Post Knee Replacement Case Studies

This episode of care occurred in a community setting. Sara has a diagnosis of Alzheimer's disease. She live alone, has no children and is a diabetic. Sara does not speak English and her first language is Polish. Sara support worker developed a close relationship with Sara but said recently her dementia as gotten wrong and she sometimes does not remember who she is. Sara has cellulitis on her legs and was refusing to let the support worker change her dressing. She kept saying it was ok and she didn't want it to be changed. The student nurse and the district nurse tried reassuring Sara and explaining why it was importance to treat her leg but she just became more agitated and aggressive. The district nurse and support worker knew it was important

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

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).

During my clinical rotation during my last semester of nursing school, I was able to work one on one with a BSN degree nurse named Judy in the ICU. Judy had three years of experience in the ICU setting. She had been a medical surgical nurse prior to her ICU transfer. The ICU at this hospital consisted of two associate degree level nurses and two BSN level nurses on my shift. I rotated three days in this particular ICU. I worked with Judy all three days of my rotation. I was excited about being placed with her for she seemed knowledgeable and skilled. We were given a male post trauma patient to work with all three days. This patient was a 30 year old male admitted for trauma related injuries and was considered unstable and was to be monitored in ICU. This patient had been involved in a motor vehicle accident and

Recovering from a serious knee injury and returning to pre-injury levels can be a difficult task to overcome, but it has been proven possible to do this. Improper injury protocols and the injuries themselves are two of the largest factors in professional athletes not having elongated and successful careers. ACL, MCL, PCL, LCL, and Patellar Tendonitis are the most common knee injuries in which athletes sustain. Sustaining a knee injury at the highest and most competitive levels of basketball can make the injury and recovery process much more difficult and stressful, however. Depending on the injury, it can take a very extended amount of time for the knee to return back to its normal functioning, especially since damaging one part of the knee does not come without other injuries. A permanent and career ending injury may be the result if the proper percussions are not taken throughout the recovery process.

During my clinical competency placement, I was working on a surgical ward when a registered nurse on duty asked me to assist Mr. A with his shower. This incident happened on the fifth day of my clinical practice. He was a dementia patient and had undergone right knee total joint replacement. She also informed me that the patient did not like too many people in his room because of his dementia. When I went into his room, his wife was there with him. I talked to the patient about having a shower and getting dressed to look smart and he agreed to have a shower. The patient got out of the bed and walked to the bathroom and sat on the shower chair to have his shower. Then I asked his wife if I needs to stay with him to assist with shower, she said she can help him as she was taking care for him at home since he has been diagnosed with dementia. Therefore, I left the patient with his wife to help with his shower and told her to ring the bell if she needs any help. After some time I left the room, the wife rang the bell. As soon as I entered the room, I heard him shouting at his wife and she started crying and left the hospital. So I had to stay with him. He was very capable of washing himself and I just had to help him wash his back as he requested. After he had washed, I asked him if he was ready to get out of the bath, he started shouting at me.

Oliver et al. (2014), exemplifies how some physicians may not be aware of their implicit bias that could be causing healthcare disparities. This study determines whether physicians’ implicit racial views of African Americans affect their decision making, regarding total knee replacement (TKR) as a treatment option for OA. They also assessed whether not, if the Racial Implicit Association test would impact TKR recommendations. In the study implicit bias was determined by the racial implicit association test (IAT) and explicit bias was tested using a questionnaire that asked physicians which race they preferred (black or white) using a 5-point Likert scale and 10-point thermometer scaled to grade physician’s feelings.

.) SP is an 84-year-old widow recently admitted to an orthopedic ward for a total hip replacement from the anterior approach. She is widowed, but has two adult children living nearby. SP has a familial history of cancer and heart disease, and she herself has experienced several different medical issues. When discussing cares, procedure options, and having general conversations with SP the health care team needs to be especially aware of her hardness of hearing, and need to use hearing aides. A communication barrier exists between the patient and the care team. This barrier exists because of both her hearing issues and her advancing age. Safety risks from improper communication related to these barriers can greatly increase her chances of experiencing undue harm from her hospitalization. An example of how this could occur would be improper communication of what hip needs to be operated on. At all times, the health

Case Study: An older woman was partially paralysed as she had a stroke. Her carers came into her home two times a day, her husband cared for her the rest of the day. Her husband became increasingly aggressive behaviour. One day at night, she asked him to help her to the toilet, he pushed her and she fell on the floor and hitting and slapping in her face. one day she called Social Services, they saw bruise on his face, injury in his knee and he was depressed. Social services also noticed that she could not move properly and due to her back pain and lot of unexplained marks. She is seeking help and was crying. Social service sent her to GP for treatment.

I was always an active person from being in sports to hanging out with friends. I always had something planned, or came up with something on the fly. My junior year in high school was a very tough time for me. I was involved in a lot of activities, organizations, and clubs. I was very active in one organization where I had to be up at school every morning at 7:15 for that meeting. Meaning I would not leave school sometimes until 6:45 to 7:00 in the evening. On the weekends I would have something to do either with friends or family. I would never go a weekend with nothing to do. Either I was out running errands or at the mall buying some new clothes.

During the home health observation day, there were several opportunities to observe a variety of patients with varying levels of functioning ability, different illnesses, and different needs and levels of interaction with the nurse. The first patient seen was a seventy-three year old Caucasian female with an ulcer on her right heel. Several weeks prior, she had scratched her left leg and she also had several small wounds on her left leg. The orders were to clean and redress the ulcer. She has a history of end stage renal disease, pneumonia, weakness, diabetes, dialysis, and right hip fracture. Upon entering the home, the patient was found to be sitting in a wheel chair in the living room watching television with her husband close by her side. She greeted the nurse with a smile and began to update her on her current condition. Her heel was “hurting” and she rated her pain an 8 on a scale of 1 to 10. She also had some “swelling” that she could not “get to go away; because, she could not get up and walk. They need to fix my foot so that I can get up and get around.” She told the nurse that she had been to see the doctor “yesterday” and the doctor had given her a written order that she wanted her to see. The order was written for an evaluation for a soft pressure shoe fitting. The nurse read the order to

People undergo total knee replacement when arthritis or injury erodes the joint's natural cushioning to the point where it's hard to walk even short distances without severe pain.

Teaching the importance of activity and exercise has a huge significance to the patient especially she undergone surgery, left knee arthroplasty. Lack of adequate knee exercise after surgery will lead to various complications that are dangerous and life threatening such as deep vein thrombosis, stroke and pulmonary embolism. Another complication that is associated with inadequate movement of the limbs and extremities is muscle contracture (LeMone et.al, 2011 p 142). Patient has a high risk of developing these complications. We wanted to educate the patient about these so that we could lower her risk at some point. We believe that even when patient is lying down on the bed, she can do a lot of things to improved her health and prevent

During my clinical experience, I encountered an unforgettable situation which holds significance to me as a nursing student. My patient had an intracerebral hemorrhage, subarachnoid hemorrhage, as well as dementia. As a result of her conditions, she was a two- person assist. While researching my patient’s health conditions the night before clinical, I became concerned about how I was going to take care of my patient due to the anticipated immobility. When I first met my patient, I began to feel apprehensive because I realized that it was a patient who I had seen on the unit two weeks ago. This patient was groaning and crying at night, disturbing other patients who were trying to sleep. Due to her restlessness, the nurses moved the patient to the nursing station every night and then moved her back into her room in the morning. Looking at

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