Robert Jones Elective Total Right Knee Arthroplasty Due to Advanced Osteoarthritis newest, Exams of Nursing

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Robert Jones Elective Total Right Knee Arthroplasty Due

to Advanced Osteoarthritis newest CASE STUDY 2025

Chamberlain nursing college/.

◻ PAGE PREVIEW

Patient Name: Robert Jones Age: 52 years old Gender: Male Reason for Encounter: Elective Total Right Knee Arthroplasty Case Year: 2025 Institution: Chamberlain Nursing College

□ Case Summary

Robert Jones is a 52-year-old male patient admitted for a scheduled total right knee arthroplasty. He has presented to the orthopedic floor as planned, and initial nursing assessments and shift reports are underway. The case focuses on preoperative and postoperative care, pain management, mobility support, and monitoring for potential complications such as infection, DVT, or delayed healing.

□ Timeline Summary

Day/Time Summary

Day 1 - 0730 Patient arrives to the ortho floor

Day 1 - 0730 Nursing assistance note

Day 1 - 0800 Your nursing shift starts

□ HISTORY

Patient Name: Robert Jones Age: 52 years old Gender: Male Chief Complaint:

 Scheduled for elective total right knee arthroplasty due to worsening right knee pain and functional limitations.

 Occupation: Accountant (sedentary job)  Smoking: Never  Alcohol: Occasionally (1–2 drinks/week)  Exercise: Limited due to knee pain  Living Situation: Lives with spouse, supportive home environment

□ Current Medications:

 Lisinopril 10 mg daily  Atorvastatin 20 mg nightly  Ibuprofen 400 mg as needed for knee pain  Multivitamin daily

□ PHYSICAL EXAM

General Appearance:

 Alert, oriented ×3, in no acute distress  Well-groomed, cooperative during examination  Walks with a noticeable limp favoring the right side

□ Vital Signs:

 Temperature: 98.6°F (37°C)  Blood Pressure: 132/78 mmHg  Heart Rate: 78 bpm, regular  Respiratory Rate: 16 breaths per minute  Oxygen Saturation: 98% on room air  Height: 5'11"  Weight: 210 lbs  BMI: 29.3 (Overweight)

□ Neurological:

 Alert and oriented to person, place, time, and situation  Cranial nerves II–XII intact  Motor strength 5/5 in all extremities except right lower extremity (4/5 due to pain/limitation)  Sensation intact bilaterally  Gait: Antalgic (limping on right leg)

❤ ◻ Cardiovascular:

 Regular rate and rhythm  No murmurs, rubs, or gallops  Peripheral pulses +2 bilaterally  No edema in lower extremities

□ Respiratory:

 Lungs clear to auscultation bilaterally  No wheezes, rales, or rhonchi  Symmetrical chest expansion

□ Musculoskeletal (Focused on Right Knee):

 Right knee shows visible swelling and mild erythema  Tender to palpation along the medial and lateral joint lines  Decreased range of motion (active and passive ROM limited by pain)  Crepitus noted with movement  No signs of open wounds or skin breakdown  Left knee normal on inspection and palpation

□ Skin:

 Intact, warm, dry

□ Risk Factors to Monitor:

 Postoperative risks: Infection, venous thromboembolism (VTE), impaired mobility  Chronic conditions: Hypertension, hyperlipidemia  Pain management needs post-op  Rehabilitation needs: Physical therapy for recovery and mobility improvement

□ Summary:

Mr. Robert Jones is a suitable candidate for total right knee arthroplasty due to chronic, debilitating osteoarthritis that has not responded to conservative management. His baseline health status is stable, and he is ready for surgery. Postoperative care will focus on pain control, mobility restoration, DVT prevention, and wound care.

□ TEST RESULTS

□ Laboratory Results (Preoperative):

Test Result

Reference Range

Hemoglobin (Hgb) 13.9 g/dL 13.5–17.5 g/dL Normal

Hematocrit (Hct) 41.2% 38.8–50.0% Normal

Notes

White Blood Cell Count (WBC)

/mm³

/mm³

Normal – no signs of infection

Platelets

/mm³

400,000 /mm³

Normal – good for clotting post-op

INR 1.0 0.8–1.2 Normal^ –^ no anticoagulation issues

Sodium (Na+) 139 mmol/L

mmol/L Normal

Potassium (K+) 4.1 mmol/L 3.5–5.1 mmol/L Normal

Test Result Reference Range Notes

Blood Urea Nitrogen (BUN) 14 mg/dL^7 – 20 mg/dL^

Normal – kidney function WNL

Creatinine 0.9 mg/dL 0.6–1.3 mg/dL

Normal – renal function normal Glucose (fasting) 92 mg/dL 70 – 100 mg/dL Normal

Lipid Panel

Elevated LDL

< 100 mg/dL Consistent with history of hyperlipidemia

□ Imaging: Right Knee X-ray

 Findings: o Moderate to severe joint space narrowing o Osteophyte (bone spur) formation o Subchondral sclerosis o No evidence of fracture or malignancy  Conclusion: o Imaging is consistent with advanced osteoarthritis of the right knee, justifying the need for total knee arthroplasty.

□ ECG (Pre-op Clearance):

 Normal sinus rhythm, no ischemic changes  Cleared for surgery by cardiology

□ DIAGNOSIS

□ Primary Diagnosis:

 Osteoarthritis of the right knee, severe (ICD-10: M17.11) o Based on clinical symptoms (chronic pain, stiffness, decreased mobility), physical exam findings (crepitus, swelling, limited ROM), and radiologic evidence (joint space narrowing, osteophytes).

o Continue antihypertensives as ordered unless otherwise directed by anesthesia o Hold anticoagulants if applicable (none listed in this case)  Pain management: Discuss post-op multimodal pain control (acetaminophen, opioids, regional anesthesia if indicated)  VTE prophylaxis: Initiate SCDs (sequential compression devices); plan for post-op anticoagulation (e.g., enoxaparin)

□ Postoperative Plan:

 Monitoring: o Frequent vitals monitoring per post-anesthesia care unit (PACU) protocol o Monitor surgical site for signs of infection, bleeding, or drainage o Pain assessment using standard scale (0–10)  Pain management: PCA pump or scheduled analgesics per orders  Activity: o Early ambulation with physical therapy within 24 hours o Weight-bearing as tolerated unless surgeon orders otherwise  DVT prevention: Continue SCDs, initiate anticoagulation (LMWH or aspirin)  Wound care: Keep dressing clean and dry, monitor for drainage  Diet: Advance diet as tolerated post-op  Labs: Monitor CBC and BMP post-op to assess for blood loss and electrolyte balance

□ Patient Education:

 Discuss post-op expectations: pain, activity, therapy schedule  Educate on signs of infection, VTE, wound care, and medication adherence  Review home support needs and discharge planning

□ ◻ MANAGEMENT PLAN

1. □ Surgical Management

 Procedure: Total Right Knee Arthroplasty (TKA)  Status: Elective, scheduled and consented  Goal: Relieve chronic osteoarthritis pain and restore joint function

2. □ Preoperative Management

 Ensure NPO status maintained prior to surgery  Start IV fluids (typically NS or LR per protocol)  Administer prophylactic antibiotics (e.g., cefazolin) within 60 minutes of incision  Confirm allergies, consent, and site marking  Pre-op anesthesia evaluation completed  Maintain home antihypertensive medications as directed  Baseline labs and ECG reviewed and within acceptable limits

3. □ Postoperative Management

 Vital Signs Monitoring: Per PACU and post-op unit protocols  Pain Management: o Multimodal: acetaminophen, opioids (e.g., hydromorphone, oxycodone), possible nerve block o Use of PCA pump if ordered  Mobility: o Encourage early ambulation within 24 hours post-op with PT/OT o Weight-bearing as tolerated (WBAT), unless contraindicated  DVT Prophylaxis: o SCDs (sequential compression devices) o Begin anticoagulation therapy post-op (e.g., enoxaparin or aspirin)  Wound Care: o Monitor incision for signs of infection or dehiscence o Keep dressing clean and dry

□ Clinical Overview:

Mr. Robert Jones is a 52-year-old male with a history of severe right knee osteoarthritis that has not responded to conservative management, including NSAIDs, physical therapy, and corticosteroid injections. His condition has progressively worsened, resulting in chronic joint pain, impaired mobility, and diminished quality of life.

He is scheduled for elective total right knee replacement surgery. Preoperative assessment indicates he is medically stable with well- managed hypertension and hyperlipidemia. Imaging and clinical evaluation confirm advanced joint degeneration.

□ Preoperative Findings:

 Antalgic gait; right knee swelling, tenderness, and crepitus  Limited range of motion and strength (4/5) in the right leg  Normal vital signs, labs, ECG, and surgical clearance  BMI: 29.3 (overweight)  No signs of active infection or contraindications to surgery

□ Plan of Care:

 Proceed with elective total right knee arthroplasty  Initiate multimodal pain management  Start DVT prophylaxis (SCDs + anticoagulants)  Promote early mobilization with physical therapy  Monitor for postoperative complications: infection, bleeding, thromboembolism  Educate patient on wound care, mobility aids, and recovery expectations  Prepare for discharge planning including home support and outpatient rehab

□ Outcome Goals:

 Pain relief  Improved knee function and mobility  Safe recovery with no postoperative complications  Successful reintegration into daily activities and return to baseline independence

□ SOAP NOTE

Patient Name: Robert Jones Age: 52 Date: [Insert Date] Procedure: Elective Total Right Knee Arthroplasty Provider: [Insert Your Name or Role] Facility: Chamberlain Nursing College Clinical Simulation

□ S: Subjective

 Patient reports chronic right knee pain worsening over the past few years.  Pain rated 7/10 on most days; aggravated by walking, standing, and stairs.  Reports decreased mobility, stiffness, and reduced ability to engage in daily activities.  Denies fever, chills, or recent trauma.  States he is ready for surgery and understands the post-op expectations.

□ O: Objective

Vital Signs:

 Temp: 98.6°F  BP: 132/78 mmHg  HR: 78 bpm

advanced osteoarthritis causing functional impairment and pain. No contraindications identified.

□ P: Plan

Preoperative Care:

 Confirm NPO status and surgical consent  Administer prophylactic IV antibiotics (cefazolin)  Start IV fluids and place compression devices  Continue antihypertensives per anesthesia orders

Surgical Plan:

 Total right knee arthroplasty (TKA) today

Postoperative Care:

 Pain control: PCA, acetaminophen, opioids as ordered  Monitor for signs of infection, bleeding, DVT  DVT prophylaxis: SCDs + enoxaparin  Encourage early ambulation and PT within 24 hrs  Monitor surgical site and vitals routinely  Advance diet as tolerated

Patient Education:

 Signs of infection or DVT  Wound care and medication adherence  Use of walker or assistive devices  Expected rehab and recovery timeline

Discharge Planning:

 Goal: Discharge in 2–3 days  Arrange home health/PT if needed  Ensure safe home environment and caregiver support

i-Human Patients. (2025). Robert Jones – Elective total right knee

arthroplasty [Virtual patient simulation]. Chamberlain University, Kaplan,

Inc.