1. Total Knee Replacement
Group 3
Barbara Anne Vergara
Edien Negasi
Kossi Kpogo
Mina Chong
Ashley Wells

2. Total Knee Replacement
Pathophysiology:
CAUSE: Arthritis in the knee
“Arthritis” means 'inflammation of the joint.' Wearing away of cartilage in the joint -- is the end result of inflammation within the joint.
Most common type of knee arthritis is osteoarthritis. This is often referred to as "wear-and-tear" arthritis
Results in the wearing away of the normal smooth cartilage until bare bone is exposed. Other types of arthritis include rheumatoid arthritis, gouty arthritis, and lupus arthritis.
Total knee replacement surgery has long been used to treat severe arthritis in elderly patients.
However, concerns arise when a patient in his 40s or 50s has severe knee arthritis that is not relieved with conservative treatments. Once reserved for elderly patients, total knee replacement surgery is becoming more common in the younger, active population.

3. Key Assessments Pain – Rate your pain on scale, 0-10
Paresthesia – Tingling?
Pallor- Capillary refill? Mucous membranes?
Polar – Warm to touch? Clammy?
Paralysis - ROM
Pulses – Palpable?
*LABS: WBC- Infection, drainage?

4. Objective and Subjective Data
“healthy” on no home medications other than NSAID
Objective:
64 Male
S/p RIGHT, Total knee Replacement

5. Nursing Diagnosis
Acute pain r/tTKR, AEB eight inches (20 cm) long incision.
Altered Mobility r/t TKR, AEB use of wheelchair
Risk for Infection r/t incision.
Disturbed Image r/t TKR, AEB, scarring and decreased mobility overall.
Impaired Comfort r/t TKR, AEB grimacing.

6. Outcome/Goal and Outcome Criteria
Client will rate pain on pain scale. Will take and follow strict medication regimen.
Client will do ROM exercises every am for 10 minutes.
Client will inspect hip incision every day for redness, heat, or drainage
Client will demonstrate hip insicion care with mild soap and water and be sure to dry it thoroughly.
Client will be placed on high protein and vitamin C diet
Client will cough and deep breathe.

7. Intervention Assess VS and pain every hour.
Assess client’s needs holistically.
Will assist patient into wheelchair on the day of surgery.
Will teach patient to walk up and down the stairs as needed.
Assess pain, paresthesia, pulse, polar, pallor, and paralysis.
Assess R.O.M.
Assess infection

8. Rationale To promote healing. Prevent Infection
Systematic ongoing assessment and documentation provide direction for treatment plan: adjustments are based on clients response, (Barry 2006.)
Prevent Infection

9. Evaluation
Client will not experience complications such as weak peripheral pulses, tachycardia, and angina.
Client will verbalize importance signs and symptoms to report.
Client will accurately describe recommended dietary restrictions and medication regimens.

10. Sources: http://orthoinfo.aaos.org/menus/arthroplasty.cfm
Nursing Diagnosis Handbook, Ackley, B.