Question

Mr. Jones who is 74 years of age, is being discharged home after having a right knee replacement. the discharged orders from the orthopedic surgeon include: continous passive motion at the current setting 0-degree extension worn when wolking with crutches (nonweight bearing postdischarge day 1, and may begin weight bearing postdischarge day 2); and home nurse visits, as needed, physical therapy should begin the day after discharge at an orthopic center. the orders will be faxed to the center. The following medication with prescription attached include: lovenox (enoxaparin) 70 mg subcutanously onces daily for seven days, vicodin (hydrocodone bitartrate) 10mg every 4 hours PRN, and colace (docusate sodium) 100mg every day. The patient is to fellow up with the orthopedic surgeon in 3 weeks. His daughter plan to stay with him for several weeks to assist him with meal and other house hold chores. and take him to physical therapy and the orthopedic surgeon for follow up. Mr Jones has three other children who live in other states. he is a widower and attends a local church. (learning object 4)

what preparation should the nurse make in advance before attainingnecessary communuity resources and referrals before the patient is discharged.

what necessary community resources and referals will the patient need

Answer 1

1Total knee replacement is usually done for patients who have severe pain and functional disabilities related to destruction of joint surfaces by arthritis or bleeding into the joint.

Discuss with the patient methods to reduce pain such as periodic rest,distraction and relaxation techniques,medication therapy-its actions,administration,effects,and schedule.

• Instruct the patient to keep the incision clean and dry.
• Take care of the wound and changing the dressing
• Recognize signsof wound infection such as fever,pain and swelling.

Explain to the patient that sutures or staples will be removed 10 to 14 days after surgery.

Teach the patient about the safe use of assisted devices,weight bearing limits,how to change positions frequently,limitations on hip flexion and adduction,how to stand without flexing hip acutely,avoidance of low-seated chairs,sleeping with pillow between two legs to prevent adduction,gradual increase in activities and participation in prescribed excercise regimen and use of important medication such as warfarin and aspirin.

Assess home environment for physical barriers.

Instruct the patient to use elevated toilet seat and to use reachers to aid in dressing.

Encourage patient to accept assistance with activities of daily living.

Assess patient for development of potential problems and instruct patient to report signs of potential problems such as dislocation of prosthesis,Deep vein thrombosis,wound infection and pulmonary emboli

Discuss with the patient the need to continue regular health care and screenings.

2. community resources available are Transitional health care centres or short term rehabilitation centres.

Referrals -excercise groups and one-to-one outpatient physiotherapy.