A Case Study Of Arthroscopic Meniscectomy

Submitted by: Anjelika Eurelle C. Mapili III-2 Group 6 July 20, 2012 Clinical Instructor: Mrs. Jocelyn Amlog, RN, MAN

I.

Introduction
An arthroscopic meniscectomy is a procedure in which the doctor uses an arthroscope and other tools to remove all or part of a damaged meniscus in the knee or, if possible, to repair a meniscus. A meniscus is a piece of rubbery tissue (fibrocartilage) between the bones of the knee joint. An arthroscope is a tube with a light at the end that projects an image of the inside of your knee onto a TV monitor. The arthroscope is about the Diameter of a pencil. When is it used? The procedure is used when you have damaged cartilage in your knee. Examples of alternatives are: Limiting your activity Taking drugs to reduce the swelling Having physical therapy Having open knee surgery Choosing not to have treatment, while recognizing the risks of your condition. What happens during the procedure? You will be given a general, regional, or local anesthetic. Which type depends on you, your anesthesiologist, and your surgeon. A general anesthetic will relax your muscles and make you feel as if you are in a deep sleep. Both local and regional anesthetics numb part of the body while you remain awake. All three types of anesthesia should keep you from feeling pain during the operation. The doctor will put an arthroscope and one or two tools into the knee joint through small incisions (cuts). Fluid is injected into the knee to expand the joint so that the structures and cartilage can be seen. The doctor will examine the knee to find any damage. She or he may repair any torn cartilage or shave down the cartilage in the knee and remove the pieces of cartilage. The doctor will then remove the arthroscope and the tools and close the small openings with stitches

II Patients History
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I.

Personal Data Name: Cherry Pineda Address: Brgy 138, Caloocan City Age: 41 Sex: Female Civil Status: Single Religion: Catholic Birthday: April 25, 1971 Room Number: 546 Attending Physician: Dr. Julius Ceasar Dalupang M.D Medical Diagnosis: Arthroscopic Meniscectomy Chief Complaint: Right knee pain Medical History: A. History of present illness 2 weeks prior to admission patient was going down a bus when she overstepped. She felt heavy feeling, popping sensation on her right knee. She felt pain on her right knee. Patient went to Emergency Room. B. Past Medical History The patient said that in her childhood she never experienced any major illness and was never hospitalized before. He also said that he only experienced those common illnesses like fever, cough and colds, flu and takes Paracetamol and Neozep when illness occurs. The patient has complete vaccines. The patient has no allergies both on food and medicines. C. Family Medical History The patients parents have Hypertension and Diabetes Mellitus on both sides. D. Social History The patient is non-smoker and drinks occasionally. She sometimes sleeps at around 1am because of the nature of her work. She is an Executive Producer at ABS-CBN she lives in a village with a quite environment. She loves to walk around her village with her dogs that is her exercise everyday.

II.

III.

Anatomy and Physiology

Anatomy and Physiology The knee joint is made up of three bony parts: the femur, the tibia, and the patella. Normally, these bones glide freely when the joint bends, due to smooth cartilage and thin membranes that line the inside of the joint and produce lubricating synovial fluid.
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These bones are held in position by four main ligaments: the lateral collateral, medial collateral, anterior cruciate, and posterior cruciate. In addition, two C-shaped fibrous pads separate the femur and tibia. These so-called menisci act as shock absorbers and provide support for the knee joint. Reasons for Procedure The most common knee joint problems are either due to osteoarthritis, a condition which tends to occur as joints age, or injuries related to athletics or work. These may result in tears of the ligaments or menisci, loose fragments of bone or cartilage, or instability of the joint. Symptoms of osteoarthritis include: pain, usually worsened by weight-bearing activities, difficulty walking, swelling of the joint, pops, clicks, or grinding of the joint. Similar symptoms may occur if you have injured any of the structures of your knee joint. In addition, you may notice: sudden buckling or giving way of the joint; a sense of the joint getting stuck in a certain position. Treatments Knee problems such as osteoarthritis or injuries are usually first treated with non-surgical methods such as: anti-inflammatory medications like ibuprofen, physical therapy or other prescribed exercises to strengthen the muscles that support the knee joint, a special device called a knee stabilizer to support the joint when the knee is stressed during weight-bearing activities, if needed, weight loss to reduce ongoing stress on the joint. If noninvasive methods fail, steroid medications may be injected directly into your knee joint to decrease inflammation and pain and to improve mobility. If pain and disability persist, knee arthroscopy may be recommended. This procedure is useful to treat tears of the menisci and to remove loose bodies in the knee. In knee arthroscopy, a fiberoptic instrument with a lighted tip is inserted into your knee joint in order to visualize, diagnose, and treat certain knee problems. Arthroscopic procedures are designed to avoid open surgical procedures, which involve a single large incision and longer recovery periods. Procedure In the days leading up to your procedure: Arrange for a ride to and from the hospital and for help at home as you recover. The night before, eat a light meal and do not eat or drink anything after midnight. If you regularly take medications, ask your doctor if you need to temporarily discontinue them. Do not start taking any new medications before consulting your doctor. Knee arthroscopy is usually done under spinal or local anesthesia. If this is the case, you will remain awake, but sedated, during the procedure and the lower half of your body will be rendered numb. If general anesthesia is used, you will be kept asleep. Your surgeon will begin by using an instrument called a trocar to make an opening, or portal, into the joint. He or she will then instill a sterile solution into the joint to push the surfaces apart and allow the structures to be viewed more easily.

Next, your surgeon will insert an arthroscope, which contains a small lens and lighting system, to magnify and illuminate the structures inside the joint. He or she will also create one or two additional portals through which pencil-sized surgical instruments will be passed. A camera attached to the arthroscope will take photographs and project images onto a monitor in the operating room. Your surgeon will examine the interior structures of your knee joint. Bone or cartilage fragments and portions of torn menisci can be removed through the arthroscope. In addition, a torn ligament or meniscus may be repaired arthroscopically. After the procedure has been completed, your surgeon will remove the arthroscope and suture the skin closed with stitches or clips. Your knee will be temporarily placed in an immobilizer. Risks and Benefits Complications of knee arthroscopy are rare, but may include: adverse reactions to anesthesia, infection, blood clots in the legs that could travel to the lungs, excessive swelling or bleeding at the joint, and/or damage to blood vessels or nerves in the affected leg. Benefits of knee arthroscopy include: ability to visualize, diagnose, and treat injuries to ligaments, menisci, and other structures of the knee, repair or removal of meniscal tears, removal of loose bodies in the knee, less recovery time and scarring than open knee procedures. In knee arthroscopy, or any procedure, you and your doctor must carefully weigh the risks and benefits to determine whether it's the most appropriate treatment choice for you. After the Procedure Because most knee arthroscopies are performed on an outpatient basis, you can usually go home the same day as your procedure. For the first 24 to 48 hours after surgery, you'll usually be advised to keep your leg elevated and to ice your knee periodically. You will likely require a knee stabilizer, crutches, or a cane when moving around for the first few days. Be sure to call your doctor immediately if you experience: A fever or chills, redness, swelling, increased pain, excessive bleeding, or discharge from the incision sites, nausea or vomiting, swelling, tingling, pain, or numbness in your toes that is not relieved by elevating your knee above heart level for one hour, coughing, shortness of breath, or chest pain.

IV. Gordons Functional Health Pattern

Functional Health Pattern Health perception Health Management Pattern

NutritionalMetabolic Pattern

Elimination Pattern

Activity Exercise Pattern

Before Hospitalization The patient perceives her health in the state of good condition. She perceives health as wealth and she values her health a lot. She practices her health by eating nutritious foods and by practicing good hygiene. The patient eats 3 times a day with snacks in between. She eats meat, fish, vegetables and fruits. She doesnt have allergies on food and drugs. Her appetite is moderate. The patient has no problem with her elimination pattern. She usually urinates 5-6 times a day without any difficulty. She added the color of her urine is light yellow. She defecates 2 times a day one in the morning and one at the evening. She could perform activities of her daily living. According to her she walks

After Hospitalization She sees herself somehow ill because she cannot walk and she cant go to work and do her everyday routine. She cannot walk without support.

Interpretation The patient somehow feels the changes that are happening to her. She is not use to being hospitalized. She cant walk and she cant do her daily routines.

The patient still eats 3 times a day with snacks in between.

The patient has no loss in appetite she still continues to eats 3 times a day with snacks in between.

The patient had no problem when it comes to her elimination pattern. She still urinates normally and defecates 2 times a day one in the morning and one in the evening.

The patient had no change when it comes to elimination pattern. There are no changes. She still urinates and defecates normally.

She could not walk without support and after her surgery she needs to rest

There is a big change in patients activity because she cant do her daily
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everyday to the park and just stay on her before going to bed. work. The patients sleeps 6-8 hours a day. She doesnt have a nap time because of tons of work.

Sleep- Rest Pattern

CognitivePerceptual Pattern

Self-Perception Self-Concept Pattern Role-Relationship Pattern

SexualityReproductive Pattern

The patients sleeps 6-8 hours a day. She also have lots of nap time since she has no work load because she is in the hospital. She is normal in She was normal as terms of her before when it cognitive activities. comes to her She has a good cognitive and memory and perceptual pattern. reasoning skills. She responds She said she is very clearly and well sensitive to the understood. She feelings of other has no sensory people. When it deficit. She comes to perceptual responds pattern she has no appropriately to problem with her verbal and physical senses. stimuli and obeys simple commands. She sees herself as a person with a good quality. She has been a good friend, sister and daughter. She said she is a nice person and she is very sensitive when it comes to the feelings of other people. She has a close Her family always The patient is very relationship with her visits her every now happy that her family. They were and then. She had family had time to five siblings in the more bonds with her visit her. They had family. She was the family; she had the more time to bond. eldest. They always chance to see her have a family long lost relatives gathering every and friends. Sunday because it is the only time that she can relax because of her busy schedule. She said that right She said that now She is quite sad now she has no she realized the when it comes to boyfriend although importance of this matter because she thinks that she having someone she is now realizing is overage already. beside her someone the importance of

activities normally and she cant walk without support and she needs to stay in bed. The patients sleeprest pattern is not change and not disturb by her hospitalization. She now has time to rest and nap. There is no change when it comes to her cognitive and perceptual pattern. She is still normal when it comes to understanding and responding.

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Coping-Stress tolerance Pattern

She is still hoping to married someday. She is still sexually active. She is very stressed because of her work she works 6 times a week. She works in a big broadcasting network. They sometimes take a overnight work just to make the show beautiful and productive.

to take care of her and someone to love her. She had the time to rest while she is in the hospital. She said that her assistants keeps calling her and asking for her opinion and ask her to do something. She said that they are still depending on her even she is in her sick leaved so shes kind of stress right now. She said that she still to continue to pray every night and after she wakes up. She cant go to church thats why she watches Sunday TV mass.

having a husband.

She can still manage her stress while she is in the hospital she was able to rest a little but now she is slightly stressed because of her work.

Value-Belief Pattern

The patient is a Roman Catholic. She attends mass every Sunday with her family. She always pray at night and after she wakes up shes been doing it ever since she was a kid,

The patient didnt lose her faith she hopes for her fast healing and as long that God is there she will be healed.

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Area Assessed

Technique

Normal Findings

Findings

Analysis

V. Physical Assessment
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A. Skin Color Inspection Light brown, tanned skin (may vary according to race) Moisture Inspection/ Palpation Temperature Texture Turgor Palpation Palpation Palpation Normally warm Smooth and soft Skin snaps back immediately B. Skin Appendages Nails Inspection Transparent, smooth and convex Nail beds Nail base Hair distribution Color Inspection Inspection Inspection Inspection Pinkish Firm Evenly distributed Black to light brown C. Upper Extremities Arms Warm to touch and tenderness Pinkish and slightly rough Warm to touch, no lesions Pinkish, slightly rough Normal Transparent, smooth and convex Pinkish Firm Evenly distributed Light brown Normal Normal Normal Normal Normal Normally warm Smooth and soft Skin snaps back immediately Normal Normal Normal Skin normally dry Skin normally dry Normal Light brown skin Normal

Palms and dorsal surface

Normal

Shoulders

Perform w/o any difficulty

Can move without difficulty and have a tattoo of his wife on left shoulder Can bend without

Normal

Elbows

Inspection

Perform without

Normal
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any difficulty Inspection skull Generally round

difficulty

Round

Normal

D. Eyes Inspection Eyes Non protruding Visual acuity : 20/20 Eyebrows Inspection Symmetrical in size, extension, hair texture and movement Inspection Eyelashes Evenly distributed Evenly distributed Normal Symmetrical in size, extension, hair texture and movement Normal Normal

Inspection Eyelids Same colour as skin Inspection Conjunctiva Transparent with light pink color Transparent with light pink color Normal Same colour as skin Normal

Sclera

Inspection Inspection

Color white

Color white

Normal

E. Ears

Free of Lesions, discharge of inflammation

Free of Lesions, discharge of inflammation

Normal

Hearing acuity

Inspection

Client normally hears words when whispered.

Client normally hears words when whispered. No tenderness

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F. Nose

Inspection

Nose in the

midline; no discharges; no bone or cartilage deviation noted. Inspection G. Neck No visible mass or lumps; symmetrical; no jugular venous distension.

noted; no signs of any discharges

Normal

No mass or lumps; symmetrical

Normal

Inspection lymph nodes May not be palpable; nontender IF PALPABLE; less than 1cm in size. Inspection thyroid Normally nonpalpable; no nodules palpable No nodules present Normal Firm; non-tender and less than 1cm in size Normal

H. Thorax Auscultation Lungs Illustrate voluntary sound Voluntary sounds present Normal

Pulsation I. Cardiovascular Pulse visible; no lift or heaves. apical pulsations is present Normal

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Inspection J. Abdomen Skin color is uniform, no lesions; some may have presence of striae or scars Inspection K. Lower extremities Equal in size; no edema; no crepitus Knees are reddish and slightly swollen It is slightly swollen No venous engorgement; no tenderness noted; no muscles guarding Normal

because it is injured

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VII. Discharge Plan

Medications: Instruct client to continue take her prescribed medications Orient the client about the name of drugs, their actions, the exact dosage, the frequency and the route of administration. Instruct client to follow the instruction when administering medication. Advice the significant others not to leave the client during medication Explain to the client the side effects and adverse effects of the drugs she t a k e s b y prescribing its manifestations. Advice client not to stop intake of prescribed medications, unless approve d b y t h e physician. Exercise: Instruct client to balance activities with adequate rest periods. Educate client on proper body mechanics to prevent muscle strain and enable client to relax. Encourage client to ambulate and assume normal Encourage deep breathing exercise Treatment: Educate client the importance of drug compliance. Discuss to the client the complication of the condition because knowledge a b o u t t h e condition supports learning that will decrease deficit and anxiety. To promote healing, eat a balanced diet rich in fresh fruits and vegetables. Hygiene Keep your incision sites clean and dry. .Encourage client to do daily hygiene Encourage client to ask assistance if needed Outpatient orders Call the doctor if any of the following occurs: Develop a fever. Become dizzy and faint. Experience nausea and vomiting. Become short of breath.
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Have heavy bleeding. Have leakage from the incision or the incision opens up. Have swelling, redness, or pain in your leg. Have questions about the procedure or its result.

Diet To promote healing, eat a balanced diet rich in fresh fruits and vegetables. Eat high-fiber foods, drink plenty of water. Instruct client to eat foods that are high in protein and vitamins and minerals

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