NCLEX Review Guide: Total Knee Replacement

Assessment and Preparation

• Assess baseline neurovascular status including pulses, sensation, movement, color, and temperature of affected extremity
• Review laboratory values including hemoglobin, hematocrit, PT/INR, and platelet count to identify bleeding risks
• Educate patient about post-operative expectations including pain management, mobility restrictions, and rehabilitation timeline
• Ensure informed consent is obtained and patient understands procedure risks including infection, blood clots, and implant failure

Immediate Post-operative Nursing Care

• Monitor neurovascular status every 2-4 hours for first 24 hours, then per facility protocol
• Assess surgical site for signs of infection including increased redness, warmth, swelling, or purulent drainage
• Maintain proper positioning with affected leg elevated and supported to reduce swelling
• Apply ice therapy as ordered, typically 15-20 minutes every 2-3 hours for first 48 hours

Neurovascular Assessment Steps

1. Check pedal and posterior tibial pulses
2. Assess capillary refill (should be <3 seconds)
3. Test sensation to light touch
4. Evaluate ability to move toes
5. Compare findings to unaffected leg

Progressive Mobility

• Begin continuous passive motion (CPM) machine as ordered, typically within 24 hours post-operatively
• Assist with weight-bearing as tolerated (WBAT) or partial weight-bearing per surgeon's orders
• Teach proper use of assistive devices including walker or crutches for safe ambulation
• Encourage quadriceps and ankle exercises to prevent muscle atrophy and improve circulation

Major Complications

• Deep vein thrombosis (DVT) prevention includes anticoagulants, sequential compression devices, and early mobilization
• Monitor for signs of infection including fever, increased pain, redness, or purulent drainage from incision
• Assess for fat embolism syndrome including respiratory distress, confusion, and petechial rash
• Watch for signs of compartment syndrome including severe pain, numbness, and decreased pulses

• Focus on neurovascular assessment - this is frequently tested and critical for patient safety
• Remember that early mobilization is key to preventing complications like DVT and pneumonia
• Practice differentiating between normal post-operative pain and complications requiring immediate intervention
• Understand that infection prevention is crucial due to the implanted device - any signs require prompt treatment