Margaret is a 56 year old lady who lives with her husband. Due to worsening osteoarthritis Margaret is waiting to undergo a right total knee replacement (TKR). When Margaret was first referred to the orthopaedic surgeon, 14 months ago she was told that due to her weight she wouldn’t be placed on the waiting list due to both the surgical risks and the expected success of the operation. At this time Margaret had a body mass index (BMI) of 40 (height 168cm, weight 113.4kg) and was told by the surgeon that she had to bring her BMI down to 35 (weight 97.5kg) before he would consider operating. Margaret has worked hard to lose the weight but is now suffering extreme pain in her right knee which is preventing her from losing any more weight as her mobility is considerably restricted. Margaret has seen the orthopaedic surgeon again following a further referral from her GP. Her BMI is currently 37 (weight 104.3kg) and he has agreed that he will operate on her.
PC: Osteoarthritis right knee, on waiting list for a right total knee replacement.
HPC: Has been suffering with osteoarthritis in the right knee since 2011, this has been getting gradually worse and Margaret is now in severe pain and has a restricted functional ability.
PMH: Morbidly obese
Gastro-Oesophageal Reflux Disease (GORD) Depression
No previous surgical history
DH: Ramipril 5mg OD
Lansoprazole 15mg OD Amitriptyline 100mg nocté Glucosamine (OTC) Chondroitin (OTC)
No known drug allergies
FH: Father died following an MI aged 67years Mother has CHD, alive
Has 1 son, alive and well, lives nearby
PSH: Works from home as a book keeper
Lives with husband (Barry, 60 years) who works as a truck driver
Enjoys socialising with family and friends, although can’t go out as much now due to pain and restricted mobility.
Attends church twice a month (Anglican)
Ex-smoker, gave up 2 years ago (30 pack years) Occasional ETOH (approx. 6 units per week)
Vital Signs (on referral): Pulse: 84 bpm regular
BP: 146/90 mmHg RR: 19 bpm
SpO2: 98% on room air Temperature: 36.7DC
Part A my response
You are the RN carrying out Margaret’s pre-operative assessment prior to her surgery. Discuss your pre-operative nursing assessment of Margaret. Your response should:
D Discuss any identified risks she poses during the intraoperative and post-operative period
D Discuss particular actions, assessments, diagnostics or referrals that may be needed to ensure her safety and well-being is maintained during surgery and throughout her stay on the ward.
Your response should be evidence-based demonstrated by an engagement with the literature and any relevant guidelines.
Your response (Approx 750 words)
Part B my response
All surgical patients are at risk of developing a surgical site infection (SSI), however Margaret could be considered at a higher risk due to a number of factors; including being obese and the nature of her surgery (orthopaedic joint replacement). Using the literature critically discuss whether Margaret is indeed at a higher risk of developing a SSI and present the nursing assessments and actions to minimise this risk. Your response must be discussed in relation to Margaret’s case and it must also demonstrate a clear link to how you will take this knowledge into practice.
Your response (Approx 750 words)