Preparing for a total knee replacement requires pre-operative and post-operative care that will help the patient prepare prior to the procedure and help the patient attain a faster recovery. The pre-operative stage usually begins several weeks before the procedure and the goal is to help the patient prepare prior to the surgery with the objective of helping the patient achieve the best possible surgical outcome from the procedure (Williams and Hopper, 2011). In a total knee replacement, the knee joint is replaced with an artificial one. The patient should expect to be home after two to four days after the surgery, and should be ready to begin recovery and rehabilitation. Before the scheduled procedure, the patient should prepare to strengthen the knee muscles that will be affected by the procedure. This can be accomplished by training for a muscle strengthening program of the knee muscles and muscles of the lower extremities for faster recovery. Strong muscles adapt well with the implant with better rehabilitation outcomes. Pre-surgery exercises of the lower extremity should be performed to promote early ambulation after the surgical procedure. Exercise also helps the patient to effectively reduce body weight that makes ambulation exercise post surgery less burdensome. The patient should already be taught on how to perform the exercises that he will undertake during the recovery phase after the procedure. This includes practicing doing isometric exercises to strengthen the muscles on the site of the surgery and gait exercises. Nutrition program is also essential as part of the pre-operative phase in a total knee replacement to help the body fight possible infection, reduce potential risks to surgical complications and to promote better surgical wound healing. It is also important for the patient to undergo laboratory tests to identify health conditions that can magnify the risk of surgery. Prior to the surgical procedure, it is also essential to address the emotional needs of the patient, especially when it is his or her first time to undergo a surgical procedure. The patient must be placed in a comfortable position when doing the prep work an hour before the procedure will be performed. The patient must be educated on what to expect the moment the doctor arrives, including what to expect after the surgery is done. Giving the patient re-assurance will help overcome the anxiety that comes from being apprehensive in undergoing a surgical procedure. The patient and his family must be oriented about the medications that will be taken before and after the procedure, including an explanation of its indication and the proper dosage to take. It also helps to explain to the patient about the proper wound care that is needed for the surgical site.
The post-operative phase of the total knee replacement procedure involves the recovery phase. The objective of post-operative phase is to promote faster wound healing, prevent surgical complications and begin to ambulate. The surgical site is assessed and medication is prescribed to hasten healing and recovery of the patient. Pain management is also important during this stage. The patient is usually discharged within a few days after the surgery in the absence of complications. The patient and his family should have already been educated about the proper medication and wound care that must be administered during the recovery of the patient at home. The patient should know that the expected outcome of the surgery will result to a pain experience that is highly manageable with medication. Nursing assessment as to the level of pain of the patient is necessary and the wound must be carefully assessed and observed for possible infection. It should not be difficult for the patient to start exercising the affected lower extremity after undergoing the pre-operative exercise training program. The patient is already taught with the proper self care program, such as proper positioning of the operated extremity and what positions to avoid post surgery. The patient should learn the proper foot exercise to prevent post surgery complications, such as the development of deep venous thrombosis. The patient should also learn to begin small movements on the affected extremities to foster faster recovery and in preparation for the ambulatory exercises. By doing small movements of the operated extremity, the blood circulation is improved that helps in the wound healing process. By starting an early ambulation post surgery, the leg becomes easily accustomed to the newly introduced artificial knee. Performing isometric exercises on the knee muscles during the acute phase after surgery will help prevent the possible complication involving muscle tightening and wasting. With early ambulation, the person’s lung also expands and promotes the movement of secretions. Before the patient begins ambulation exercise, pain management must be effectively implemented in the nursing plan with better outcomes. Pain that is controlled will make the recovery faster. The intervention program should also emphasize to the patient that his cooperation plays an important role in preventing the potential complications of surgery and in promoting a successful treatment outcomes.
Reference:
Williams, L.S. and Hopper, P.D. (2011). Understanding Medical Surgical Nursing. USA: F.A. Davis Company.
