NURSING DIAGNOSIS: Knowledge deficit

regarding the surgical procedure, hospital routines associated with surgery, physical preparation for total knee replacement, sensations that normally occur following surgery and anesthesia, and postoperative care.

Desired Outcome
The client will verbalize an understanding of the surgical procedure, preoperative care, and postoperative sensations and care.
Nursing Actions and Selected Purposes/Rationales
  1. Refer to Standardized Preoperative Care Plan, Diagnosis 4, actions a.1-4, for information to include in preoperative teaching.
  2. Provide additional information about specific preoperative care for clients having a total knee replacement:
    1. explain that the following measures will be performed to reduce the risk of a postoperative knee infection:
      1. the operative leg will be scrubbed with an antiseptic solution (e.g. povidone-iodine) before surgery
      2. existing infections will be treated before surgery; instruct client to report any symptoms of infection (e.g. cough, runny nose, burning on urination)
      3. antimicrobials will probably be administered prophylactically before and after surgery
    2. explain that anticoagulants (e.g. low-molecular-weight heparin, low-dose warfarin) may be administered before surgery to reduce the risk of postoperative thrombus formation; inform client that coagulation studies are usually done before starting these medications, especially if he/she has been taking aspirin or other nonsteroidal anti-inflammatory agents (e.g. ibuprofen)
    3. explain that a physical therapist will fit crutches or walker and provide instructions on postoperative physical therapy regimen.
  3. Allow time for questions and clarification of information provided.
Desired Outcome
The client will demonstrate the ability to perform activities designed to prevent postoperative complications.
Nursing Actions and Selected Purposes/Rationales
  1. Refer to Standardized Preoperative Care Plan, Diagnosis 4, action b.1, for instructions on ways to prevent postoperative complications.
  2. Provide additional instructions about ways to prevent complications following total knee replacement:
    1. reinforce physician's or physical therapist's instructions on:
      1. exercises to improve strength and facilitate mobility (e.g. quadriceps- and gluteal-setting, knee flexion, straight leg raising)
      2. transfer and ambulation techniques and proper use of ambulatory aids; weight-bearing limitations are determined by the physician and vary depending on the type of prostheses inserted (usually partial weight bearing is allowed initially with progressive weight bearing as tolerated)
    2. instruct client in the correct way to use overhead trapeze and unoperative leg to move self
    3. inform client that he/she will need to avoid extreme flexion of the knee for first few weeks after surgery in order to prevent dislocation of the prosthesis(es)
    4. explain the purpose for the continuous passive motion (CPM) machine and the need to leave the extremity in the machine as ordered
    5. describe or show client the knee immobilizer and explain purpose for wearing immobilizer.
  3. Allow time for questions, clarification, and return demonstration.