Question

A client is five hours postoperative total knee replacement. Which assessment result requires the nurse to notify the physician? A. Temperature of ${100}^{\circ }$ Fahrenheit B. Hematocrit of $24\mathrm{\%}$ C. Dime-size serous drainage on dressing D. $300\mathrm{mL}$ Foley output in five hours

Short answer

Answer: The nurse should notify the physician about the hematocrit value of 24%.

Step-by-step solution

Option A

A temperature of ${100}^{\circ }$ Fahrenheit is just slightly above normal body temperature. This can indicate a mild fever, but it's not unusual for patients to have a mild fever following surgery. Therefore, this option does not require the nurse to notify the physician urgently.

Option B

A hematocrit of $24\mathrm{\%}$ is a matter of concern. Hematocrit is the percentage of red blood cells in the blood. The normal range for hematocrit in adult males is between $38.8\mathrm{\%}$ and $50\mathrm{\%}$, while for adult females, it's between $34.9\mathrm{\%}$ and $44.5\mathrm{\%}$. A hematocrit value of $24\mathrm{\%}$ is significantly lower than the normal range, which could indicate anemia or substantial blood loss. This outcome requires the nurse to notify the physician immediately.

Option C

Dime-size serous drainage on the dressing after five hours of surgery is not uncommon in postoperative total knee replacement patients. It is typically not a cause for worry, and the nurse does not need to notify the physician urgently.

Option D

A Foley output of $300\mathrm{mL}$ in five hours following total knee replacement surgery is within the normal range for urine output. There's no urgent need for the nurse to notify the physician about this, as it does not indicate a significant problem. In conclusion, the nurse should notify the physician about the assessment result with a hematocrit value of $24\mathrm{\%}$, which is option B.

Key concepts

Knee Replacement

Knee replacement surgery, also known as knee arthroplasty, is a common operation designed to replace a worn, damaged, or diseased knee with an artificial joint. This procedure is typically performed when a knee joint is severely damaged due to arthritis or injury, causing pain and impairment of day-to-day activities. People often undergo knee replacement when non-surgical treatments, such as medication and physical therapy, no longer provide relief.

The surgery involves removing the damaged joint surfaces and replacing them with metal and plastic components shaped to allow continued movement. While the procedure is quite effective in reducing pain and improving mobility, it requires careful postoperative care to ensure successful outcomes. Patients need to adhere to their rehabilitation plan and attend physical therapy sessions to regain strength and flexibility in the knee joint. Understanding the nuances of knee replacement is crucial for both patients and healthcare providers to manage expectations and recovery strategies effectively.

Postoperative Assessment

After knee replacement surgery, continuous postoperative assessment is crucial to ensure patients' safety and promote healing. This process involves regularly monitoring vital signs and checking for any signs of complications.

Key aspects of postoperative assessment include:

• Checking for signs of infection, which may include redness, warmth, or discharge at the surgery site.
• Monitoring for blood clots, commonly in the legs, which can be dangerous if they move to the lungs.
• Assessing the level of pain and administering prescribed pain relief medications accordingly.
• Observing drainage and surgical dressing to track any unusual fluid accumulation.
• Reviewing urine output, as reduced output may signify dehydration or renal issues.

These assessments help ensure patients recover smoothly and allow healthcare providers to address any complications promptly. Regular evaluations are essential components of post-surgical care, guiding healthcare teams on the necessary interventions.

Nursing Considerations

Nursing considerations play a pivotal role in the recovery of a patient after knee replacement surgery. Nurses are responsible for implementing the care plan and monitoring the patient's progress. This includes managing pain effectively and assisting with a gradual increase in activity levels, as movement is crucial for preventing complications like blood clots.

Some important nursing considerations include:

• Assessing the patient's pain and administering pain relief as prescribed.
• Monitoring for potential signs of complications, such as infections or bleeding.
• Encouraging mobility and guiding patients through gentle exercises tailored to their recovery phase.
• Educating patients about their postoperative recovery process, including any restrictions and signs that warrant medical attention.

Nurses play a key role in educating and motivating patients, providing them with the necessary knowledge to support their own recovery. By doing so, they help promote a safe, smooth, and effective postoperative experience.

Hematocrit Levels

Hematocrit levels are measured to evaluate the proportion of red blood cells in a person's blood. Red blood cells are vital as they carry oxygen from the lungs to the rest of the body. A hematocrit test is particularly significant in postoperative care, as it helps healthcare providers gauge a patient's blood status after surgery.

Normal hematocrit levels vary slightly between genders and age groups:

• For adult males, the normal level ranges from 38.8% to 50%.
• For adult females, it ranges from 34.9% to 44.5%.

A significantly low hematocrit level, such as 24%, indicates that there may be an issue, such as anemia or significant blood loss, that could require immediate medical attention. In the context of knee replacement postoperative care, monitoring hematocrit levels is crucial to identify patients who may be experiencing complications like excessive bleeding. Immediate intervention, such as a blood transfusion, may be necessary to stabilize the patient's condition. Understanding hematocrit levels helps ensure that patients receive the necessary care for optimal recovery.