2. Total Knee Arthroplasty (TKA) Total knee arthroplasty is surgery done to remove and replace knee joint. Knee joint is where the femur and tibia meet. The patella protects the knee joint. Arthritis, hemophilia, Paget’s disease or an infection can damage knee joint. Avascular necrosis and surgery on femur can also damage knee joint. These conditions cause knee pain and decrease ability to do activities and sports

3. Total Knee Arthroplasty During TKA, damaged parts of knee joint are removed and replaced with an implant. Implants are made of metal, ceramic, or plastic. TKA surgery may decrease, take away knee pain, and make standing, sitting, and walking easier.

4. Knee Anatomy

5. Patient Care Plan for TKA Day 1 Assessment Vital signs done Q 4 Hours Neurovascular assessment to be done Q 4 Hours Assess I/O Q shift and document Knee dressing to be assessed Q shift and documented. Dressing should be Dry and Intact. Notify Physician if there is excessive bleeding.

6. Care Plan Day 1 Activity Knee extension. No pillow under knee. Provide bed with overhead trapeze for movement in bed. Patient repositioned Q 2 hours as per protocol. Help patient perform Range of Motion (ROM) on affected extremity 10 times while awake.

7. Care plan Day 1 Treatments Teach patient to use IS 10 times while awake, to perform deep breathing and coughing exercise. Provide ice therapy to operative knee. Make use of knee immobilizer if ordered by physician. Continuous Passive Motion machine to be used if ordered by physician. Make use of Sequential Compression Device. Make sure Foley catheter is inserted and document output. Monitor results of laboratory orders and notify physician of critical results.

8. Care Plan Day 1 Medications Teach patient to use PCA pump effectively. Make sure antibiotics, anticoagulants, IV fluids, and stool softeners prescribed are explained to patient and used as prescribed. Start patient on clear liquids as ordered. Assess patient for adequate pain relief Q 4 hours. Assess patient on readiness for teaching Nurse should initiate a teaching plan on TKA.

9. Care Plan Day 2 Assessment Continue to monitor vital signs Q 4 hours. Neurovascular checks to be done Q 4 hours Asses incision site for signs and symptoms of infection, and if any should be reported to physician. Dressing should be dry, clean, and intact. Continue to assess and document I/O’s Q shift. Output should be greater than or equal to 240 ml.

10. Care Plan Day 2 Activity Make sure there is no pillow under affected knee. Patient to perform range of motion on affected extremity independently. Patient to change positions in bed with minimal help Assist patient with transfer from bed to chair. Encourage patient to start ADL’s

11. Care Plan Day 2 Treatments Continue use of ice to operative knee Encourage patient to cough, deep breath, and use incentive spirometer while awake. Continue use of SCD’s, CPM, and knee immobilizer as ordered. Remember to D/C Foley catheter. Dressing on knee to be assessed and changed as ordered. Continue to monitor ordered laboratory results and notify physician of critical values.

12. Care Plan Day 2 Medications Continue with the use of stool softeners, antibiotics, anticoagulants, and IV fluids as ordered. Assess patient and advocate for laxatives if no bowel movement. Encourage patient on fluid intake to be greater than 1500 Q shift, and diet to be changed as tolerated. Assess patient for pain relief Q shift. Continue and involve family with teaching plan on TKA.

13. Care Plan Remainder of stay in Hospital Assessment Vital signs and Neurovascular checks done Q 8 hours. Continue to assess incision sites for signs and symptoms of infection. Patient incision site to be clean, intact, dry, and healing. Assess patient on bladder patterns after D/C of Foley catheter.

14. Activity Patient to transfer from bed to chair TID with minimal assistance. Encourage patient to continue with ADL’s independently Patient to continue with ROM exercises, and change positions in bed. Encourage patient to get involved with all therapy sessions.

15. Treatments Wound should be opened to air. Continue with deep breathing, cough, and incentive spirometer use while awake. Continue use of knee immobilizer, SCD’s, and CPM machine as ordered. Patient can also use elastic socks. Monitor laboratory results as ordered.

16. Medications Discontinue use of PCA pump. Saline lock IV and D/C saline lock if possible. Patient to continue with current ordered medications. Assess patient for adequate pain relief. Assess patient on progress with teaching plan on TKA

17. Discharge Plans Discuss with patient discharge date, destination, and mode of transportation. Assess patient for family/friend support. Review with patient all discharge education. Provide patient with prescriptions. Assess patient for knowledge of home care, and follow up with physician. Make sure all patient questions and concerns are addressed.