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  • Subject Name : Nursing

Total Knee Replacement

Introduction to Effect of Rehabilitation Therapy

According to Choojaturo, Thosingha, & Satayawiwat et al. (2017), a nurse is expected to take complete care of the patient after he/she arrives from the surgical ward. This includes taking care of vital signs like blood pressure, respiratory rate, the functioning of major organs, and many others. The nurse effectively and comprehensively assesses the patient and documents his/her health status as well. Moreover, the nurse also makes sure that the complications that might arise or have already arisen are managed and taken care of. The nurse also educates the patients and the family members as well for long-term delivery of quality care. In this essay, a 72 years old patient named Gerald Jaworski had undergone a total knee replacement surgery. Although, he had well-controlled hypertension he had a history of benign prostatic hypertrophy. He was prescribed with few medications after he returned from the surgical ward and had a urinary catheter as well.

The Preparation for The Patient’s Return to The Ward Postoperatively

The nurses play a major role in the care of the patient and they lie in the frontline of delivering care services to the patients. Their role, responsibilities, and interaction with the patient are of great significance. According to McDonall, Steiger & Reynolds et al. (2016), soon after the patient arrives from the surgical ward, there should be proper arrangements with types of equipment in the room of the patient for assessment and frequent monitoring of his circulatory and cardiovascular health, vital signs, pain, respiratory rate, catheters, level of consciousness, and few others. There should be care providers present all day long for complete surveillance of the aged patient, back and leg care, mouth care, hair, and nail care, bed making, medications should be scheduled and set for administrations on scheduled time. There should be proper arrangement of aids to support the knee of the patient like wheel-chairs, pillows, a walker, ice packs, sleepovers, or blankets. There should be effective communication including verbal or non-verbal modes to get more insight into the body language of the patient. The patient should be asked for feedback to know about the health status of the patient. He should also not be left alone as old patients often suffer from surgical stress post-operatively (Szeverenyi, Kekecs, & Johnson, et al., 2018).

The Considerations for Patient Assessments and Documentation

As 72 years, the old patient has recently returned from the surgical ward with a catheter. Therefore, he should be assessed for pain, vital signs like high blood pressure or hypotension, cognitive, mental, and behavioral functions, catheter infection, fluid-balance, wound site hygiene, and a few others. He will also be assessed for benign prostatic hypertrophy because he had a history of the same. According to Corman, Shah, & Dagenais (2018), the documentation of the patient’s assessments can be made in form of medical records, medical reports, or in form of (SOAP) framework. This is a subjective, objective, assessment, plan framework for documenting the patient’s assessments during nursing care. The patient with hypertension or benign prostatic hypertrophy can suffer from reoccurrence of these issues again after surgery (Timmers, Janssen, & Weegen et al., 2019). According to Liu, Zhang, Guo et al. (2019), with the help of a catheter assessment tool, pain score scales, cognitive assessment tools, blood tests for checking other issues can be conducted. It is often found that soon after surgery, the patient might suffer from vomiting, nausea, depression, severe pain, bleeding, skin texture changes, swellings, and few others. These should also be considered during assessments and should be documented in records as well. The medication administration lists and other written records should be updated and double-checked. 

The Two Complications and Their Management

The two possible complications can be hypertension and severe pain. The patient already had hypertension issues that might increase soon after surgery as well. According to Kruthiventi, Kane, & Sprung et al. (2019), it is often found that 4 to 35 % of the population suffers from hypertension post-surgery; if left untreated then this complication can lead to myocardial ischemia, hemorrhage, heart stroke, cerebral edema, damage to blood vessels and others. Therefore, this needs to be treated by managing the surgical stress or other depression issues of the patient, reducing the salt content of the diet, he should be educated not to take alcohol or smoking, and he should be administered with his medications on scheduled time as well. There should be no skipping of meals or medicines. The patient with hypertension can be administered with potassium-sparing diuretics, ACE inhibitors, or thiazide diuretics (Hussain, Franz & Brown et al., 2016). It should be ensured that the room is silent and the patient gets enough sound sleep. According to Schreiber (2017), the patient might suffer from severe pain with signs like skin texture changes or swelling. These issues can be resolved with help if effective nursing management. The frequency, intensity, duration, and quality of pain should be assessed to determine the composition of the pain relief drug for the patient. The nurse is never supposed to prescribe the drug but she/she performs the assessments and administration of prescribed drugs. The nurse investigates the factors that elevate the pain, provide massages, ice packs, conduct sessions with physiotherapists, and use and encourage acupressure (Buisman, Hasiuk & Gunn et al., 2017). The nurse should frequently conduct pain assessment tests, conduct X-rays, ultrasound, or magnetic resonance imaging (MRI). These help to get more insight about the knee and the factors that might be causing pain, like blood clots, tendon breakage, injuries in cartilage, or other soft tissues. The orthodontists should also be involved in care delivery to ensure the involvement of a multidisciplinary team. Effective communication for brief feedback from the patient and involvement of multidisciplinary team results in the delivery of patient-centered and comprehensive care (Dong, Li, & Liu, 2017). According to Mohamed, Othman, & El Alphy (2017), the blood clot is alp one of the reason for pain after total knee replacement surgeries, so the patent should be provided with blood thinners like fondaparinux, enoxaparin, heparin, and others. The pain can also be removed with the help of exercise, which improves the circulation and resolves the issues of blood clots we as well. The signs of pain include swelling, redness, warmth, or skin texture changes; therefore the patient should also be informed about the same.

Patient Education During and After Discharge

 According to Finnegan, Shaffer & Remington et al. (2017), the patient and their family members should be educated about the medical procedure, the signs that are unexpected like swelling or prolonged severe pain, and the symptoms that depict that improving health like increase rate of physical activity. They should be educated to follow the medical prescriptions like no skipping or meals or medications, no high salt content diet, intake of 8 glasses of water per day, a healthy balanced diet, loose body clothes, help in daily physical activities like bathing, going to washrooms, and others. The patient should be asked not to exert force on the legs and use support aids for walking like a wheelchair, stick, or the help of a family member (Brian, Walters & Howard et al., 2017). There should be frequent self-management and visit doctors for monitoring and evaluation of improving health status. The exercises taught by the physiotherapists should be conducted for better results with no smoking or alcohol intake. The patient should be asked to maintain the safety and hygiene of the wound area and no use of ointments or creams that have not been prescribed by the doctors for the wound site (Price, Alvand & Troelsen et al., 2018). The family should be educated for not leaving the patient too alone as it can lead to depression or feeling of loneliness and they should also ensure that the patient’s knee area does not get any sudden jerks or unbalanced position. 

Conclusion on Effect of Rehabilitation Therapy

A patient who has undergone a total knee replacement surgery requires few preparations in the room like types of equipment for checking of vital signs, monitoring of health status, pillows, or other aids to support the body balance of the patient. There should be assessments for pain, functions of vital organs, cognitive functions, catheter infection, fluid balance, taking care of hygiene, medications, checking the level of consciousness, and a few others. This surgery can lead to a few complications as well like catheter infection, hypertension due to uncontrolled blood pressure or severe pain. Therefore, effective care should be delivered and the patient or his family members should be educated for the medical procedure, signs, and symptoms of the condition. The patient should be asked not to get involved in any bad habits like smoking, alcohol intake, skipping meals, or skipping medications. The patient should be educated for self-management, frequent monitoring of the vitals, or another health status.

References for Effect of Rehabilitation Therapy

Brian, K. T., Walters, T. L., Howard, S. K., Kim, T. E., Memtsoudis, S. G., Sun, E. C., & Mariano, E. R. (2017). A matched case-control comparison of hospital costs and outcomes for knee replacement patients admitted postoperatively to acute care versus rehabilitation. Journal of Anesthesia31(5), 785-788. DOI:10.1007/s00540-017-2372-9

Buisman, M., Hasiuk, M. M., Gunn, M., & Pang, D. S. (2017). The influence of demeanor on scores from two validated feline pain assessment scales during the perioperative period. Veterinary Anaesthesia and Analgesia44(3), 646-655. DOI: 10.1016/j.vaa.2016.09.001

Choojaturo, S., Thosingha, O., Satayawiwat, W., & Turajane, T. (2017). The effects of guided imagery on post-operative pain and state anxiety in total knee arthroplasty patients. Medical Journal61(6), 314-317. Retrieved from: https://www.semanticscholar.org/paper/The-Effects-of-Guided-Imagery-on-Postoperative-Pain-Choojaturo-Thosingha/ceda7151bf425bf84c01bc6216b598314d7ee34c#citing-papers

Corman, S., Shah, N., & Dagenais, S. (2018). Medication, equipment, and supply costs for common interventions providing extended post-surgical analgesia following total knee arthroplasty in hospitals. Journal of Medical Economics21(1), 11-18. DOI:10.1080/13696998.2017.1371031

Dong, F., Li, M., & Liu, J. (2017). Effect of department of orthopedics rehabilitation integrated mode on knee joint pain, function and quality of life in total knee arthroplasty. Biomedical Research, 28(21). Retrieved from: https://www.biomedres.info/biomedical-research/effect-of-department-of-orthopedics-rehabilitation-integrated-mode-on-knee-joint-pain-function-and-quality-of-life-in-total-knee-a-9300.html

Finnegan, M. A., Shaffer, R., Remington, A., Kwong, J., Curtin, C., & Hernandez-Boussard, T. (2017). Emergency department visits following elective total hip and knee replacement surgery: Identifying gaps in continuity of care. Journal of Bone and Jornal of Surgery99(12), 1005-1012. DOI: 10.2106/JBJS.16.00692

Hussain, T., Franz, W., Brown, E., Kan, A., Okoye, M., Dietz, K., & Anderson, C. A. (2016). The role of care management as a population health intervention to address disparities and control hypertension: A quasi-experimental observational study. Ethnicity & Disease26(3), 285.DOI:10.18865%2Fed.26.3.285

Kruthiventi, S. C., Kane, G. C., Sprung, J., Weingarten, T. N., & Warner, M. E. (2019). Postoperative pulmonary complications in contemporary cohort of patients with pulmonary hypertension.  Journal of Basic Medical Sciences19(4), 392. DOI:10.17305%2Fbjbms.2019.4332

Liu, X., Zhang, P., Guo, C., Xu, J., & Hu, M. (2019). Effect of rehabilitation therapy and nursing intervention on postoperative recovery of patients with hypertensive intracerebral hemorrhage. Experimental and Therapeutic Medicine17(6), 4598-4604. DOI:10.3892/etm.2019.7486

McDonall, J., de Steiger, R., Reynolds, J., Redley, B., Livingston, P., & Botti, M. (2016). Patient participation in postoperative care activities in patients undergoing total knee replacement surgery: Multimedia intervention for managing patient experience (MIME). Study protocol for a cluster randomised crossover trial. BMC Musculoskeletal Disorders17(1), 294. DOI:10.1186/s12891-016-1133-5

Mohamed, A., Othman, W., El Alphy, B., & Sheble, A. (2017). Effect of implementing nursing care guidelines on the occurrence of deep vein thrombosis among orthopedic patients. IOSR Journal of Nursing and Health Science6(3), 28. DOI:10.9790/1959-0603012836

Price, A. J., Alvand, A., Troelsen, A., Katz, J. N., Hooper, G., Gray, A., & Beard, D. (2018). Knee replacement. The Lancet392(10158), 1672-1682.DOI:10.1016/S0140-6736

Schreiber, M. L. (2017). Lower limb amputation: Postoperative nursing care and considerations. Medsurg Nursing26(4), 274. Retrieved from: https://search.proquest.com/openview/a6b3568c1f8884885afd8daf86d918b9/1?pq-origsite=gscholar&cbl=30764

Szeverenyi, C., Kekecs, Z., Johnson, A., Elkins, G., Csernatony, Z., & Varga, K. (2018). The use of adjunct psychosocial interventions can decrease postoperative pain and improve the quality of clinical care in orthopedic surgery: A systematic review and meta-analysis of randomized controlled trials. The Journal of Pain19(11), 1231-1252. DOI: 10.1016/j.jpain.2018.05.006

Timmers, T., Janssen, L., Van der Weegen, W., Das, D., Marijnissen, W. J., Hannink, G., & Kool, R. B. (2019). The effect of an app for day-to-day postoperative care education on patients with total knee replacement: Randomized controlled trial. JMIR mHealth and uHealth7(10), e15323. DOI:10.2196/15323

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