Patient with a Left TKA...need help with care plan

[b.randolph]

I have a 76 year old male patient who had a left TKA one day ago and will have the right one done next week. He had a MI in 1991 and is stable on low dose aspirin and antihypertensives. He has arithitis. His albumin level was 3.3 and he recieved 500 ml Albumin 5% today. I came up with Acute Pain, Risk for Injury, and Impaired Physical Mobility. I am at a loss for the as related too and another dx. My instructor suggests only to do something with the albumin. His BMI is 24.9, so he's not "imbalanced nutrition less than" Any help would be appreciated.

[Mike R, ADN, BSN, RN]

.... My instructor suggests only to do something with the albumin. His BMI is 24.9, so he's not "imbalanced nutrition less than" .....

On the contrary. Just because BMI is a normal value doesn't necessarily mean he's receiving enough nutrients. Would you agree that a normal aging process is decreased GI secretions? Parietal cells in the stomach secret gastric intrinsic factors which are responsible for absorbing vit B12. B12 is involved in a plethora of things including RBC and albumin formation. Which is why albumin levels are a huge indication of malnutrition.

When aging slows down parietal cells, they run a higher risk of pernicious anemia and edema due to loss of oncotic pressure from decreased albumin, among other things.

This should be more than enough information to get you on your way. Look at the big picture and think in what ways decreased RBC's could affect the body.

[AggieNurse99, BSN, RN]

Does he have a pre-albumin level? It is much more indicative of actual malnutrition as albumin itself reflects 3 days. Malnutrition, as the above poster pointed out, does not just reflect BMI.