nashrur fathin ajrun
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1. To enhance our understanding
in orthopedic cases
2. To promote clear understanding
regarding specific nursing careplan for orthopedic cases.
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The knee isthe largestjoint in the
body.
Normal kneefunction isrequired to
perform mosteverydayactivities.
The knee ismade up of the
femur, whichrotates on thetibia, and the
kneecap(patella), which
slides in a
groove on theend of the
femur.
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The joint surfaces wherethese three bones touch
are covered with articularcartilage, that enablesthem to move easily.
All remaining surfaces ofthe knee are covered by athin, smooth tissue liner
called the synovialmembrane.
This membrane releases a
special fluid that lubricatesthe knee, reducing frictionto nearly zero in a healthy
knee.
Large ligaments attach to
the femur and tibia toprovide stability. The long
thigh muscles give the kneestrength.
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Osteoarthritis is alsocalleddegenerativearthritis orwear-and-
teararthritis.
Arthritis is whathappens when the
tissue(cartilage)that
protects the bones
wears away.
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Researchers have concluded that there are 3 signsand 3 symptoms that correctly identify of kneeosteoarthritis patients.
The signs you should be aware of include:
crepitus
restricted movement or range of motion
bony enlargement
The symptoms include:
persistent knee pain
short-lived morning stiffness
functional limitation
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Deterioration ofarticular cartilage
previous knee injuryrepetitive strain on
the knee
fractures, ligamenttear, and meniscal
injurygenetics obesity
problems withsubchondral bone
(the bone layerunderneath
cartilage)
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A total kneereplacement is a
surgical procedurewhereby the
diseased kneejoint is replaced
with artificialmaterial.
During a total
kneereplacement, theend of the femurbone is removedand replaced with
a metal shell.
The tibia is alsoremoved and
replaced with achanneled plastic pi
ece with a metalstem.
Depending on thecondition of the
kneecap portion ofthe knee joint, aplastic "button"
may also beadded under thekneecap surface.
In total kneereplacement
surgery theposteriorcruciate
ligament iseither retained,sacrificed, or
substituted bya polyethylene
post.
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blood clots
shortness ofbreath
chest painurinary tract
infection
nausea andvomiting
chronic knee painand stiffness
bleeding
blood vesselinjury
infection
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PATIENTSIDENTITY
Name :ZUHARI B
MAT
IC :580819-03-5409
DIAGNOSIS :LEFT KNEE
OSTEOATHRITIS.
Plan fortotal kneereplaceme
nt.
PRESENTILLNESS
HPT
DM
HPL
CHIEFCOMPLAINT
C/O left knee
pain for threeyears
Alleged fall threeyears back
Walk with gait allthese years
No history ofswelling to joint
HISTORY
Activesmoker forthe past 20
years
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Patient admitted to ward walking byhimself. Case referred from orthopedicclinic. Patient vital sign was taken and
recorded. Bp: 140/90 P:89 T:37.0. Patientwas oriented around the ward. Doctorplanned for TKR on 18 March 2011.
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Alert and consciousGENERAL
NADHEAD
NADMOUTH
NADNECK
NADBREAST
S1 S2, no murmurCARDIOVASCULAR
SYSTEM
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ClearLUNGS
NADLYMPH NODE
Soft, no tenderABDOMEN
NADCNS
No murmurJOINTS
NADGENITALIA
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FBC/PTT/APTT/INR
RBS
UFEME GSH
X RAY
LEFT KNEE (ANTERIOR ,POSTERIOR , LATERAL)
FEMUR (ANTERIOR, POSTERIOR)
TIBIA (LATERAL)
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PH 6.0
LEUKOCYE NEGATIVE
NITRITE NEGATIVE
PROTEIN NEGATIVE
GLUCOSE NORMAL
UROBILINOGEN NORMAL
KETONES NEGATIVE
BILIRUBIN NEGATIVE
ERTYTHROCYTE H 10.0
COLOR P.YELLOW
HB 15
RBC 4.96
PCV 44.8
MCV 90.3
MCH 30.2
MCHC 33.5
PLATELET 227
TWBC 8.16
NEUT 56.1
LYMPH 27.8
MONO 10.3
EOSI 5.4
BASO 0.4
PT 11.5
PTR 1.0
INR 0.9
APTT 26.8
APTTR 1.1
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16/3 /11
Patient was admitted to ward around 8.30 am.
Doctor planned for TKR on 18 March 2011. Doctor plan for Blood investigation, chest X-ray and ECG.
17/3/11
Plan for OP For anaest review today
Keep patient NBM 12 midnight On IVD N/s 3pints
18/3
Operation day For Post Op Order
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GOAL NURSING INTERVENTION RATIONALE EVALUATION
Patient will be
able to explainnature of the
disease,
operation and its
complication.
1. Explain briefly the
present disease, itscauses and prevention.
2. Explain to patient about
operation and post
operative complications
e.g bleeding, signs of
infection.3. Educate patient about
importance of taking
medications according to
schedule.
4. Explain type and
importance of well
balanced diet, exercise
and healthy life style.
5. Encourage patient to ask
about his disease.
1. To give clear
understanding topatient.
2. To increase patient
knowledge about his
disease.
3. To prevent patient
developing anycomplication.
4. To promote healing.
5. To evaluate patient
understanding about
his disease
Patient able to
explain nature ofthe disease,
operation and its
complication
NURSING DIAGNOSIS Knowledge deficit related to operation
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NURSING DIAGNOSIS Self care deficit related to disease process.
GOAL NURSING INTERVENTION RATIONALE EVALUATION
Patient will be
able to performself care activities
within physical
limitations.
1. Assess the patient
condition.2. Place needed objects
within patient bed
3. Give praises for
patients
accomplishment.
4. Assist patient withactivities which he is
unable to perform
5. Encourage family
members to participate
in self care activities.
1. To evaluate patient ability
to perform basic needs fordaily living.
2. Easy patient to reach his
things.
3. To give emotional support
4. To promote patient
comfort in doing ADLs.5. To give patient support in
doing his self care
activities.
Patient able to
perform selfcare activities
with assistant.
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NURSING DIAGNOSIS Potential infection related to disease process.
GOAL NURSING
INTERVENTION
RATIONALE EVALUATION
Patient will not
acquire
infection.
1. Assess patient
condition.
2. Monitor patient vital
sign such as
temperature, pulse
and BP four hourly.
3. Maintain asceptictechnique
4. Keep dressing clean
and dry all the times
5. Observe for redness
around the wound.
6. Administer medicationas prescribed.
1. To identify patient
problems.
2. Vital sign shows
reflection of
infection.
3. To promote clean
wound dressing.4. To prevent
patient to
develop more
infection
5. To prevent any
signs ofcomplication.
6. To promote fast
wound healing.
Patient still not
acquire infection.
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Weight control is important to successful arthritis management.
Controlling your weight can:
1. Lessen pain by reducing stress on the weight-bearing joints (hips, knees,back, feet)
2. Increase self-esteem and avoid the risk of depression that can affectoverweight individuals
3. Weight loss should be coupled with a regimen of more physical activity.
4. A productive goal is a total of 30 minutes of daily exercise.
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Strengthening and stretching exercises can help by:
Relieving pain and improvingjoint movement
Building up the muscles around the joint, making the joint more stable and resistingfurther damage.
Three types of exercise are used to treat osteoarthritis:
1. Stretching exercise/ ROM exercise it helps to maintain joint flexibility and reach.
2. Isometric exercise.
This is exercise in which muscles are tensed for a period without actually moving them.
it can be performed without actually bending a painful joint. As muscles are exercised
against resistance, their size and power will increase.
3. Aerobic exercise.
This is endurance-building exercise that improves cardiopulmonary fitness.
For most individuals with osteoarthritis, the best aerobic exercises are:
Swimming (especially in a heated pool)
Walking on level ground
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Heat and cold treatments are well-known to
reduce the pain
stiffness
and occasional swelling associated with osteoarthritis.
hot packs can be positioned over stiff joints
Cold can lessen pain in a sore joint by numbing thelocal tissues.
Ice and cold packs never should be placed directly on the skin,as they are likely to cause skin damage. Instead, ice and cold
packs should be wrapped in a towel before they are applied