Struggling with a nursing diagnosis/care plan for TKA

[fazeydee]

Hi, All, I am new here, new to nursing. At the end of my first semester in PN school and am about to fill out my final paper on my recent clinical patient and I am stumped.

My first priority for this patient is the relief of acute pain, but since I've done care plan on pain already, I need to pick another one . I've chosen Risk for impaired tissue perfusion, related to surgical procedure on Left knee, d/t osteoarthritis, because on Maslow's , oxygenation is the first listed , left to right.

Maybe I need to walk away from it and clear my head and then when I come back, it'll make sense, but I've hit a brick wall.

Do you have any suggestions? I don't want you to do my work for me, that won't help me learn. I'm old school that way .:) Just need a boost.

Thanks!

Fazey

[fazeydee]

Hi, it's me again, here's what I came up with. It helped me to get away from the situation a bit. :) btw, this is for the day after the surgery, and if it were immediatly after ,I know that I'd be assessing the pt much more frequently. :)

Nursing Diagnosis:

Risk for impaired tissue perfusion r/t surgical procedue to L knee, d/t osteoarthritis.

Goal:

Patient will experience adequate tissue perfusion in order to promote healing of impaired tissues due to surgery.

Interventions and rationales:

*Assess and document vs and pain level of patient qh- to stay aware of pt's status, in case hcp should be notified

*Keep oxygen n/c applied as prescribed, check qh-to ensure that oxygen level is high enough to promote proper healing.

*Encourage use of incentive spirometer , db&c, q2h-To keep fluid from building up in lungs, which would hinder oxygen intake.

*ASsess neuro status qh - to be assured that patient is not experiencing respiratory depression due to use of narcotics for pain.

*Assess respirations, symmetry of chest expansion, regularity of breathing, such as deep or shallow qh-to ensure that pt is bearthing deeply enough to rec. adequate oxygen, and that both lungs are clear.

*Promote use of cpm, and walking to beside commode, etc,- physical activity enhances tissue perfusion

*Educate patient on importance of adequate tissue perfusionq day- so that she will cooperate with nursing interventions

Outcome- Patient experienced adequate tissue perfusion- goal met

Pt hx 66yo female, w/HTN, OA, diabetes, sleep apnea and elevated cholesterol.

R TKA in 2003, L TKA march 2011, then 3 more TKA surgeries following (on L knee) because of MRSA infection (total of 4 surgeries on this left knee in 2011)

What do y'all think?

Fazey

[nurseprnRN, BSN, RN]

i think you've put the cart before the horse. assessment comes before diagnosis, not afterwards. how would you like it if your physician said, "you've got cancer. now let's go find some data to support that"?

" i've chosen risk for impaired tissue perfusion, related to surgical procedure on left knee, d/t osteoarthritis, because on maslow's , oxygenation is the first listed , left to right."

what data do you think justify this? i mean, maslow's right, we all need decent tissue perfusion, of course. but why does this diagnosis strike you as important for this patient? what did you assess about her that tells you she is at risk? just having had surgery? is there something about surgery that increases risk? (hint: there's something else that increases her risk of bad perfusion, but you've passed right by it without saying hello )

also, all that respiratory stuff is well and good, but not really related to the cause of her problem that you identified (having had surgery). there's another clue that it probably isn't a potential cause (risk for...). however, you could look at possible problems she's going to have being in bed (hint hint!) (and there's another big big thing she has you've walked right past without saying hello, too!).

[ama8215]

You are probably done by now, but in case anyone reads this in the future your goal needs to be measurable. You should define a parameter for "adequate perfusion" and there needs to be a specific time frame also.

Good luck!