1
Total Knee Arthroplasty (TKA)
UNFOLDING Reasoning
John Roberts, 68 years old
Primary Concept
Infection
Interrelated Concepts (In order of
emphasis)
● Perfusion
● Tissue Integrity
● Pain
● Clinical Judgment
● Patient Education
● Communication
NCLEX Client Need Categories Percentage of Items from Each Covered
Category/Subcategory in Case
Study
Safe and Effective Care Environment
● Management of Care 17- ✔
23%
● Safety and Infection Control 9-15%
Health Promotion and Maintenance 6-12% ✔
, 2
Psychosocial Integrity 6-12% ✔
Physiological Integrity
● Basic Care and Comfort 6-12% ✔
● Pharmacological and Parenteral Therapies 12- ✔
18%
● Reduction of Risk Potential 9-15% ✔
● Physiological Adaptation 11- ✔
17%
, 3
UNFOLDING Reasoning
History of Present Problem:
John Roberts is a 68-year-old Caucasian male who is 6 feet tall (180 cm) and weighs 260 lbs. (118.2 kg) (35.3 BMI). He
has a history of diabetes, hypertension, and hyperlipidemia and smokes one pack per day since the age of 18 (50 pack-
years). He has osteoarthritis (OA) in his right knee and the pain has significantly increased over the past year.
John had a right total knee arthroplasty (TKA) four days ago and refused to go to a rehabilitation center because of the
expense and distance from his home. He decided to have physical and occupational therapy home health services. You are
the home health nurse that will be caring for him, and you have arrived for his first home visit.
Personal/Social History:
John is a retired lumberjack who enjoys being outdoors. He has become increasingly frustrated because
he is not able to do the outdoor activities he once did. He has been married for 50 years to Mary and lives
in the rural Appalachian Mountains and must travel a long distance for basic medical care.
What data from the histories are RELEVANT and must be interpreted as clinically significant by the nurse?
RELEVANT Data from Present Problem: Clinical Significance:
1. History of diabetes, hypertension, and 1. It is important to know the patient’s health history. This could affect
hyperlipidemia. the patient's current condition. The nurse must keep in mind John's
2. Tobacco use (50 pack years). health history when planning patient care.
3. Increased pain in the right knee due to 2. Tobacco use is always a concern especially in older patients.
osteoarthritis Tobacco use can alter the patients healing process and slow it
4. Refusal to go to a rehabilitation center down. It also causes compromised immunity.
due to expense and distance 3. Increased pain over a period of time indicates a worsening
condition and must be addressed to prevent further damage.
4. Getting the proper care is key in achieving post-operative desired
outcomes. John’s refusal to go to a rehabilitation center may put his
health in jeopardy. The patient’s concerns in expenses and travel are
also significant for the nurse to assess to ensure he has enough
resources to meet his basic and health needs.
RELEVANT Data from Social History: Clinical Significance:
1. Retired lumberjack 1. Knowing John’s previous occupation can help the nurse identify the
2. Easily frustrated possible cause of medical complaints.
3. Area of residence (Appalachian 2. Knowing that he is easily frustrated due to his current condition
Mountains) indicates that the patient is also psychologically affected and the
4. Long distance travel for medical care nurse must address his psychological and social needs.
3. Patients with bone and joint problems are especially sensitive to
high altitude environments due to the cold weather. Joint pain and
stiffness with osteoarthritis may increase during the colder season.
4. The distance of the closest medical center is relevant data which
allows the nurse to assess if John is able to get the care he needs in
time of emergencies.
Patient Care Begins:
Current VS: P-Q-R-S-T Pain Assessment:
Total Knee Arthroplasty (TKA)
UNFOLDING Reasoning
John Roberts, 68 years old
Primary Concept
Infection
Interrelated Concepts (In order of
emphasis)
● Perfusion
● Tissue Integrity
● Pain
● Clinical Judgment
● Patient Education
● Communication
NCLEX Client Need Categories Percentage of Items from Each Covered
Category/Subcategory in Case
Study
Safe and Effective Care Environment
● Management of Care 17- ✔
23%
● Safety and Infection Control 9-15%
Health Promotion and Maintenance 6-12% ✔
, 2
Psychosocial Integrity 6-12% ✔
Physiological Integrity
● Basic Care and Comfort 6-12% ✔
● Pharmacological and Parenteral Therapies 12- ✔
18%
● Reduction of Risk Potential 9-15% ✔
● Physiological Adaptation 11- ✔
17%
, 3
UNFOLDING Reasoning
History of Present Problem:
John Roberts is a 68-year-old Caucasian male who is 6 feet tall (180 cm) and weighs 260 lbs. (118.2 kg) (35.3 BMI). He
has a history of diabetes, hypertension, and hyperlipidemia and smokes one pack per day since the age of 18 (50 pack-
years). He has osteoarthritis (OA) in his right knee and the pain has significantly increased over the past year.
John had a right total knee arthroplasty (TKA) four days ago and refused to go to a rehabilitation center because of the
expense and distance from his home. He decided to have physical and occupational therapy home health services. You are
the home health nurse that will be caring for him, and you have arrived for his first home visit.
Personal/Social History:
John is a retired lumberjack who enjoys being outdoors. He has become increasingly frustrated because
he is not able to do the outdoor activities he once did. He has been married for 50 years to Mary and lives
in the rural Appalachian Mountains and must travel a long distance for basic medical care.
What data from the histories are RELEVANT and must be interpreted as clinically significant by the nurse?
RELEVANT Data from Present Problem: Clinical Significance:
1. History of diabetes, hypertension, and 1. It is important to know the patient’s health history. This could affect
hyperlipidemia. the patient's current condition. The nurse must keep in mind John's
2. Tobacco use (50 pack years). health history when planning patient care.
3. Increased pain in the right knee due to 2. Tobacco use is always a concern especially in older patients.
osteoarthritis Tobacco use can alter the patients healing process and slow it
4. Refusal to go to a rehabilitation center down. It also causes compromised immunity.
due to expense and distance 3. Increased pain over a period of time indicates a worsening
condition and must be addressed to prevent further damage.
4. Getting the proper care is key in achieving post-operative desired
outcomes. John’s refusal to go to a rehabilitation center may put his
health in jeopardy. The patient’s concerns in expenses and travel are
also significant for the nurse to assess to ensure he has enough
resources to meet his basic and health needs.
RELEVANT Data from Social History: Clinical Significance:
1. Retired lumberjack 1. Knowing John’s previous occupation can help the nurse identify the
2. Easily frustrated possible cause of medical complaints.
3. Area of residence (Appalachian 2. Knowing that he is easily frustrated due to his current condition
Mountains) indicates that the patient is also psychologically affected and the
4. Long distance travel for medical care nurse must address his psychological and social needs.
3. Patients with bone and joint problems are especially sensitive to
high altitude environments due to the cold weather. Joint pain and
stiffness with osteoarthritis may increase during the colder season.
4. The distance of the closest medical center is relevant data which
allows the nurse to assess if John is able to get the care he needs in
time of emergencies.
Patient Care Begins:
Current VS: P-Q-R-S-T Pain Assessment:
