Nursing : A Total Knee Replacement ( Tka ) Is The Most Common Joint Surgery Performed?

* Pre-Op Nurse: The pre-op nurse is the second person in the process to interact with the patient and their family. The pre-op nurse is responsible for all pre-surgical workups for the patient. This includes medical and family related activities. The pre-op nurse communicates with the family the specific expectations for the patient’s surgery and associated timeframes.

Osteoarthritis (OA) is a degenerative joint disease, highly prevalent in African Americans. African Americans men are 3 times more likely then Caucasians men to have involvement of all three compartments of the knee (Jordan, 2015). Total Knee Replacement (TKR) is a cost-effective treatment. Nonetheless, TKR rates are lower in African Americans.

According to Goodman and Fuller (2009) Osteoarthritis is divided into 2 classifications: Primary and secondary. Primary OA is a disorder of unknown cause which in the cascade of joint degeneration it is believed to be a related defect in the articular cartilage. Secondary OA has a known cause, which may be trauma, infection, hemarthrosis, osteonecrosis, or some condition Primary Osteoarthritis (OA) is the most common joint disorder in the world and often affects the knee and hip joints (Rubak, Svendsen, Soballe, & Frost, 2013). For patients with primary hip OA, pain and disability are the most important indications for total hip replacement (THR) (Rubake et al., 2013, p.486) Primary symptoms of OA include joint pain, stiffness, and limitation of movement. Disease progression is usually slow but can

A total hip replacement is when the ball of the hip joint (which is also known as the femoral head) and the socket ( also known as the acetabulum) are removed and replaced with prosthetic part. Most people who have this procedure suffer from either sever hip fracture, they were born with a hip condition, or they suffer from an acute chronic arthritis(Stuart Fischer md,2010). The most common reason for a total hip replacement is a form of arthritis(osteoarthritis). Patient have this surgery to relive chronic pain they are suffering from. Someone who is suffering from a damage or a disease joint will be in constant pain(Stuart Fischer md, 2010).

A patient arrives at the hospital for their knee replacement surgery that has been scheduled for today. The patient is checked in at admitting and is called back to the pre-operative area by the nurse. The patient changes and the nursing staff begin to take the patient’s vital signs, review the patient’s history, draw blood for lab work and they let the patient know what to expect before, during and after surgery. The surgeon arrives and checks in with the patient, asks if they have any final questions before surgery and then leaves for the operating room to prepare. The patient is taken to the operating room, anesthesia is given, and the operation begins. The procedure goes smoothly and the patient is taken to the post-op area. When the patient comes out of the anesthesia, the surgeon

The surgical procedure. A total knee replacement is a surgical procedure where the diseased knee joint is completely replaced by artificial materials that resemble the original knee joint. The orthopedic surgeon removed the end of the femur and the end of the tibia by using metal pieces and sawing the bone, to ensure that he removes the right amount of bone. The end of the femur bone is replaced with metal and the end of the tibia bone is replaced with plastic and metal. A plastic piece was added under the patella because the surface under the patella was damaged as well. These artificial materials, called prosthesis, have smooth surfaces so when they rub against each other, it does not cause damage and is pain-free. The purpose of this surgery is to remove the diseased portions of the joint and replace it with artificial materials to prevent further deterioration and eliminate pain, stiffness, and decreases in function that were caused by the osteoarthritis.

Once the nurse and patient establish a rapport, and the patient is comfortable and willing to proceed with the intervention, preoperative care

As stated earlier, the patient admitting challenge was right total knee replacement related to history of osteoarthritis as evidenced by unrelieved pain. Osteoarthritis (OA) is a disease that “results from cartilage damage that triggers a metabolic response at the level of the chondrocytes” (Lewis, Dirksen, Heitkemper, Barry, Goldsworthy & Goodridge, 2011, p. 1881). As it progress, it causes the cartilage to become “dull, yellow, and granular” instead of being “smooth, white, translucent” (Lewis et al., 2011; Gulanick & Myers, 2014, p. 1881).As a result, it eventually becomes softer, less elastic, and less capable to resist wear during heavy use. Moreover, as the “central cartilage becomes thinner, cartilage and bony growth increases at the joint margins … that results to uneven distribution of stress across the joint” that contributes to a decrease in motion. (Lewis et al., 2011; Gulanick & Myers, 2014, p. 1882). According to this patient, OA has been giving her pain for about two years that lead her to the decision of having the knee replacement.

As a new graduate working on the Medical/Surgical floor the use of a Continuous Passive Motion Machines (CPM) in post total knee arthroplasty (TKA) patients was essential. Seasoned nurses drilled onto graduate nurses that the patient had to wear the CPM for a minimum of eight hours per day. As a new nurse, I did not question the why, nor did I ask if there was data supporting the importance of using CPM machines.

VASNHS Surgical Specialty Outpatient department has a designated pre-operative management unit that oversees the patients undergoing surgery. The predicaments stem from various guidelines or protocol originating from numerous surgeons and clinics. At present, the pre-operative nurses abide simple pre-op instructions (NPO protocol, medications, what to bring, during the surgery, transportation, cancellation instructions) for the entire Surgical Specialty Outpatient department. Surgical procedures are being canceled due to lack of communications and cancelations of patients prior to surgery date.

Ensures safe nursing care for the perioperative patient, including implementation and documentation of safe patient position, adapts care for special needs patients, performs routine nursing procedures including starting an IV and Foley catheterization, and assesses patient condition throughout the perioperative period.

Total knee replacements are known as the most effective orthopedic procedures in the world. These surgeries are most often preformed on geriatric patients. Over time, because the knee is one of the lowest joints in the body, it is typically more prone to wear compared to joints holding less body weight. In the United States, the overall amount of total knee replacements exceeds over four times the overall number of total hip replacements. In the year of 2015, the estimated number of total knee replacements was predicted to be about 719,000 ("Inpatient Surgery." Centers for Disease Control and Prevention). Ordinarily knee replacements are used to ease pain and disability caused by arthritis or other joint problems, while preserving movement.

After referral by their general practitioner, Mark is sent to the preadmission clinic where a pre-admission nurse attends to him. This is where the preadmission nurse carries out a preadmission examination prior to admitting for surgery (Brykczynska and Simons 2011). In the preadmission stage, the nurse is responsible for gathering the patient's clinical history and general physical condition (Crisp,

The most common indication for total knee replacement is osteoarthritis, or degenerative joint disease. The end stage of osteoarthritis is wearing out of cartilage (smooth, gliding bone ends) resulting in bone-to-bone contact in diseased joints. It is progressive and becomes increasingly painful as the cartilage erodes. Younger people who get knee replacements have damaged their joints by trauma (accidents that destroy joint surfaces), infection, cancer or tumor, and inflammatory conditions such as rheumatoid arthritis.

It is a joint disease and commonly the leading cause of pain in older adults. With osteoarthritis, joint cartilage becomes rough and worn. The damaged tissue causes the cells to release an enzyme which contributes to breakdown the cartilage. Inflammation is present in synovium, the lining of the joint. Overtime, the space in the joint becomes narrower. Patient with osteoarthritis experience joint stiffness and pain with weight bearing and movement. As the disease progresses, pain becomes extremely severe (VanMeter & Hubert, 2014 p 175). This the reason why patient had left knee arthroplasty. In left knee arthroplasty, the femoral and tibia component of the knee are replaced with an artificial material called prosthesis to relieve pain and allow a person to restore performance of activities of daily living (LeMone et.al, 2014 p 1356). According to Shmerling (2014), the patient’s risk for developing blood clots increases after surgery. Clots can form inside the blood vessels and this is where it becomes dangerous. Blood clots in the veins will hinder or block the return of blood to the vital organs of the body such as the heart. Due to the patient’s inactivity the flow of her blood becomes sluggish and causes the blood to pool commonly at the lower part of the body such as the leg and could lead to a clot. This is often called as Deep vein thrombosis. There is a tendency, that this clot could travel in the body and lodge in other