Physiological Integrity Q 43
The nurse is assessing the client with a total knee replacement 2 hours postoperative. Which information requires notification of the doctor?
A. Bleeding on the dressing is 3cm in diameter.
B. The client has a temperature of 100.6°F (38.1°C).
C. The client’s hematocrit is 26%.
D. The urinary output has been 60 during the last 2 hours.
Correct Answer: C. The client’s hematocrit is 26%.
The client with a total knee replacement should be assessed for anemia. A hematocrit of 26% is extremely low and might require a blood transfusion. Results from a hematocrit test are reported as the percentage of blood cells that are red blood cells. Normal ranges vary substantially with race, age, and sex. The definition of normal red-blood-cell percentage also varies from one medical practice to another.
Option A: Bleeding of 2cm on the dressing is not extreme. Circle and date and time the bleeding and monitor for changes in the client’s status. Healthline analyzed data on over 1.5 million Medicare and privately insured people to take a closer look. They found that 4.5 percent of people who are aged under 65 experience complications while in the hospital after a knee replacement.
Option B: A low-grade temperature is not unusual after surgery. Ensure that the client is well hydrated, and recheck the temperature in 1 hour. If the temperature is above 100.6°F (38.1°C), report this finding to the doctor. Tylenol will probably be ordered. Infections are rare after knee replacement surgery, but they can occur. Infection is a severe complication, and it needs immediate medical attention.
Option D: Voiding after surgery is also not uncommon and no need for concern. In rare cases, a person may have osteolysis. This is inflammation that occurs due to microscopic wear of the plastic in the knee implant. The inflammation causes bone to essentially dissolve and weaken.