About
Usually as a result of osteoarthritis, the knee or hip joint is replaced surgically by an Orthosurgeon.
Assess
Assess for common post-operative complications ( Infection, bleeding, DVT's, pneumonia Constipation); Pain and pain control measures; mobility; understanding of post-operative plan of care; Vital signs; Dressing and site of incision; Continuous Passive Motion machine settings.
Complications
Hemorrhage- monitor for abnormal bruising.
Acute compartmental syndrome- monitor for circulation to area distal to joint including pulses, pallor, warmth, pain, pressure, paralysis or parasthesias.
Post-operative complications- infection, pneumonia, constipation, blood clots, joint stiffening, immobility.
Diagnosis
- Impaired physical mobility related to surgery
- Acute pain related to surgical procedure
- Risk for infection related to surgical procedure
- Deficient knowledge related to post surgical treatment regimen.
Goals
- The client will maintain mobility of effected joint.
- The client will not have any post-operative complications.
- The client will demonstrate medications administration, including subcutaneous injections to prevent clots.
- The client will verbalize treatment plan while in the hospital and when returning to the community setting, including out-patient physical rehab.
Interventions
- Monitor vitals every 15 minutes X 2; every 30 minutes X 2; than every four hours post-operatively.
- Assess the client's incision for s/s of infection and bleeding.
- Monitor for complications, including hemorrhage, infection, impaired tissue perfusion.
- Utilize Continuous Passive Range of Motion machine for knee replacements as ordered; use abductor pillows for hip replacements.
- Administer analgesics, as ordered, to control pain.
- Ambulate the client as soon as possible after surgery, utilizing precautions to prevent excess pressure on joint.
- Demonstrate how to utilize assistive devices and how to administer subcutaneous injections as needed.
- Encourage client to actively participate in plan for continuing care, both inpatient and out-patient.
- Encourage client to use coughing and breathing techniques, including incentive spirometry, each hour while awake.
- Teach the client about medication therapies, including anticoagulants, to prevent complications and to manage pain.
- Monitor for signs/ symptoms of complications.
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