TKR- My Present

8/8/2019 TKR- My Present

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Total Knee ReplacementTotal Knee Replacement

Done by:Done by:

Sajeda MohadSajeda Mohad


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ObjectivesObjectives

Discuss Background of My patient.Discuss Background of My patient.

Discuss the chief complains, history of present illness, past history, riskDiscuss the chief complains, history of present illness, past history, risk

factors and social history of my patient.factors and social history of my patient.

Explain the physical assessment which include V/S, physical examination,Explain the physical assessment which include V/S, physical examination,

and diagnostic studies.and diagnostic studies.

Define Congestive Cardiac Failure and it incidence in Bahrain andDefine Congestive Cardiac Failure and it incidence in Bahrain and

worldwide.worldwide.

Explain the medical, surgical, and nursing management for my patient.Explain the medical, surgical, and nursing management for my patient.

Plan health education to my patient.Plan health education to my patient.

SummarySummary


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Background of My patientBackground of My patient

Mr. A.A 55 years old Bahraini female. She is widow with children

.presented to the emergency with complain of left knee pain for 6

month and radiated to her toes, especially during walking and lifting

heavy things. Patient cannot describe the nature of pain, associated

with limitation of movement. Patient also was complaining of right

knee pain but less severe than left knee.

She admitted to Salmaniya Medical Complex on 26/4/2010 with

known case of diabetes mellitus (DM), hypertension (HTN), reactive

airway disease (bronchial asthma), dyslipidemia, coronary heart

disease (CAD), and peptic ulcer disease (PUD).


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Case DescriptionCase Description

1. chief complains : LF Knee pain X6 month.

2. history of present illness PQRS:

- Pain walking & long standing (activities).

- Pain sitting position.

- Gradual pain start before 6 months (moderate) and rich peak

(sever)before one week ago.

- Pain scale: 8.

- Pain concentrated on middle of left knee and radiate to toes.


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3. past history & social history :3. past history & social history :--

- Father and mother known case of DM and HTN.

- She is known case of : DM,HTN,CAD, asthma,

dyslipidemia, and PUD. Unknown allergy.

- underwent Percutanueous transluminal coronary

angioplasty (PTCA) on February 2006 in BDF

medical hospital.

- widow and has 7 children, social person and love

meeting others.


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44. Risk factors:. Risk factors:--

estrogen cartilage erosion

Water & Sodium retention Vit.D

absorption Calcium deposit on thebone .

Hypertension& CAD

Age(55)


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carrying more body weight placesmore stress on weight-bearing

joints

44. Risk factors Con. Risk factors Con

Hormoneimbalances


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physical assessmentphysical assessment

V/S:

Blood pressure: 121/79 mmHg

Temperature: 37 C.

Pulse Rate: 65 beat per minute.

Respiratory Rate: 18 breaths per minute.

Body weight: 75.3 kg.

Height: 153.5 cm.


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Physical examination:Physical examination:

General appearance:

Conscious, alert, oriented, pale, and little

cyanosed.

system that being examined:

Musculoskeletal, Respiratory, Cardiovascularsystem.


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Systems Abnormal findings Reasons

Musculoskeletal Restriction of movementof joints, discomfort, and

swelling.

Because of erosion ofbone end (osteoarthritis).

Respiratory system Patient feel difficultytaking deep breath

Because she is a knowncase of asthma.

Cardiovascular system No abnormal Finding.


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Diagnostic studies:Diagnostic studies:

Test name Reasons for this studies

Heparinised blood

: U+E+CR

- Low, not cause for concern, and may lead to aging

which cause low muscle mass.

Serum: Calcium +Phosphorous

- Normal

Full Blood Count - High WBC inflammation.

- High RBC renal problem of dehydration.

- Low MCV iron deficiency or by bone disease.

- Low cell HB, and high Red Cell Size Distribution

normal after surgery bc. Loss of blood.


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-NormalPlasma: PT+APTT

- High, bc. Increasing in WBC will

elevate blood sugar level.

Fasting blood sugar (FBS)

ContCont


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Radiographic:Radiographic:

1- Electrocardiogram (ECG):to measures andrecords the electrical activity of the heart.

Results: normal P and T waves.

2- Magnetic resonance imaging (MRI):Showsearlier and more quantitative detection of articular cartilagechanges

Results: were bone end rube together because of cartilageerosion.


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3- Chest X-ray:to evaluate organs and structureswithin the chest.

Results: Normal heart size & shape .No evidence ofcongestive cardiac failure. Lungs are clear.

4- X-ray both knees wt bearing:

Results: Knee joint are noted bilaterally as well as atthe patella- femoral joints, worse on the left side,anderosion of bone end.


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Total Knee ReplacementTotal Knee Replacement

Definition:Definition:

A total knee replacement involves cutting away thedamaged bone of the knee joint and replacing itwith prosthesis. This new joint prevents the bones

from rubbing together and provides a smooth kneejoint. Knee replacement surgery is performed totreat advanced or end-stage arthritis.


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OsteoarthritisOsteoarthritis

The cartilage that cushions the bones of the kneeThe cartilage that cushions the bones of the kneesoftens and wears away. The bones then rub againstsoftens and wears away. The bones then rub againstone another, causing knee pain and stiffness.one another, causing knee pain and stiffness.


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Incidence of Osteoarthritis and TKR :Incidence of Osteoarthritis and TKR :--

common in older age.common in older age. In younger people, bc. joint injury, a joint malformation, or aIn younger people, bc. joint injury, a joint malformation, or a

genetic defect in joint cartilage.genetic defect in joint cartilage.

before agebefore age 4545 male more than female.male more than female.

AgeAge 4545 yrs and above female more than male.yrs and above female more than male. 9090% of those people which having Osteoarthritis undergo total% of those people which having Osteoarthritis undergo total

knee replacement.knee replacement.

Name Disease

(Condition)

200

7

Incidence in

Bahrain

Incidence in

Worldwide

Orthopedic Surgery &

Fracture

62 2.455 203 per 100,000


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Collaborative management:

1- Medical management:

Light- dressing and elevated leg with billow :

To maintain circulation especially on the lowerextremities and easy to check wound site hourly.

IV.F 100 ml /NS /24 hours: On first 24 hrs post- operatively to administer necessary

medications.

Cardiac Diet:

provides controlled amounts of sodium, cholesterol,saturated and total fat.

Medications: Rocephin, naproxen, metformin,perindopril, aspirin, simvastatin, Omeprazole, and foradil.

pethidine and phenergan PRN


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2- Surgical management :Total kneeReplacement

How it performed?

1- Teaching exercises

2- Damaged tibial bone

surface removed


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3- Damaged patellar bone

surface removed4- Femoral Implant


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3- Nursing management:

Actual and Potential nursing diagnosis:

1. Pain related to operation wound.

Asses the pain level by interview the patient & the pain scale to plan next

nursing intervention.

Teach patient the breathing exercise to reduce the pain.

Elevate the left leg with pillow to help in venous return & reduce the swelling

& pain.

Apply ice pack to the pain & swelling area according doctors order to reduce

the pain & swelling.

Give analgesic such as naproxen according doctors order to reduce the pain

Tell doctor if the pain still persist after the analgesic to prevent any

complication.


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Health education:Health education:

have enough rest.have enough rest.

avoid salty and fatty foods.avoid salty and fatty foods. continue prescribed medicationscontinue prescribed medications

observe for any alterations on condition.observe for any alterations on condition.

importance of maintenance of hygiene.importance of maintenance of hygiene.

perform leg exercise as tolerated such as walking toperform leg exercise as tolerated such as walking tofacilitate mobilization on lower extremities.facilitate mobilization on lower extremities.

come back for followcome back for follow--up checkup check--up as scheduled forup as scheduled for

her.her.


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Some Exercises strength the kneemuscle


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SummarySummary


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Thanks For your listeningThanks For your listening

Any Questions ???Any Questions ???

Documents

TKR- My Present