The patient presents with a S/P R TKA, which stands for a 'status post right total knee replacement,' of rehabilitation after a surgical right knee...

Question Answered step-by-step The patient presents with a S/P R TKA, which stands for a “statuspost right total knee replacement,” of rehabilitation after a surgical right knee replacement. The patient is a 60-year-old male. The following information was obtained as a result of his initial evaluation:Subjective:Current History/ Mechanism: -Patient has experienced about 10 years of right knee pain -Received injection in knees but did not help with pain; pain has worsened and patient has experienced a decreased range of motion -Previous appendectomy -Surgery on 10/10/11: in hospital for four days and took part in home health physical therapy for three weeks but experienced no improvements -Suffers from Type II diabetes -Bad circulation in familyPrevious History/ Surgery: -6/1010: Left Total Knee Replacement -Functionality: sore with walking and bending, no driving, trouble putting on socks; only sleeps 3-4 hours at nightMajor Complaints: -Pain rating: 3-4 on a scale of one to 10 (1= no paint, 10= go to ER)Assisting Device/ Splint/ Brace -Walks with a cane in public for increased stability and confidence in walking but not at home -Sleeps in bed with feet up -Bathes in tub, able to step overMedication: -Prescribed as oxycodone for pain as needed, takes 2-3 per dayOccupation/ Hobbies: -Retired -Since June 2001, has lived alone in one story home with 5-6 steps to enter and a ramp -Enjoys watching TV, working on the computer, and writingDiagnostic Tests: -X-Rays/ MRI: show healing wellObjective:Posture/Gait: -Walks with supporting cane; uses walker to get into tub -Slight right limp -Decreased extension during hamstring bending and stanceRange of Motion: -Left: 4-115 degrees -Right: 22-96 degrees -Restricted patellar mobility: all directionsSpecial Test: -Lower Extremity Functional Scale: 36% functionStrength: -Left: 5 out of 5 -Right: Hip flexion= 4 out of 5; Quad= 3 out of 5; Hip= 3 out of 5Neurological: -Some tingling in hands and feet and has worsened since surgeryPalpation: -NormalEdema/ Atrophy: -Moderate right edema -Encision Healing wellGoals: -Increase extension to 0 degrees to improve heel strike during gait -Increased range of motion to fully bend knee -Increase functioning so as to be able to drive and activities of daily living (socks, shoes, etc.).B. InterventionIn order to increase range of motion and flexion and extension of the knee, the patient will come into the clinic for Physical Therapy three times a week for up to twelve visits to participate in range of motion, stretching, strengthening, and balancing/proprioceptive exercises in addition to physical therapy education, manual therapy, and modalities via application of electrical stimulation and ice.Exercises:Treatment: what exercise are appropriate for each phase C. Outcomes: The patient’s progress was marked through the compiling of daily SOAP notes. Notes of the patient’s progress may be found below:DateSubjectiveObjectiveAssessmentPlan11/7See evaluation under “Diagnosis”11/9Patient reports back pain with exercisesScar healing; Added single leg stance and weight shifting, CKC TKE, gastroc stretch, and bikeContinues to exhibit extension lag but improves with therapeutic exercises and manual therapyAdd bridging next visit; Continue with Plan of Care11/11Patient says not feeling good yetScar healing; Skin integrity normal; Added 1 # weights, bridgingPt. reports knee pops with long arch quads; almost able to fully rotate knee on bike; struggle with bridging and 1# Straight Leg RaisesContinue to progress and add weights and frequency; Add step-ups next visit.11/15Pt. reports pain medicine is giving acid reflux/indigestion so not taking any moreScar healing; normal skin integrity; Added step-ups and heel tapsPatient says difficult to lay flat on table; continues to walk with cane with flexed posture of the trunkLunges next visit11/16Tried no pain medicine but took Tylenol because was hurting in night; iced before came to PTAdded lunges; Axial Range of Motion Flexion: 111 degreesPt. able make complete revolutions forward and backward on bike; minor difficulty with lunges; improving range of motionComplete Doctor’s Note at next visit for doctor visit11/18Pt reports stiffness in the morning because of cold weatherScar healing; Skin integrity normal; added sit to stand exercise; improved supine flexion and extensionStruggled with sit to standAdd airex foam for squats next visit; Dr. note on Monday11/21Pt. reports better functioning in Activities of Daily LivingPain average about 4-5 out of tenPatient still use cane but moves at steady pace; back still arched; back pain during lungesContinue to progress with plan of care; add leg press11/23Pt. says experiencing some pain so take Tylenol at night and before coming to therapy; driving on own; relies on railing when doing single leg stanceImproved posture; experiences some tightness but loosens up with exercises.Pt. walks without cane but carries just in case; Increased speed in ROM on recreational bikeBack to Dr. in 3 months.; Increase leg press; Patient has 4 sessions left PHYSICAL THERAPY INTERVENTION Physical therapy related. answer questions 1-11 Total knee Arthroplasty (TKA). what happens during acute phase, sub acute and chronic phase of healing after TKA and what are the contradiction/precaution.what exercise can be done during this phase of healing in physical therapy and how would you instruct the patient to do them. and what modality are good to use for this phase of healing and why. strengthening resistive exercises and protocols. balance and functional exercises. goals what should they be able to do like ROM what are the protocols -what causes TKA -what are some of the precautions to treatment -what ae contraindications to treatment -Acute stage goals for -Acute weight bearing status and assistive devices -Acute stage exercises that are appropriate for this patient during physical therapy -Sub acute goals -sub acute exercises -chronic exercises -chronic stage goals -how would instruct a patient to do there exercises at home and tell them why its important to them Health Science Science Nursing NURSING 121 Share QuestionEmailCopy link Comments (0)