Nursing Management 1 Running Head: Left Anterior Cruciate Ligament Tear Nursing Management of a Patient with Left Anterior Cruciate Ligament Tear Bula, Monesa Bianca Carillo, Kathlyn O. Our Lady of Fatima University Nursing Management 2 Nursing Management of a Patient with Left Anterior Cruciate Ligament Tear M. G. , a 23 year old male soldier was involved in a vehicular accident a year ago, and was diagnosed with left symphysis pubis diastasis with sacroiliac joint disruption and underwent Open Reduction Internal Fixation on the plate of symphysis pubis and screw fixation of his left sacroiliac joint in April of 2011.
During patient’s stay at the hospital, he was also assessed to have knee instability, a diagnostic arthroscopy was scheduled but the patient requested to be discharged first so he can process his reenlistment papers. After a month, the patient went back to the hospital for readmission and was identified to have Left Anterior Cruciate Ligament Tear and underwent Left Anterior Cruciate Ligament Reconstruction in June 2011.
Bonifacio(2010) states that the patient’s who suffers from anterior ligament tear exhibits pain during ambulation. So our main argument for this patient is pain. Pathophysiology Brunner (2010) has explained that the anterior cruciate ligament and the posterior cruciate ligament of the knee stabilize anterior and posterior motion of the tibia articulating with the femur. These ligaments cross each other in the Nursing Management 3 center of the knee.
Injury occurs when the foot is firmly planted and the leg sustains direct force, forward or backward. If the force is forward, the anterior cruciate ligament suffers the impact from the force. The injured person may report feeling and hearing a “pop” in the knee with this injury. If the patient exhibits significant swelling of the joint within two hours after the injury, the anterior or posterior cruciate ligament may be torn. A torn cruciate ligament produces pain, joint instability and pain with weight bearing. History M. G. a 23 year old male soldier was involved in a vehicular accident a year ago, and was diagnosed with left symphysis pubis diastasis with sacroiliac joint disruption and underwent Open Reduction Internal Fixation on the plate of symphysis pubis and screw fixation of his left sacroiliac joint in April of 2011. After a month, the patient also had undergone diagnostic arthroscopy to visualize and diagnose problems inside the patient’s joints. Nursing Management 4 Nursing Physical Assessment M. G. was alert and oriented to person, place and time.
The patient’s temperature was 36. 5°C, pulse rate was 72, respirations were 19, blood pressure was 120/90, lungs were clear. The patient’s skin was warm and dry with dark complexion. The patient has three surgical incision site: one on the left posterior carpal, second is on the supra-pubic area and third is on the left patellar part; all of the incision site are intact with no swelling nor erythema. The patient has no bowel movement for 3 days and a urine output of approximately 900-1000 ml a day. The patient was on DAT(diet as tolerated).
The patient has good appetite and drinks little amount of water. M. G. ’s height was 5’8” and his weight was 65 kg. The patient uses assistive device or crutches for ambulation, experiencing pain on the knee during prolonged walking and standing with pain level of 5 and cannot perform independent activities of daily living without assistance. Related Treatments The patient has no skin and food allergies, absence of skin rashes and itching. Patient complains about the pain he felt in his knee as he uses Nursing Management 5 assistive device such as crutches for support.
The patient’s medications were paracetamol (acetaminophen is an over-the-counter analgesic used as a pain reliever and antipyretic. Common brand names are Aeknil and Biogesic), tramadol (is a centrally acting analgesic that is used in the treatment of moderately severe pain). The patient’s diet is diet as tolerated. The patient also underwent anterior cruciate ligament reconstruction, it is a surgical procedure always performed athroscopically that involves removing fragments of the damaged anterior cruciate ligament and replacing it with another form of soft tissue called graft.
Nursing Care Plan M. G. ’s nursing diagnosis is pain related to ambulation as a result of anterior cruciate ligament tear (Bonifacio, 2010). Patient complains of knee pain during ambulation with pain level of 5. According to Brunner(2010), a torn cruciate ligament produces pain with bearing. During ambulation, the weight of the patient is directed downward due to the pull of gravity, thus, much of the patient’s weight are accumulated at the lower extremities and Nursing Management 6 contributes much for the pain perception.
The short term goal is to reduce the pain that the patient feels. Nursing intervention for the patient includes teaching patient for diversional activities such as focus breathing, imaging, watching television, or reading books to distract attention and reduce tension (NANDA,2008). Providing comfort measures like application of heat/cold packs or repositioning and rest to promote non-pharmacological pain management (NANDA,2008). Administering pain relievers such as paracetamol and tramadol as prescribed by the physician (NANDA,2008).
The patient was responsive to education regarding pain and reported the alleviation of pain perception. Recommendations Patient should be instructed of taking analgesics as needed to alleviate pain as early as possible. He can do range of motion exercises such as extension of the knee with gradual progression of flexion initially 0-90 degrees until full range of motion is attained after 6 weeks or as soon as possible because immobilizing the lower extremities may lead to muscle atrophy; and Nursing Management 7 with the emphasis for protecting the surgical graft.
Caution patient to avoid twisting and pivoting motions for 6-8 wks to minimize shear forces to the healing graft. After 5-6 months, the patient may return back to sports based on the physician’s approval, minimal pain at rest or with activity, no knee joint effusion and full pain-free range of motion. If the patient experiences pain during ambulation with crutches, he may stop and sit for a while or take a rest to prevent fatigue. He may use hot/cold application in the course of the pain attacks with precaution on the duration of its appliance.
Nursing Management 8 References Bonifacio, V. (2010). My Ortho Book: Guide in Orthopedic Nursing (Vol. 1st edition). Quezon City: C&E. p. 44-45 Doenges, M. , Moorhouse, M. F. , & Murr, A. (2008). Nurse’s Pocket Guide (Vol. 11 edition). Pennsylvania: F. A. DAVIS COMPANY. p. 498-503 Smeltzer, S. , Bare, B. , Hinkle, J. , ; Cheever, K. (2010). Brunner and Suddarth’s textbook of medical and surgical nursing (Vol. 12). Philadelphia: Lippincott Williams & Wilkins. p. 2083 (n. d. ). Retrieved from http://orthoinfo. aos. org/topic. cfm? topic=a00109 (n. d. ). Retrieved from http://medical-dictionary. thefreedictionary. com/cruthches (n. d. ). Retrieved from http://www. nursingcare101. com/paracetamol (n. d. ). Retrieved from http://www. nuringcare101. com/tramadol (n. d. ). Retrieved from http://drmillett. com/acl-knee-injuries-anterior-cruciate-ligamet (n. d. ). Retrieved from http://www. nlm. nih. gov/medlineplus/ency/article/003188. htm (n. d. ). Retrieved from http://www. scribd. com/doc/58986871/Knee-Acl-Reconstruction