Question help

Editorial Team / Admin · Feb 7, 2016

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

nortonplusRN · Feb 7, 2016

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

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

Editorial Team / Admin · Feb 7, 2016

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?

purplegen1 · Feb 7, 2016

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.

nortonplusRN · Feb 7, 2016

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.

purplegen1 · Feb 7, 2016

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.

nortonplusRN · Feb 7, 2016

Thank you so much 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

Editorial Team / Admin · Feb 8, 2016

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.

RainMom · Feb 8, 2016

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.

Editorial Team / Admin · Feb 8, 2016

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.

nortonplusRN · Feb 8, 2016

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.