Question

A client has just had an arthroscopy of the right knee for diagnostic evaluation of chronic knee pain. Which assessment finding has the highest priority for being reported to the surgeon? A. Report of pain is 7 out of 10 on pain scale B. Strength of right pedal pulse is decreased. C. Capillary refill time is 3 seconds.. D. Pain is unrelieved by application of ice.

Short answer

B. Strength of right pedal pulse is decreased.

Step-by-step solution

- Understanding the Scenario

A client has undergone an arthroscopy of the right knee for diagnostic evaluation. Post-procedure, several findings need to be assessed to determine the highest priority for reporting to the surgeon.

- Evaluate Pain Level

Evaluate the reports of pain. A pain level of 7 out of 10 indicates significant discomfort but does not necessarily indicate an emergency.

- Assess Pulse Strength

Assess the strength of the right pedal pulse. A decreased right pedal pulse could indicate compromised blood flow, which is a significant concern, but we need to compare it with the other options.

- Check Capillary Refill Time

Check the capillary refill time. A time of 3 seconds is within the normal range (less than 3 seconds), indicating normal peripheral perfusion.

- Evaluate Response to Ice Application

Evaluate the client's pain response to ice application. Pain that is unrelieved by ice could suggest problems beyond normal post-operative pain, potentially indicating complications that might require surgeon intervention.

- Determine Highest Priority

Compare the findings: A decreased pedal pulse and pain unrelieved by ice are concerning. However, a decreased pedal pulse is the highest priority to report to the surgeon as it could indicate significant vascular issues or potential complications affecting blood flow.

Key concepts

Arthroscopy

Arthroscopy is a minimally invasive surgical procedure used to diagnose and treat joint problems. It involves inserting a small camera, called an arthroscope, into the joint through a tiny incision. This allows the surgeon to see the inside of the joint on a monitor and to perform corrective procedures if necessary. Common joints examined by arthroscopy include the knee, shoulder, elbow, and ankle. For our patient, arthroscopy was performed on the right knee to evaluate chronic knee pain. This procedure typically has fewer risks and a quicker recovery time compared to traditional open surgery.

Chronic Knee Pain

Chronic knee pain is pain in the knee that persists for more than 12 weeks. It can result from various conditions, including arthritis, cartilage injuries, tendonitis, or ligament injuries. In this case, the patient underwent arthroscopy to identify the cause of their chronic knee pain. Common symptoms include swelling, stiffness, weakness, and an inability to fully straighten the knee. Initial treatments might include rest, physical therapy, and anti-inflammatory medications. If conservative treatments fail, procedures like arthroscopy may be necessary to explore and address underlying issues.

Pedal Pulse Evaluation

The pedal pulse evaluation is crucial in assessing blood flow to the lower extremities. The pedal pulse can be felt on the top of the foot, and its strength provides information about circulation. A decreased pedal pulse may indicate reduced blood flow, which is concerning as it could signify vascular complications, especially after a procedure like arthroscopy. In the exercise, a decreased right pedal pulse was noted, making it a high priority finding that should be reported to the surgeon immediately. Maintaining adequate blood flow is essential for healing and preventing further complications.

Pain Management

Pain management is critical in the post-operative care of patients. Effective management involves assessing the patient's pain level, understanding the cause, and providing appropriate interventions. In this scenario, the patient reported a pain level of 7 out of 10, and pain was unrelieved by ice application. While high pain levels are concerning, the inability to relieve pain with ice might indicate complications beyond normal post-operative discomfort. Keeping the patient comfortable while monitoring for signs of complications ensures better recovery and patient satisfaction.

Capillary Refill Time

Capillary refill time assesses the efficiency of blood flow to the body's tissues. It is performed by pressing on the nail bed until it turns white and then releasing it to see how quickly color returns. Normal capillary refill time is less than 2 seconds. In our example, a refill time of 3 seconds was noted, which is close to normal but should still be monitored. This measure helps identify perfusion issues that could indicate circulatory complications. Keeping an eye on capillary refill time post-procedure helps catch potential problems early.