Total Knee Replacement

Done by:
Sajeda Moha’d
 Objectives

 Discuss Background of My patient.

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

factors and social history of my patient.

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

examination, and diagnostic studies.

 Define Congestive Cardiac Failure and it incidence in Bahrain and

worldwide.

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

 Plan health education to my patient.

 Background 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).
 Case 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.
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.
 -:Risk factors .4

Age
(55)

↓ estrogen → ↑ cartilage erosion

Water & Sodium retention → ↓ Vit.D

absorption → ↓ Calcium deposit on the
bone .
Hypertension
& CAD
 Risk factors .4
…Con
b e t es
Di a s - 2
i t u
mell
Hormone
imbalances

i d em i wt: 7
Dysli p Ht: 1 5.3 kg.
O b e sity 53.5
a& cm.

carrying more body weight places

more stress on weight-bearing
joints
 physical 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.
 :Physical examination

 General appearance:
 Conscious, alert, oriented, pale, and little
cyanosed.

 system that being examined:

 Musculoskeletal, Respiratory, Cardiovascular
system.
 Systems Abnormal findings Reasons

Restriction of movement Because of erosion of

Musculoskeletal
of joints, discomfort, and bone end (osteoarthritis).
swelling.

Because she is a known

Respiratory system
Patient feel difficulty case of asthma.
taking deep breath

Cardiovascular system No abnormal Finding.

 :Diagnostic studies

Test name Reasons for this studies

Heparinised - Low, not cause for concern, and may lead to aging
blood : U+E+CR which cause low muscle mass.

Serum: Calcium + - Normal

Phosphorous

- High WBC → inflammation.

Full Blood Count
- 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.
…Cont

-Normal Plasma: PT+APTT

- High, bc. Increasing in WBC will Fasting blood sugar (FBS)

elevate blood sugar level.

 :Radiographic

1- Electrocardiogram (ECG): to measures and

records the electrical activity of the heart.
 Results: normal P and T waves.

2- Magnetic resonance imaging (MRI): Shows

earlier and more quantitative detection of articular cartilage
changes

 Results: were bone end rube together because of cartilage

erosion.
3- Chest X-ray: to evaluate organs and structures
within the chest.

 Results: Normal heart size & shape .No evidence of

congestive cardiac failure. Lungs are clear.

4- X-ray both knees wt bearing:

 Results: Knee joint are noted bilaterally as well as at

the patella- femoral joints, worse on the left side,and
erosion of bone end.
 Total Knee Replacement
 Definition:

A total knee replacement involves cutting away the

damaged bone of the knee joint and replacing it
with prosthesis. This “new joint” prevents the bones
from rubbing together and provides a smooth knee
joint. Knee replacement surgery is performed to
treat advanced or end-stage arthritis.

so w
hat t
he m
do th ain c
is su ause
rgery to
?
 Osteoarthritis

 The cartilage that cushions the bones of the knee

softens and wears away. The bones then rub against
one another, causing knee pain and stiffness.
 Incidence of Osteoarthritis and TKR :-
 common in older age.
 In younger people, bc. joint injury, a joint malformation, or a
genetic defect in joint cartilage.
 before age 45 male more than female.
 Age 45 yrs and above female more than male.
 90% of those people which having Osteoarthritis undergo total
knee replacement.

Name Disease 200 Incidence in Incidence in

(Condition) 7 Bahrain Worldwide

Orthopedic Surgery & 62 2.455 203 per 100,000

Fracture
 :Collaborative management
1- Medical management:
 Light- dressing and elevated leg with billow :
 To maintain circulation especially on the lower
extremities 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
 Surgical management :Total knee -2
Replacement

 How it performed?

2- Damaged tibial bone

1- Teaching exercises surface removed
3- Damaged patellar bone 4- Femoral Implant
surface removed
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 doctor’s order to reduce
the pain & swelling.
 Give analgesic such as naproxen according doctor’s order to reduce the pain
 Tell doctor if the pain still persist after the analgesic to prevent any
complication.
 :Health education

 have enough rest.

 avoid salty and fatty foods.
 continue prescribed medications
 observe for any alterations on condition.
 importance of maintenance of hygiene.
 perform leg exercise as tolerated such as walking to
facilitate mobilization on lower extremities.
 come back for follow-up check-up as scheduled for
her.
Some Exercises strength the knee
muscle
Summary
 ??? Any Questions

Thanks For your listening