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Question:

Discuss about the Pre-operative Nursing Assessment of Margaret.
 
 

Answer:

Introduction

Osteoarthritis of the knee affects 10% of the population aged 60 years and above , however the risks is increased on persons who are obese and have joint damages, (Scott & Kowalczyk, 2007). Osteoarthritis incidence increases with age. Current treatments that are available include non-operative procedures and operative process. Surgical procedures include arthroscopy, cartilage repair, osteoctomy and knee arthroplasty. The choice made on any of these methods depends on a number of factors which include stage of osteoarthritis, co morbidities, (Ronn, Reischl, Gauiter and Jacob, 2011).

Identifiable Risks at Intra operative and Post Operative stage

Patients with knee osteoarthritis like Margaret, have decreased pressure pain, enabled temporal summation of pain and decreased modulation of pain. Preoperative temporal summation of pain reflects the postoperative pain intensity and it is used as a predictor of chronic postoperative pains who have undergone total knee replacement like Margraret, There is high chance for the development of chronic pain after the surgery. Margaret posses the risk factor of being obese and studies have shown that weight loss is associated with reduction of pain, and the needed weight loss is by 16.5 %, (Coriolano, et al., 2016).

Obesity is not a barrier in total knee replacement, however it affects the healing process of the patient, considering the weight Margaret has, she may develop complications in would healing process at the preoperative infection occurrences. From the history, she has been referred, due to her weight concerns but now it has reached the point of no return, she has to undergo the surgery.

Heart risk assessment is performed and should be performed prior to surgery. If of any underlying heart or lung diseases in this cases none, advice on cessation should be offered. Preoperative patient education is critical in making the patient to be aware of the condition that she might encounter. Studies done have shown that postoperative period improves patient outcome including pain control management, lower anxiety levels and higher patent satisfaction. As the nurse caring Margaret, these key steps will be beneficial in offering the support and care at this critical moment. In the preoperative peace Margaret will have to be admitted at the hospital, where she will have to sign the necessary consent form, thereafter admission of anaesthesia, then surgical process which usually takes 45 minutes to 2 hours in complex cases, thereafter the patient is taken to the recovery rooms, where she is going to rest and given painkillers to ease pain, at times oxygen support might be needed.

 

Nursing care assessments and diagnostics

The preoperative process involves the administration of prophylaxis which aid in reduction of pain. In consultation with the doctor, appropriate regiment of prophylaxis should be used so as to reduce the rate of infection level later on.

Due to her weight Margaret may not be able to walk freely as the weight might exert excess pressure on the lower limbs, hence getting mobile might be successful on the second day after surgery. She will be removed from the painkillers drips, fluid or oxygen therapy. Slow walking progress should be initiated depending on the patient ability and the outcome of the healing process. For Margaret she might need to use crutches or frame to walk , this can be aided with presence of physiotherapist at the health facility, physiotherapist will provide the needed posture and care so as not cause further harm and injury to the surgical knee.

In post operative process of pain management , the recommended elements for assessment include questions such as ; the onset and pattern of pain, the location of pain, degree, the intensity; how severe it is, promoting factors, treatment regimes, effect of pain on other physiological process, pain management barriers and factors underlying like culture, language barrier, cognitive barrier and interventions misconceptions.

A systematic study review by Roger et al., (2015) of post operative care has been conducted and came up with recommendations on type and mode of care medical patient attendants and clinicians should use in the management of post operative pain, which its guidelines can be applied on Margaret case. Patient and family centred care approach should be used; education information specifically tailored to the patient should be used. The information should include the treatment options for postoperative pain management and clear plans of goals for pain management are to be initiated with Margaret. An assessment of Margaret patient status needs to be assessed.

Caregivers should be involved in education processes on the procedures of assessing pain and administration of analgesics and simple pain management processes. The approach should be a shared decision making process, which is based on factual information, as patient involvement in decision making process have better health outcomes, (Hibbard, 2013).

 

References

Coriolano, K., Aiken, A., Harrison, M., Pukall, C., Brouwer, B., & Groll, D. (2016). Changes in knee pain, perceived need for surgery, physical function and quality of life after dietary weight loss in obese women diagnosed with knee osteoarthritis.

Hibbard, J. Engaging health care consumers to improve the quality of care. Med Care. 2003; 41: 161–170.

Peersman, G. MD; Laskin, R. MD; Davis, J. RN; Peterson, Margaret PhD, (2001). Infection in Total Knee Replacement: A Retrospective Review of 6489 Total Knee Replacements. Clinical Orthopaedics & Related Research: November 2001 - Volume 392 - Issue - pp 15-23

Petersen, K. K., Arendt-Nielsen, L., Simonsen, O., Wilder-Smith, O., & Laursen, M. B. (2015). Presurgical assessment of temporal summation of pain predicts the development of chronic postoperative pain 12 months after total knee replacement. Pain, 156(1), 55-61.

Rönn, K., Reischl, N., Gautier, E., & Jacobi, M. (2011). Current surgical treatment of knee osteoarthritis. Arthritis, 2011.

Scott, D., & Kowalczyk, A. (2007). Osteoarthritis of the knee. BMJ clinical evidence, 2007.
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