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Robert Jones 52 y/o Male Primary Diagnosis: Elective Total Right…
Robert Jones
52 y/o
Male
Primary Diagnosis:
Elective Total Right Knee Arthroplasty
Medications
Calcium Carbonate 600 mg PO every morning
Enoxaparin 40 mg subcut injection every morning
Oxycodone ER 10 mg PO every 12 hrs
Normal Saline (0.9%) 5 mL IV flush every 8 hrs
Docusate 100 mg PO BID
Normal Saline (0.95%) 75 mL/hr IV continuous
PRN Medications
Oxycodone IR 5 mg PO PRN every 4 hrs for pain score of 4 or less
Oxycodone IR 10 mg PO PRN every 4 hrs for pain score of 5 or greater
Ondansetron 4 mg IV PRN every 4 hrs for nausea/ vomiting
Senna 8.6 mg PO PRN @ bedtime for constipation
Abnormal Labs
No abnormal lab results found, all labs were within normal ranges
Diagnostic Tests
Right Knee X-Ray (Day 1 1015); right knee implant in proper position
12 Lead Electrocardiogram (Day 1 0800); Normal sinus rhythm
Right Knee X-Ray (Day 1 0730); Impression- Large osteophytes, marked joint space narrowing, sclerosis and definitely bony deformity of the R knee
Psycho/Social
Warehouse worker
Married for 30 yrs
Has a 29 y/o son
Denies use of alcohol or substance abuse
Smoker; half pack a day for 32 years- quit 4 months ago
Minimal exercise
Pathophysiology
Osteoarthritis causes the cartilage in joints to breakdown causing pain. A total knee arthroplasty is a surgery which replaces the knee with an artificial replacement. A potential complication of a knee replacement is a Deep vein thrombosis, which is a blood clot that forms in the deep veins commonly in the calf. If left untreated it can break free from the vein wall and move to the lungs causing a pulmonary embolism. To prevent a DVT patients should take anti clotting medications, compression devices and move within 24 jours of surgery.
Medical History
chronic osteoarthritis
Family History
Grandparents:
All decreased from "natural causes"
Mother:
Died at 82 y/o from a CVA. History of HTN, HLD
Father:
died at 80 y/o from an AMI. History of CAD, HTN and HLD
Child
: 29 y/o son with no known medical conditions
Treatment
Osteoarthritis in right knee was treated with an elective total right knee replacement
PT worked with patient recommending use of a wheeled walker and elevated toilet seat
General Diet
Medications to manage pain
Risk for bleeding
Monitor Hct and Hgb
Risk for Infection
Monitor for increased swelling, pain and redness
Risk for thrombus formation/ DVT
Refuse use of SCDs
Prophylaxis use of Enoxaparin
Get patient to ambulate
Monitor for signs of DVT; pain, swelling, warmth in calf
Call provider immediately if patient experiences SOB
Risk for Fall r/t surgery
2 person assist when ambulating
Use of walker
Implement fall precautions
Check for abnormal bleeding; unusual bruising, fatigue, low BP, increased HR
Risk for constipation r/t immobility and opioid use
Ambulation of patient
Scheduled use of docusate and PRN Senna
Height:
5 ft 9 in
Weight:
184 lb
BMI:
27.2
Patient is showing symptoms of a DVT in RLE:
Increased pain in calf "8/10" constant deep cramping
swelling in RLE; right calf 30 cm, Left calf 27 cm
Redness and warmth in calf between ankle and knee
1+ pitting edema in RLE
Pain upon palpation and flexion of RLE