and dry

What is the primary reason for encouraging the patient to perform deep breathing exercises after surgery?

D) To maintain blood pressure stability

What is the most appropriate initial nursing intervention for a patient experiencing mild orthostatic hypotension during ambulation?

B) Assist the patient to a seated position and check blood pressure

A) Encourage the patient to continue walking to build tolerance

B) Assist the patient to a seated position and check blood pressure

C) Increase the patient's oral fluid intake immediately

D) Administer prescribed anti-hypotensive medication

What is the primary purpose of applying ice packs to the patient's operated knee during the early stages of recovery?

B) To reduce swelling and inflammation

A) To prevent infection at the surgical site

B) To reduce swelling and inflammation

C) To improve circulation to the area

A patient recovering from knee surgery reports mild swelling and warmth in the operated area. Which nursing intervention is most appropriate to address the patient's concern?

D) Apply ice packs intermittently and elevate the leg

A) Apply a heating pad to the knee

B) Encourage increased fluid intake

C) Administer a diuretic medication

D) Apply ice packs intermittently and elevate the leg

What is the primary reason for monitoring C-reactive protein (CRP) levels in a postoperative patient?

C) To detect inflammatory processes

D) To monitor blood sugar levels

Which of the following interventions is most appropriate to manage the patient's mild knee swelling and warmth post-surgery?

C) Encourage high-impact exercises

Which of the following vital signs indicates that the patient is stable and recovering well post-surgery?

A) Blood pressure 122/78 mmHg, heart rate 74 bpm

B) Blood pressure 160/100 mmHg, heart rate 90 bpm

C) Blood pressure 90/60 mmHg, heart rate 110 bpm

D) Blood pressure 140/90 mmHg, heart rate 100 bpm

Which of the following nursing interventions is most important to monitor for signs of infection at the surgical site?

B) Maintain the surgical site clean and dry

A) Assess the patient's vital signs regularly

B) Maintain the surgical site clean and dry

C) Instruct the patient on proper hydration

D) Encourage the patient to perform range of motion exercises

Total Knee Replacement - Nursing Case Study

Pathophysiology

• Primary mechanism: Degeneration of knee joint cartilage due to osteoarthritis leads to bone-on-bone contact, causing pain and reduced mobility. This wear and tear is the most common reason for a Total Knee Replacement (TKR).

• Secondary mechanism: Inflammatory processes further damage joint structures, resulting in swelling, stiffness, and deformity. This inflammation exacerbates cartilage loss and joint dysfunction.

• Key complication: Post-surgical infection can occur, potentially leading to prolonged recovery or revision surgery. Proper aseptic techniques and early detection are crucial to minimize risks.

Patient Profile

Demographics:

65-year-old female, retired school teacher

History:

• Key past medical history: Osteoarthritis of the right knee

• Current medications: Acetaminophen 500 mg as needed, Calcium and Vitamin D supplements

• Allergies: No known drug allergies

Current Presentation:

• Chief complaint: Persistent knee pain affecting daily activities

• Key symptoms: Swelling and stiffness in the right knee, occasional mild pain during movement

• Vital signs: Blood Pressure - 128/78 mmHg, Heart Rate - 72 bpm, Respiratory Rate - 16 breaths/min, Temperature - 98.6°F, Oxygen Saturation - 98% on room air

Section 1

Initial Assessment Findings:

Following her Total Knee Replacement surgery, the patient, a 65-year-old retired school teacher, was transferred to the orthopedic recovery unit for post-operative care. Upon initial assessment, the patient appeared alert and oriented, with no signs of acute distress. Her vital signs were stable, with a blood pressure of 130/82 mmHg, heart rate of 74 bpm, respiratory rate of 18 breaths per minute, and an oxygen saturation of 97% on room air. The surgical site on her right knee was covered with a sterile dressing, which was clean and dry with no visible signs of bleeding or infection.

The patient reported experiencing mild pain at the surgical site, rated as 4 on a 0-10 pain scale. She was administered acetaminophen 500 mg for pain management, as per the post-operative pain protocol. The patient expressed some anxiety about mobilizing post-surgery but was reassured and educated about the importance of early mobilization to prevent complications such as deep vein thrombosis. The nursing staff initiated an individualized care plan, focusing on pain management, monitoring for signs of infection, and encouraging early ambulation with the assistance of a walker.

Her initial lab results post-surgery showed a hemoglobin level of 12.5 g/dL and white blood cell count of 8,000/mm³, both within normal limits, indicating no immediate concerns for anemia or infection. The nursing staff emphasized the importance of deep breathing exercises and ankle pumps to enhance circulation and prevent respiratory complications. These initial findings and interventions set the stage for the patient's recovery process, highlighting the importance of ongoing monitoring and patient education in her post-operative care plan.

Section 2

The following morning, the patient showed promising signs of progressing well in her post-operative recovery. Upon assessment, her vital signs remained stable, with a blood pressure of 128/80 mmHg, heart rate of 76 bpm, respiratory rate of 16 breaths per minute, and oxygen saturation of 98% on room air. She reported a slight decrease in pain, now rated as 3 on the 0-10 pain scale, following regular administration of acetaminophen. The surgical site dressing remained clean and dry, with no signs of discharge or infection. The patient was encouraged by the nursing staff to continue her deep breathing exercises and ankle pumps, and she was reminded of the benefits of these activities in preventing complications such as atelectasis and deep vein thrombosis.

However, during her morning mobility exercise with assistance, the patient experienced slight dizziness upon standing. Her blood pressure was checked and found to be 110/74 mmHg, indicating a possible mild orthostatic hypotension. The nursing team promptly assisted her back to a seated position and encouraged fluid intake to address potential dehydration, which could contribute to this condition. The patient's intake and output were closely monitored, and she was reassured about the importance of gradual position changes to minimize dizziness.

By the afternoon, the patient was able to ambulate a short distance with a walker and assistance, showing improvement in her comfort and confidence with mobility. She was educated on the importance of pacing herself and reporting any new symptoms or concerns. As the day progressed, the patient continued to demonstrate stable vital signs and effective pain management, setting a positive trajectory for her ongoing recovery and rehabilitation. The nursing staff planned to continue monitoring her closely for any changes in status and to provide additional support and education as needed.

Section 3

The following day, during the morning assessment, the patient's condition continued to show favorable signs of recovery. Vital signs remained consistent with the previous day's findings, displaying stability: blood pressure at 126/82 mmHg, heart rate at 78 bpm, respiratory rate at 17 breaths per minute, and oxygen saturation steady at 97% on room air. The nursing staff noted a slight increase in the patient's reported pain level, now at a 4 on the 0-10 scale, likely due to increased mobility exercises. To address this, an additional dose of acetaminophen was administered per the pain management protocol, providing relief within an hour. The surgical site remained clean, dry, and intact with no evidence of infection or unusual discharge.

However, a minor complication arose as the patient expressed concern over mild swelling and warmth in her operated knee, which had not been present the previous day. Upon examination, the nursing staff confirmed the findings and educated the patient on the normalcy of such symptoms in the early stages of recovery. They emphasized the importance of continuing to apply ice packs intermittently and elevating the leg to reduce swelling. The patient was reassured that these measures, combined with ongoing mobility and exercises, would facilitate the reduction of inflammation. The nursing staff also monitored the patient's intake of fluids, ensuring she remained well-hydrated to support healing.

Throughout the day, the patient participated actively in physical therapy, demonstrating increased strength and stability with the use of a walker. Encouragement and positive reinforcement from the nursing team bolstered her confidence, and she was reminded to continue deep breathing exercises and ankle pumps regularly. As the patient adhered to her recovery regimen and reported a slight reduction in swelling by the evening, the nursing staff prepared to initiate the next steps in her rehabilitation plan, focusing on gradually increasing her ambulation distance and independence in activities of daily living. With ongoing support and monitoring, the patient was on a promising path toward a successful recovery.

Section 4

The following morning, the nursing staff conducted another assessment of the patient to evaluate her progress. Vital signs remained stable with a blood pressure of 124/80 mmHg, heart rate at 76 bpm, respiratory rate at 16 breaths per minute, and oxygen saturation at 98% on room air. Pain levels had decreased to a manageable 3 on the 0-10 scale following the administration of scheduled acetaminophen and continued adherence to the mobility regimen. The surgical site remained clean and dry, with no signs of infection. However, the patient still experienced mild swelling and warmth in her knee, though slightly reduced from the previous day.

To further investigate, a routine set of lab tests was conducted, including a complete blood count (CBC) and C-reactive protein (CRP) level, to rule out any underlying inflammatory or infectious processes. The results showed a slightly elevated CRP level, indicating mild inflammation, which was expected given the recent surgery. The white blood cell count remained within normal limits, offering reassurance that infection was not a concern. The nursing team continued to emphasize the importance of ice application, elevation, and hydration to manage these symptoms effectively.

Throughout the day, the patient continued to engage actively in her physical therapy sessions, demonstrating improving mobility and confidence with the walker. The nursing staff provided ongoing support and education, reinforcing the recovery plan and encouraging the patient to report any new or worsening symptoms. As the day progressed, the patient noted further reduction in knee swelling and warmth, suggesting a positive response to the interventions in place. The team planned to focus on gradually increasing her activity levels and enhancing her independence, preparing her for a smooth transition to the next phase of recovery.

Section 5

On the following morning, the nursing staff conducted their routine assessment and noted some positive developments in the patient's recovery process. Vital signs continued to be stable, with her blood pressure at 122/78 mmHg, heart rate at 74 bpm, respiratory rate at 16 breaths per minute, and oxygen saturation at 99% on room air. The patient reported her pain level as a 2 on the 0-10 scale, indicating further improvement and effective pain management with the current medication regimen. The surgical site remained clean and dry, with no signs of infection, and the mild swelling and warmth in her knee had noticeably decreased, a testament to the effectiveness of ice application and elevation practices.

During the morning physical therapy session, the patient showed increased strength and coordination, confidently using her walker to navigate the hospital hallway. Encouraged by her progress, the nursing staff and physical therapist discussed the plan to gradually increase her walking distance and introduce simple exercises to enhance her range of motion and flexibility. These exercises aimed to promote healing, prevent stiffness, and prepare the patient for a more active role in her recovery process.

As the day went on, the patient expressed a growing sense of independence and optimism about her recovery journey. The nursing staff continued to provide education on the importance of maintaining hydration, adhering to her prescribed exercise regimen, and recognizing signs of potential complications. With her discharge planned for the following day, the team focused on equipping the patient with the knowledge and confidence needed to manage her recovery at home, laying the groundwork for a successful transition and ongoing rehabilitation.