Perioperative Nursing Written Paper
New York University College of Nursing
A total knee replacement (TKA) is the most common joint surgery performed in the United States (Turner, 2011, pp. 27-32). Each year, over 650,000 Americans undergo this surgery (Wittig-Wells, 2015, pp. 45-49). It is an invasive surgery that involves an incision on top of the knee and replacing damaged parts of the knee with artificial parts that are either metal, ceramic or plastic. Someone would get a total knee replacement for damage of the joint, osteoarthritic, posttraumatic, or inflammatory arthritis. The cartilage is damaged, wears away and then you develop bony deformity and contracture of ligaments but it starts out with specific defects or wear of cartilage. The top nursing priorities for a total knee arthroplasty is to “prevent complications, promote optimal mobility, alleviate pain, and provide information about diagnosis, prognosis, and treatment needs” (Doenges, 2014, pg. 627). A possible nursing diagnosis from the patient who is undergoing a TKA might be ‘impaired physical mobility related to pain and discomfort as evidenced by reluctance to attempt movement.’ Another one could be ‘acute pain related to chronic joint disease as evidenced by reports of pain’ (Vera, 2014). The preoperative phase begins when the patient is scheduled for surgery. The role of the perioperative nurse is to first determine any risks the patient may
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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.
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
* 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.
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.
Once the nurse and patient establish a rapport, and the patient is comfortable and willing to proceed with the intervention, preoperative care
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.
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.
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).
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.
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.
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.
If nonsurgical treatments like medications and using walking supports are no longer helpful, you may want to consider total knee replacement surgery. Joint replacement surgery is a safe and effective procedure to relieve pain, correct leg deformity, and help you resume normal activities.
The postoperative AKP (Anterior Knee Pain), PFA (Patello-Femoral Arthritis), type of prosthetic design and knee ROM (Range of Motion) could be among the apparent factors affecting the kneeling ability after TKA.
Currently, I am working in Biology department at Dartmouth College, NH, USA on one year postdoctoral leave from QAU from September, 2015. Besides I wanted to get knee pain treatments and after detailed checkups and physiotherapies, doctors here suggested me for the knee replacement surgery in early 2016. Meantime, they figured it out that they have to first do another surgery (some gynecological issue) in emergency to keep my Hemoglobin levels normal (as I had to go for the blood transfusions almost every second month), So they did this surgery on 13th of July (Attached doctor’s letter-1) and rescheduled Knee replacement surgery in November, 2016 (Attached doctor’s letter-2) provided everything goes ok. I am still on bed rest after
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,