• Subject Name : Nursing

Outpatient Total Knee Arthroplasty

Table of Contents

1 Introduction.

2 Patient’s Return to the Ward.

3 Care Requirements.

3.1 Considerations for Patient Assessment

3.2 Possible Complications.

3.3 Health consideration after Discharge.

4 Conclusion.

5 References

1 Introduction to Gerald Jaworski Case Study

The patient is 72 years old Gerald Jaworski. He came for knee replacement in the hospital with the history of benign prostatic hyperplasia, also referred to as BPH, is a disorder in men with a swollen and not cancerous prostate glands. Benign prostatic hyperplasia is also referred to as benign prostatic hypertrophy. The prostate has two major stages of development as a man grows old. The first happens as the prostate doubles in size in early puberty. The second growth period starts at around 25 years old and is going on for most of a man's life. The second step of development also includes benign prostatic hyperplasia. He has also well controlled hypertension. He lives in the supported care capability with his wife.

2 Patient’s Return to the Ward

The patient was shifted to the ward with NaCl running at 85ml/hr. He has a urinary catheter insitu. Whilst the most common urology condition in elderly men is benign prostatic hyperplasia (BPH), the pathophysiology remains vague. But recently, it was speculated, that the combined effects of prosthetist (the static component) and α1-adrenoceptor-mediated increased smoother prostatic muscle tone (the dynamic component) resulted from the vacuuming (obstructing) and stored (irrelative) of BPH (Causey-Upton, 2018).

As a result of this, inhibitions of α1-adrenoceptor antagonists in the smooth muscle of the prostate gland and bladder neck were usually attributed to inhibit of α1adrenoceptors, resulting in the improvement of blocking bladder outlet. However, the frequency of lower urinary tract problems (LUTS) and the scale of the prostate or bladder obstruction interventions are not associated. Moreover, the storage effects also persist even after blockage is resolved by prostatectomy. Recent experimental data indicate the role in LUTS relief mediation, particularly in terms of storage symptoms, of a central mechanism of action of α1-adrenoceptor antagonists. In addition, findings from the Veterans Affairs collaboration report analyses of adverse effect evidence suggest that dizziness and asthenia associated with antagonists of α1-adrenoceptors could not be attributable to vascular incidents. He also has well controlled hypertension (Griesdale, 2015).

3 Care Requirements

3.1 Considerations for Patient Assessment

The most prevalent neoplastic disease affecting men is Benign Prostatic Hyperplasia (BPH) and it is a significant cause that affects the health of the American men and women. The intimate anatomical relationship between the prosthetic and bladder necks makes this pathological shift significant. In autopsy experiments with measured and real weight, prostate length, or histology, the correlation of BPH with ageing has frequently been shown. Randall and Harbitz and Haugen found that, with histological data, in men over 50 years of age the prevalence of definite and definitely BPH was above 50%. As men reach their eighth decade, this incidence increases to 75%. Patient with benign prostatic hyperplasia will normally suffer either voiding (susceptibility, poor current, endangerment, or incomplete empirical) or storage (urinary duration, nocturne, night enuresis, or urgent impairment) symptoms in primary care with low urinary tract symptoms (LUTS). Hematuria and haematospermia may be other less frequent symptoms. In order to discern BPH from prostate cancer, a digital rectal exam (DRE) is necessary. A firm symmetrical and smooth prostate is a comfortable sign. As part of the original evaluation, each patient really should finish an International Prostate Symptom Score (IPSS) survey (Steers, 2015).

3.2 Possible Complications

The risk of urinary arthroplasty after hip or knee has varied widely among the various research, depending on the anesthesia and analgesia, with figures ranging from 0 to 75%. In a recent study, the weighted average frequency of persistent peripheral nerve blockade was calculated by authors to be as low as 8,8 percent (95 % confidence interval [CI] 5,2–12,4) for epidural analgesia to be as high as 34,1% (95 % CI 32,9–35,4). Urinal restriction after postoperative surgery can lead to serious morbidity including prosthesis and sepsis. URC is well known, but risk assessments rely on small samples can differ significantly in reporting following spinal anesthesia for hip or knee arthroplasties. Similarly, the detection of urinary retention risk factors in this group contributed to differences (Steers, 2015).

The launch in English Columbia (BC) Canada of the Center for Surgical Innovation (CSI), an effort to minimize wait times on hip and knee arthroplasties, gave us the chance to research a huge homogeneous number of patients receiving related anesthesiology arthroplasty treatments. Both the BC Provincial government as well as the Vancouver Coastal Health Authority developed the Centre for Surgical Innovation (CSI) of the University of BC Hospital to eliminate wait times for outpatient major joint replacement procedures, and initiated the Osteoarthritis Service Integration System (OASIS) initiative. The University of BC Hospital is a related university-referral center in Vancouver, BC. The CSI concentrates on optional primary reconstruction treatments for hip and knee. Patients of joint substitute for acute injuries are ineligible, including such hip fractures (Abdul-Muhsin, et al., 2020).

Although the anesthetic was not uniform, it was identical to the department's participants. Induction of intravenous opioids, propofol and rocuronium was done for general anesthesia. Anesthesia of rocuronium and intravenous opioids (morphine or hydromorphone) was sustained using sevoflurane or desflurane, if applicable. A propofol injection was applied often intravenously. Neuraxal blockade with the intrathecal long-acting local anesthetic (bupivacaine or ropivacaine) with intrathecal Morphine applied at the discretion of the anesthesiologist concerned was accomplished for spinal anesthesia. Until surgical incision, patients got 2 g iv cefazolins (or 600 mg iv clindamycins if penicillin Allergy is reported) (Causey-Upton, 2018).

Crystalloides (normal saline or plasmalyte) consisted of intravenous fluid therapy alone. Both patients administered intravenous morphine or hydromorphone oral oxycodone as well as patient-controlled illgesia after operation. Physiotherapy and treatment followed a clinical course to encourage treatment quality. As regards neutrality, the nursing approach was to prevent the regular catheterization of the patient's bladder intraoperatively or postoperatively due to infection issues. In comparison to prostate cancer which is normal in the periphery of the gland, BPH occurs in the transition region of the prostate near the urethra. If you know, this urethra moves into the prostate, which results in urinary problems by the prolongation of the prostate near the urethra. Digital rectal screening for prostate cancer is an important screen, as the majority of prostate cancer occurs in the periphery of the glass near the rectal surface. This is not the case for BPH since it induces urinary problems by the growth of tissue near the urethra (Gogineni, 2019).

3.3 Health Consideration After Discharge

Knee substitution is the replacement surgery of both knee parts in the joint (Kerrigan & Saltzman, 2017). Knee substitution is a joint substitution surgery. The tibia section substitutes for the top part of the tibia, the femoral substitute for the femoral condyles, the patellar groove, and the patellar substitute the bottom surface of the patellar. TKR is given when osteoarthritis impacts both sides of the knee. Osteoarthritis worsens with time and affects the articular cartilage, resulting in discomfort and rigidity when the bone systems freeze. As the wife of patient is very careful so it’s easy for them to take care of him after surgery at home (Griesdale, 2015).

Controversial are the screening criteria for patients searching for outpatient TKA. For this reason, many morbidity scoring and rating schemes of various performance levels were used. These include the classification of ASA, Charlson Comorbidity Index and Ambulatory Arthroplasty Risk Assessment (AAAR). Among them, the AAAR classifications are highlighted. The BMI, physical and cognitive activity and social assistance in the home are other significant underlying influences of the patient.

During 2018, Gogineni et al identified three main outpatient factor categories (inclusion criteria): surgical factors (primary and first / second case of TKA); medical factors (age < 75 years; BMI < 35 years; no anemia, no chronic obstructive pulmonary disease; no congestive heart defect; no cirrhosis. TKA was shown to be healthy, has a low readmission rate and is financially beneficial. In fact, clinical studies have been reported as strong as in sick patients (Gogineni, 2019). Shah et al announced in 2018 that ambulatory overall joint arthroplasty (TJA), which is released into the home at an individual ambulatory hospital, is a healthy alternative to a multidisciplinary TJA route after growth. Gromov has evaluated in two hospitals that have been tested for possible DOS release all consecutive and unselected patients scheduled for THA or TKA. Readmission rates could be comparable for paired patients with at least one extra night in DOS patients. No security signal with the same-day discharge (SDD) may be available with the selection criterion used (Gogineni, 2019).

4 Conclusion on Gerald Jaworski Case Study

In conclusion it is stated that Gerald Jaworski is 72 years old. He has been knee-replaced by a background of benign prostatic hyperplasia in a hospital, also called BPH, which is a condition in men with enlarged prostate and not cancer. Benign hyperplasia of the prostate is also known as benign hypertrophy. As a man grows up, the prostate has two main stages of growth. The first emerges in early puberty as the prostate doubles. Benign prostatic hyperplasia is part of the second stage of growth. He also regulates elevated blood pressure well. He lives with his wife in the assisted treatment. He has shifted to ward with NaCl. Later he was discharged to home with precautions to take care of.

5 References for Gerald Jaworski Case Study

Abdul-Muhsin, H. M., Jakob, N. M., Cha, S. M., Zhang, N. M., Schwartz, A. M., Navaratnam, A. M., . . . Humphreys, M. M. (2020). Incidence, Outcomes, and Prediction of Postoperative Urinary Retention After a Nonurologic Procedure. Global Research and Reviews, 4(5).


Gogineni, H. C. (2019). Transition to outpatient total hip and knee arthroplasty: experience at an academic tertiary care center. Arthroplast Today, 5(1), 100–105.

Griesdale, D. E. (2015). Risk factors for urinary retention after hip or knee replacement: a cohort study. Can J Anaesth, 58(12), 1097–1104.

Rodríguez-Merchán, E. C. (2020). Outpatient total knee arthroplasty: is it worth considering? EFORT Open Rev., 5(3), 172–179.

Steers, W. D. (2015). Clinical ease of using doxazosin in BPH patients with and without hypertension. Prostate Cancer and Prostatic Diseases, 152–157.

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