Total Knee Replacement.pptx is to replace damage fracture knee to prosthetic

Total knee replacement

1. Total Knee Replacement Prepared By Mamata kc MN 1 st Year, 13 Th Batch Pokhara Nursing Campus

2. Introduction Knee replacement, also known as  knee arthroplasty , is a surgical procedure to replace the weight-bearing surfaces of the knee joint to relieve pain and disability, most commonly offered when joint pain is not diminished by conservative sources. In this, damaged parts will be removed of the natural knee joint and replace them with an artificial joint (a prosthesis) which is made of metal and plastic.

3. Contd … Artificial knee joints used in knee replacement surgery are typically made of metal and plastic. Metal parts replace the damaged thighbone and shinbone. Plastic replaces cartilage on the shin and kneecap parts.

4. Indications Treatment of cartilage damage Reconstruction of the anterior cruciate ligament Osteoarthritis Severe joint pain, stiffness Bone fracture in the knee ,Pathologic fractures from metastatic cancer

5. Diagnostic Criteria Medical history- gather information about general health and a the extent of your knee pain and your ability to function. Physical examination. This will assess knee motion, stability, strength, and overall leg alignment. X-rays. These images help to determine the extent of damage and deformity in your knee.

6. Contd … Other tests. Occasionally, blood tests or advanced imaging, such as a magnetic resonance imaging (MRI) scan, may be needed to determine the condition of the bone and soft tissues of knee.

7. Patient Preparation Describe procedure to the patient and answer he or she may have Instruct patient for fasting after midnight before procedure. Tell the patient who will perform procedure and where. Make sure the patient or family member has signed a consent form. Check or ask the patients history for hypersensitivity of anesthesia.

8. Contd … Instruct client to arrange blood prior to surgery Instruct for weight management before surgery

9. Post-op Care Monitor pain level, changes in physiological parameters Watch for fever, swelling, drainage Assess for localized inflammation at the localizes site If the patients reports discomfort administer analgesics as prescribed Use sterile technique while dressing Promote hand washing, maintain cleanliness

10. Contd … Encourage for high protein diet, vitamin C, zinc that helps in wound healing Helping with basic movement and functions as well as emotional support Having a clear understanding of your medication and ensuring they are administered in a timely manner

11. Contd … Keep the wound clean and dry Educate client to avoid bending and twisting of knee Some amount of swelling is normal after knee replacement and may last for more than a month. It can be controlled by icing and elevating your leg for 30 to 60 minutes every day.

12. Management Frequent assessment for sign of swelling, infection Prevent thromboembolism by continuous use of elastic hose and sequential compression device while patient is in bed. Discontinue sequential compression device when patient is ambulatory. C-reactive protein and erythrocyte sedimentation rate can be used to quantify the risk of periprosthetic join infection.

13. Contd … Ambulation may begin after surgery Ambulation with aids, such as walkers are encouraged as tolerated and based on patients condition and type of prosthesis Caution is taken in moving the patient to upright position and the patient is monitored for orthostatic hypotension. Elevate the leg on pillows to control swelling.

14. Contd … Continuous passive motion may be started to facilitate joint healing and restoration of joint ROM. Use of knee immobilizer

15. Complications Infection Deep vein thrombosis Nerve palsy- common peroneal nerve palsy sometimes occur in cases requiring dissection on the lateral side of the knee. Spontaneous recover occur in most cases. Fracture Knee stiffness

16. Nursing Diagnosis Impaired physical m obility related to joint stiffness or discomfort as evidenced by altered gait and difficulty in ambulating. Acute pain related to surgical intervention, joint tenderness as evidenced by a ltered physiological parameters. Risk for Infection Implantation of a foreign body or prosthesis

17. Assessment Assess the patient’s pain characteristics; location, onset, intensity Assess for s welling, stiffness, muscle weakness Assess for ROM; decreased muscle strength/control Bruising and discoloration Numbness and tingling sensation around the surgical area

18. Nursing Intervention Impaired physical m obility: Knee immobilizer must be applied Elevate the limb Assist the patient in ambulating with the use of assistive devices like; walker, crutches.

19. Contd … Encourage the patient to adhere to rehabilitation interventions for exercises and ambulation that promotes early recovery and healing and prevents complications. Refer the patient to a physical therapist as this can help to strengthen aff ected muscle and promote recovery.

20. Contd … Relieving pain and Discomfort Ensure proper positioning of the affected joint to reduce muscle spasm and prevent tension on new knee prosthesis. Encourage non-pharmacologic pain relief interventions like; distraction, rest, cold application.  Administer pain medication as indicated.

21. Contd … Provide comfort measures (frequent repositioning, back rub) and diversional activities. Encourage stress management techniques (progressive relaxation, meditation). Initiate and maintain extremity mobilization: ambulation, physical therapy, exercise  that increases circulation to affected muscles.

22. Contd … Prevent Infection: Use a strict aseptic technique when dressing the surgical site. Instruct on symptoms of infection to be alert for swelling, drainage, increased pain, etc.  Administer antibiotics as ordered. Encourage fluid intake and a high-protein diet.

23. Contd … Investigate reports of increased incisional pain and changes in the characteristics of pain as deep, dull, aching pain in the operative area may indicate a developing infection in a joint. Promote good hand washing by staff and patients. Monitor temperature. Note the presence of chills as continuous elevation of temperature and chills may indicate sepsis or infection.

24. Discharge Teaching Encourage patient to continue to wear elastic stocking after discharge until full activities are resumed. Do not participate in any activity like sudden stress in joint (jogging, jumping, lifting heavy loads) Keep knee apart ,do not cross legs Assess home for safety to prevent falls

25. Contd … Avoid MRI studies because of implanted metal component. Teach patient use of supportive equipment (crutches, canes) Monitor for late complications like- Deep infection, dislocation, fracture of components, increased pain or decreased function associated with loosening of prosthetic components.

26. References Sharma,K.S .(2017). Lippincot Manual of Medical- Surgical Nursing(3 rd Edition). India:Wolters Kluwer Pvt.Ltd . Sharma,Dr.M.,Paudel,Dr.K.,& Gautam,R .(2080).Comprehensive Textbook of Medical Surgical Nursing(4 th Edition). Kathmandu:Samikshya Publication House Pvt.Ltd .

27. Contd … Maheshwari & Mhaskar (2023).Essential Orthopaedics (7 th Edition).New Delhi:Jaypee Brothers Medical Publishers Pvt.Ltd . https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/knee-replacement-surgery-procedure https://orthoinfo.aaos.org/en/treatment/total-knee-replacement/ https://www.mayoclinic.org/tests-procedures/knee-replacement

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