Arthroplasty Care

Arthroplasty Care: General Guidelines or Key Steps (A-R-T-H-R-O-P-L-A-S-T-Y C-A-R-E)

A – Alert the physician for any changes in the patient’s vital signs. Alterations in vital signs may indicate infection, hemorrhage or other postoperative complications. Check patient’s vital signs every 15 minutes, twice, every 30 minutes until stable and then every 2 to 4 hours and routinely thereafter.

R – Respiratory complications prevention:

  • Encourage the patient to perform deep breathing and coughing exercises.
  • Assist patient with incentive spirometry is ordered.

T – Thorough neurovascular status assessment and monitoring:

  • Assess the patient’s neurovascular status every 2 hours for the first 48 hours and then every 4 hours for signs of complications.
  • Check the affected leg for color, temperature, toe movement, sensation, edema, capillary refill and pedal pulse.
  • Investigate complaints of pain, burning, numbness or tingling.

H – Have a compression stocking applied to the unaffected leg to promote venous return, prevent phlebitis and pulmonary emboli. Remove the compression stocking once every 8 hours and check the leg especially the heel for pressure ulcers and reapply it.

R – Reduce or eliminate pain by administering pain medications as ordered.

O – Ordered I.V. antibiotics should be administered for 24 hours after the surgery to minimize the risk of wound infection.

P – Prevent or minimize the risk of thrombophlebitis and embolus formation by administering the ordered anticoagulant therapy. Observe the patient for bleeding and the leg for signs and symptoms of phlebitis such as warmth, tenderness, redness and a positive Homan’s sign.

L – Loss of blood should be checked through dressing inspection. Circle any drainage on the dressing and mark it with the nurse’s initials, the date and the time. Sterile dressings should be applied as needed using a hypoallergenic tape. Excessive bleeding should be reported to the physician immediately.

A – Assess the closed-wound drainage system for discharge color and amount. A proper drainage prevents hematoma. Presence of a purulent drainage and fever indicates infection. Using a clean technique, empty and measure the drainage as ordered.

S – Screen or monitor the patient’s fluid intake and output every shift. Wound drainage in the output measurement should be included.

T – To reduce swelling, reduce pain and control bleeding, an ice bag should be applied to the affected site for the first 48 hours.

Y – Your patient should be repositioned every 2 hours. Position changes enhance comfort, prevent pressure ulcers and help prevent respiratory complications.

Daisy Jane Antipuesto RN MN

Currently a Nursing Local Board Examination Reviewer. Subjects handled are Pediatric, Obstetric and Psychiatric Nursing. Previous work experiences include: Clinical instructor/lecturer, clinical coordinator (Level II), caregiver instructor/lecturer, NC2 examination reviewer and staff/clinic nurse. Areas of specialization: Emergency room, Orthopedic Ward and Delivery Room. Also an IELTS passer.

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