L13

Question 1

Arthroplasty

Answer 1

Reconstruction or replacement of a joint
1. Reduce pain
2. Maintain or improve range of motion
3. Correct deformity

Question 2

Pre-op care for arthroplasty

Answer 2

1. Assessment of CBC, LRFT, clotting profile, type and screen, ECG and X-ray
2. Marking
3. Signed consent; pre-op checklist

Question 3

Post-op for total-knee replacement

Answer 3

1. Monitor blood loss and I&O
2. Monitor hemodynamic status Q1H
3. Assess lower limb circulation and sensation
4. Pain management
5. Observe vital signs
6. Wound dressing:
   - use hydrofiber or hydrocolloid (higher absorptive capacity)
   - monitor for oozing and odour (mark if excess oozing and inform doctor)
   - off stitches on D10-14
   - prescribe prophylactic antibiotics
7. Drainage care: used 1-2 days after the surgery; ensure anchoring stitch in situ and no dislodgement
8. Prevent knee contracture:
   - limit flexion during transfer; encourage active flexion of foot every hour
   - xxx put pillow under the knee
   - protect the knee with a knee immobiliser and elevated it when sitting
9. Continuous passive motion
   - initial: 10 degree of extension and 50 degree of flexion
   - by discharge: 0 degree of extension and 90 degree of flexion

Question 4

Post-op complication of total-knee replacement

Answer 4

1. Haemorrhage/Hypovolemic shock
2. Wound infection
3. Neurovascular dysfunction
   - assess for temperature, colour, toe capillary refill, sensation and numbness
   - assess the pedal pulse
   - assess for edema and swelling
   - elevate extremities (keep leg below hip when sitting)
   - report for leg tightness

Question 5

Post-op care for Total hip replacement

Answer 5

1. Check hemodynamic status hourly
2. Check vital signs
3. Monitor blood loss and I&O
4. Monitor lower limb circulation and sensation
5. Pain management
6. Drain care (with suction if applicable)
7. IVF
8. Urinary catheter
9. Apply abduction pillow (between two legs) to avoid dislocation; monitor and report if have s/s dislocation; limited flexion during transfer and sitting
10. At early stage, bed head elevation <60 degree to prevent hip dislocation
11. Encourage exercise: upper limb exercise, leg exercise, active ankle range of motion; deep breathing and coughing exercise; avoid extreme flexion of hip when sitting
12. Weight bearing restriction: partial weight bearing <20 kg of pressure on foot; begin with a walker

Question 6

S/s of hip dislocation

Answer 6

1. Increased pain at surgical site, swelling, and immobilisation
2. Acute groin pain and discomfort in affected hip
3. Reported ‘popping’ sensation in hip
4. Shortening of leg
5. Abnormal internal or external rotation
6. Restricted ability or inability to move leg

Question 7

Potential complications of total hip replacement: deep vein thrombosis (DVT)

Answer 7

S/s:
1. Unilateral edema or swelling distal to the site
2. Pain; if in calf, then cramp over affected area
3. Redness, induration, warmth and tenderness along the affected vein

Prevention:
1. Regular leg exercise
2. Use of sequential compression device
3. Wear compression stockings (TED stockings)

Nursing management:
1. Administer low molecular weight heparin (anti-coagulant)
2. Measure calf circumference daily

Question 8

Nursing diagnosis for total shoulder arthroplasty

Answer 8

1. Pain related to surgical incision: assess pain level and use of analgesic
2. Impaired physical mobility: maintain position (abduction, neural rotation, limited extension); use heel protector to keep pressure off heel; do quadriceps and gluteal-setting exercise
3. Risk of dislocation of prosthesis
4. Ineffective health maintenance