Question

1. Mr. Jones, who is 74 years of age, is being discharged home after having a right knee replacement. The discharge orders from the orthopedic surgeon include: continuous passive motion (CPM) at the current setting of 0-degrees extension worn when walking 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 orthopedic center. The orders will be faxed to the center. The following medications with prescriptions attached include: Lovenox (enoxaparin) 70 mg subcutaneously once daily for 7 days, Vicodin (hydrocodone bitartrate) 10 mg every 4 hours PRN, and Colace (docusate sodium) 100 mg every day. The patient is to follow up with the orthopedic surgeon in 3 weeks. His daughter plans to stay with him for several weeks to assist him with meals and household 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 Objective 4)

What preparations should the nurse make in advance before attaining necessary community resources and referrals before the patient is discharged?

What necessary community resources and referrals will the patient need

Answer 1

After a knee replacement surgery, the patient has to learn may things before getting discharged from the hospital. The nurse has to provide adequate health education regarding the care to be taken at home.

• She should identify the care provider at home who will assist the patient in performing ADL. A care provider be it a family member or other health personnel who will assist in the activities of the patient should also participate in the education program.
• A physical therapist will be needed to check patient at home for the safe environment of the patient and to train him to adjust his activities according to his condition.
• The nurse should teach the patient about his medication intake and should demonstrate how to administer Enoxaparin subcutaneously.
• The nurse should educate the patient how to make the home environment safe so as to reduce a events of falls. All the things should be made available at the patients easy reach.
• Teach him to assess his wound site for any signs of infection and to do dressing in an aseptic way. Instruct him when the stitch has to be removed.
• Teach him when to call the doctor.
• Patient should be given adequate information on use of walking aids

After discharge, the patient who has underwent knee replacement will require various rehabilitative services like physiotherapist, nutritionist etc. The rehabilitaion will improve the strength and gait of the Mr.Jones. It will help to recover the range of motion. Mr.Jones can access the community physiotherapy clinics, regional home and community care services,private rehabilitation clinics. The referral services aims at provide tertiary care to the patients. The referral is made based on the patients progress with the existing rehabilitation services. The community resources includes the supply of medical equipments needed for assistance like crutches, canes and wheel chairs etc.