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Bilateral Total Knee Replacement Concept Map

By: Sacorra Luckett

Medical Diagnosis

Bilateral Total Knee Antrhoplasty

Medical Diagnosis

Pathophysiology

Pathophysiology

This surgery is needed when the knee joint has been damaged from rheumatoid arthritis, trauma, or other conditions and the patient begins to lack mobility and has pain at rest. During the surgery, damaged cartilage and bone from the knee joint is removed and resurfaced. That area is then replaced with metal and plastic to be used as a shock absorber (Varacallo et al., 2020).

  • Patient has pain of 6/10 that is radiating through knees at rest and with movement.
  • Patient has trouble with moving when when walking for short periods of time.
  • Patient is able to sit upright independently.
  • Patient needs assistance and a walker to ambulate.

Subjective information

  • Blood pressure: 109/58
  • MAP: 72 mmHg
  • Heart rate: 87 bpm (Regular)
  • Respirations: 16 breaths per minute (Regular)
  • SpO2: 96% RA
  • Temperature: 37.2 C
  • Weight: 113.4 kg
  • Height: 198 cm
  • BMI: 28.93
  • Patient's lower extremity muscle strength is 2+.

Objective information

Nursing diagnosis: Impaired physical mobility related to musculoskeletal impairment as evidenced by a muscle strength of 2+ with the lower extremities (Doenges et al., 2010).

Nursing Diagnosis #1

Interventions

  • The nurse will promote patient ambulation 3 times a day.
  • The nurse will encourage the patient to participate in PT once a day.
  • The nurse will provide rest periods to the patient twice a day for an hour.

(National Association of Orthopaedic Nurses, 2018)

Evaluating Interventions

  • Patient will be able to walk down the corridor by discharge with assistance.
  • Patient will participate in PT once a day and show increased muscle strength.
  • The patient will express less feelings of tiredness when ambulating.

Goals

  • Long term: Patient will be able to ambulate without feelings of weakness 4 months post-operation.
  • Evaluation in process.
  • Short term: Patient will be able to walk down hospital corridor by discharge.
  • Goal was partially met. Patient was able to ambulate hallway down the hospital corridor.
  • Short term: Patient will not fall while admitted in the hospital.
  • Goal was met as patient did not fall during hospital stay.

Nursing diagnosis: Low self-esteem related to body image as evidenced by negative thoughts about altered structures of body (Doenges et al., 2010).

Nursing Diagnosis #2

Interventions

  • The nurse will educate the patient about the harmfulness of negative self-image.
  • The nurse will provide the patient with privacy when talking to the patient.
  • The nurse will educate the patient about skin care to promote adequate healing.

(National Association of Orthopaedic Nurses, 2018)

  • Patient will be able to tell the nurse 3 ways a negative self-image can be detrimental.
  • The patient will express that they feel as though their privacy is maintained in the hospital environment during their stay.
  • The patient will be able to demonstrate how to care for skin to the nurse.

Evaluating

Interventions

  • Long term goal: The patient will show minimal scaring from the incision site 1 year post-operation.
  • Evaluation in process.
  • Short-term goal: Patient will not show signs of depression about their current condition by discharge.
  • This goal was met as patient was content about their surgery and displayed no negative thoughts about current condition.
  • Short-term goal: The patient will had no redness, swelling, discharge, or signs of infection at incision sites.
  • The goal was met as patient exhibited no signs of infection at insertion site.

Goals

Nursing diagnosis: Self-care deficit related to activity tolerance as evidenced by weakness in the lower extremities (Doenges et al., 2010).

Nursing Diagnosis #3

Interventions

  • The nurse will provide the patient with ways to optimize their independence.
  • The nurse will confirm that the patient has a family member or agency to assist with ADLs once discharged.
  • The patient will participate in occupational therapy once a day while admitted.

(National Association of Orthopaedic Nurses, 2018)

  • Patient can demonstrate 5 ways to optimize their independence.
  • The patient will be able to describe the person or agency that will assist with ADLs.
  • The patient will complete 30 minutes of occupational therapy a day.

Evaluating interventions

  • Long term: Patient will be able to perform activities of daily living independently 4 months post-operation.
  • This goal is still be evaluated.
  • Short-term: Patient will be able to ambulate to the bathroom and dress oneself before discharge.
  • This goal has been met as patient was able to ambulate to the bathroom and dress oneself with minimal assistance.
  • Short-term: The patient will maintain a pain level of 3/10 or below by discharge.
  • This goal was met as patient's pain level was 2/10 upon discharge.

Goals

Diagnostic Test

ECG

Chest Radiography

Knee Radiography

Labs and Diagnosis

Reasoning: Used to check for lung abnormalities such as lung disease or enlarged heart that can delay surgery.

Results: No signs of infiltration or enlarged heart.

Reasoning: To check to see if heart has any rhythm abnormalities.

Results: Normal sinus rhythm. No abnormalities noted.

Reasoning: Used to assess for fractures or joint degeneration.

Results: Signs of degeneration in joint space.

(Ignatavicius et al., 2018)

Lab Results

Lab Results

  • NA: 136 mmol/L (L)
  • K: 4.2 mmol/L
  • Cl: 108 mmol/L
  • CO2: 20 mmol/L
  • Ca: 8.5 mg/dL
  • Glucose: 163 mg/dL (H)
  • BUN: 16 mg/dL
  • Creatinine: .95 mg/dL
  • PT/INR: .9
  • PTT: 12.9 s
  • RBC: 3.72 x 10 mcL (L)
  • HGB: 11.5 g/dL (L)
  • HCT: 34.7% (L)
  • Plateletes: 188 k/mcL
  • WBC: 11.1 k/mcL (H)
  • MCHC: 33.1 g/dL
  • RDW-SD: 44.4 fL
  • RDW-CV: 12.9%
  • Hemoglobin A1c: 5.2 %

Abnormal Lab

Reasoning

  • Sodium can be low due to increased cortisol and ADH being released due to stress after surgery. This causes the body to dilute sodium in the body.
  • Glucose high could be due to stress of surgery combined with him being prediabetic.
  • RBC can be low due to blood loss during surgery.
  • Hemoglobin can be low due to blood loss during surgery.
  • Hematocrit can be low due to blood loss during surgery.
  • White blood cells can be high after surgery due to trauma and stress caused to the bone marrow, resulting in leukocytosis.

(Ignatavicius et al., 2018)

References

References

Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2010). Nurse's pocket guide:

Diagnoses, prioritized interventions, and rationales (12th ed.). Philadelphia, PA: F.A. Davis Company.

Ignatavicius, D., Workman, M. L., & Rebar, C. (2018). Medical- Surgical

Nursing: Concepts for Interprofessional Collaborative Care (9th ed., Vol. 1). St. Louis, MO: Elsevier.

National Association of Orthopaedic Nurses. (2018). Patient Education

Manual Total Knee Replacement. NAON. Retrieved from www.orthonurse.org

Varacallo M, Luo TD, Johanson NA. (2020). Total Knee Arthroplasty (TKA)

Techniques. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Retrieved from www.ncbi.nlm.nih.gov/books/NBK499896/

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