Simulation Help

[esunada]

Hi,

I am confused about this portion of a simulation test. The data I was provided said she is BRP one assist but she had total knee replacement three days ago and it also says she has toe touch weight bearing on left leg, which means she can touch her toes to the ground but not put weight on it. She won't get crutches until later in the day. So how would she have BRP? In other words how would she get there if she can't put any weight on her feet even if I helped her as a one person assist? Is this a trick? I just don't want to jeapordize their safety, so I'm thinking bedpan but it's good if they can ambulate if there is a way.

[SnowStar4]

Those are weird orders for a knee replacement, there must have been other issues or yeah, worked wrong. Our are usually WBAT the first day! When we do have patients that can't walk on either leg though, sometimes we will use a slide board to slide them to a cammode, chair, or wheelchair so that they are not always in bed. Maybe that will work?

[thmpr]

I agree about that order being strange, but it doesn't say BR so I would interpret BRP as a desired outcome. Most 3 day post op total knees w brp assist x1 are (or ought to be) weight bearing. See if there is a fww & gait belt you can use. Be prepared to use bsc if necessary.

Note: Why is she non weight bearing on effected side? Pain? Fear? ASSESS: If possible, assess her pain prior to getting oob... total knees (quads) tend to stiffen up with immobility. Pain management will help significantly with weight bearing and self efficacy. Also, it helps to have her use CPM prior to getting oob.

PS "Is this a trick?"

Good critical thinking. If you continue to ask these questions in your career you will do well

[traumaholic87]

I have past experience in Physical Therapy, so there are a few ways to go about this, and yes, it is possible, because I see, at our hospital, other nursing staff performing it successfully, not just physical therapy.. One, use a walker, if you guys have one readily available, and have two people, one on each side, with a gait belt around the patient, assist them in a pivot transfer to a bedside commode. It is easier for some to just pivot than it it is to hop, though I have seen on many occasions pt's hop with short steps with a walker.. And if they have good upper body strength, there is no reason why they can't walk. Or, if no walker's are available, still using a gait belt (and this is the PT background talking), because no transfers of any kind should be used without a gait belt, have one person on each side of the pt, one hand on the belt, and one hand under each arm, and have them bear full weight on their good leg, using the replaced knee more for balance, and help them with a pivot transfer to a BSC. Hope this helps and wasn't too confusing!!

[Pepper The Cat, BSN, RN]

I would do a pivot transfer to a commode and then , if possible, put the commode over the toilet.

I try to avoid bed pans is at all possible. I find that most people just don't empty their bladders as well on a bedpan as they do sitting up on the toilet. Plus, just getting up and moving is better for the pt in general. The longer you let them stay in bed using the bedpan, the longer their rehab process.

Being NWB after a knee replacement is very strange but I guess it could happen.

Once they have crutches/walker, they should definitely be made to go to the toilet.

Bedpans may be easier, but may not be always the best choice, esp from a rehab point of view!

[traumaholic87]

I would do a pivot transfer to a commode and then , if possible, put the commode over the toilet.

I try to avoid bed pans is at all possible. I find that most people just don't empty their bladders as well on a bedpan as they do sitting up on the toilet. Plus, just getting up and moving is better for the pt in general. The longer you let them stay in bed using the bedpan, the longer their rehab process.

Being NWB after a knee replacement is very strange but I guess it could happen.

Once they have crutches/walker, they should definitely be made to go to the toilet.

Bedpans may be easier, but may not be always the best choice, esp from a rehab point of view!

You're right, being NWB is unusual after a TKA, but it does happen, especially if the case is complicated or if there are weight issues, or we sometimes see it if the operated knee has already been operated on before and something has happened in the recovery process. But surprisingly, I find that a majority of the NWB TKA's do very well actually.. Idk why that is, maybe it's because they've already been fighting an uphill battle with their knee.

Interesting stuff!

[esunada]

Thank you for your help!

[Pepper The Cat, BSN, RN]

Frankly, I'd be more concerned that a 3 day post op Knee Replacement didn't have a walker or crutches yes! Even NWB!