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Discussion

Question help

Hey there. I came across this nclex type question and its confused me. Of course it's from a book with no answer key. I believe the answer would be 2 do to the knee gatch. However answer 1 seems like it might be the answer to prevent DVTs but I keep thinking it was only arthroplasty not a replacement. And he is ambulatory since he's at the office. Any help would be appreciated. Thanks in advance.

During a visit to the medical office a nurse collects data from a client who had a knee arthroplasty 1 week ago. Which of the following statements made by the client should concern the nurse most?

1. "I am so glad to off those blood thinners."

2. "I will keep a pillow under my knee when I am in bed."

3. "I am planing to use my wheelchair to help me get around."

4. "I plan to take Motrin instead of the prescribed Lortab for pain control."

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    • Featured Replies

    • Admin

    Arthroplasty = replacement. What is the standard for post op care of a total knee patient?

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    Try to eliminate some answers first. Eliminate 3. Now which one is most concerning?

    Out of the 3 left, which one can cause death?

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    • Admin
    Try to eliminate some answers first. Eliminate 3. Now which one is most concerning?

    Out of the 3 left, which one can cause death?

    Why would you eliminate answer 3?

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    • Author

    Not taking the blood thinners could cause death do to a formation of a clot that could travel to the lung. But the knee gatch with the pillow can cut off circulation. And not taking the prescribed pain med is not life threating.

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    Not taking the blood thinners could cause death do to a formation of a clot that could travel to the lung. But the knee gatch with the pillow can cut off circulation. And not taking the prescribed pain med is not life threating.

    There you go. That is the most concerning. NCLEX is an strategy test exam. By the way, Motrin is NSAIDS which can cause bleeding. [emoji106][emoji106]

    Why would you eliminate answer 3?

    Its less important than the pt developing clot which can turn to PE then death.

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    • Author

    Thank you so much :yes: have been out of school for seven months and I feel like I have lost common sense and the ability to assess.

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    Thank you so much :yes: have been out of school for seven months and I feel like I have lost common sense and the ability to assess.

    Your welcome. Good luck with your NCLEX.

    For further reading, pls read this article.

    Medscape: Medscape Access

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    • Admin
    1. "I am so glad to off those blood thinners."

    Was the patient on anticoagulation preop? If not, the anticoagulation is only short term. There are other methods of DVT prevention other than medication. Those are often the better option as anticoagulation medications are not risk free.

    2. "I will keep a pillow under my knee when I am in bed."

    You mentioned concern due to the knee gatch. Unless the patient has a hospital bed at home, there is no knee gatch to be concerned about. A pillow under the knee is acceptable.

    3. "I am planing to use my wheelchair to help me get around."

    Is the patient wheelchair bound? The goal is to get these patients up and walking the day of or the day after surgery. That mobilization will help with DVT prevention, decrease risk of pneumonia, and decrease risk of other complications of immobility.

    4. "I plan to take Motrin instead of the prescribed Lortab for pain control."

    What is the patient's pain level? A week out from surgery, it is quite possible that the pain is quite manageable with OTC medications.

    Thus, I would say the answer is 3. The whole goal of knee replacement is to increase mobility. A wheelchair contradicts the goal.

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    Its less important than the pt developing clot which can turn to PE then death.

    The significance of using a WC instead of ambulating (a week after surgery!) is that it also contributes to developing blood clots. Answers 1,2,3 & 4 all have to do with coagulation.

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    • Admin
    Its less important than the pt developing clot which can turn to PE then death.

    Except there are other methods of preventing DVT and PE than anticoagulation medications that are not risk free.

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    OP pls read the article i posted from medscape. This supports my answer. The NCLEX question asked for the most concerning statement. The pt stopped taking anticoagulant after only one week.

    "Total Knee Arthroplasty. The duration of anticoagulation needed to prevent DVT after hospital discharge is an important aspect of care. Current guidelines recommend extending prophylaxis for 10 days after knee arthroplasty and for four to six weeks after hip arthroplasty and hip fracture surgery" from that article.

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    OP, it really is too bad that your source did not give you an answer with rationale. 50% or more of our TKR are dc on aspirin & fish oil; coumadin only if a home med & xarelto if they have a significant hx of dvt.

    Sure, get your pt to take 3 more days of whichever med was rx but are they gonna get their butt up from the wc? If not, 10 days of anticoag is not going to benefit them in the long run.

    Not to mention, they may as well set a date for a knee manipulation & injection. But that could just be "real world" thinking. 😆

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