nashrur fathin ajrun

8/3/2019 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

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