Osteoarthritis knee OA knee Osteoarthritis hip OA hip

• Osteoarthritis knee) OA knee( • Osteoarthritis hip (OA hip & ( Avascular necrosis (AVN) hip

Osteoarthritis knee )OA knee) operation : Total knee arthroplasty ) TKA(

Care map การดแลผปวยผาตดเปลยนขอเขาเทยม Admission date Operation date Post-op D 1 Date…………… Pre-op …. …. Assessm Assess ประเมน V/S ent Complication ประเมน I/O + Progression PE Observe shock pain scale Informed ประเมน I/O consent Test CBC, U/A, FBS CBC (Hct) F/U film BUN, Cr, Electrol yte G/M Film เขา (APlat sky line view( EKG, CXRสงอ าน Film Treatme Pre-op order ABO IV nt Drug & Analgesic Reconcilliation Medicati ยาทตองงดก IV fluid on อนผาตด Warfarin Plavix Foley's cath NSAIDs ASA Drain Coumadine Cryo cuff Standard pre O 2 /Jone's op order bandage ใหเลอด (as for TKR need( Cryo cuff /Jone's bandage Anticoagulant ปองกน Consulta ตดตอเครอง PT tion มอ ขออนมตคา (Total knee replacement( Post-op D 2 Date…………… Post-op D 3 -D/C …. Assess ขยบเขา 0 -90 Complication องศา + Progression กอนกลบบาน pain scale ประเมน I/O ABO IV(as need) Analgesic Off drain Off Foley's cath Dressing (as need) Analgesic Dressing (as need) Keep vein NSS Lock Off Cryo cuff / Jone's bandage. DVTตามขอบงช PT PT

Pre operation § PE § Inform consent § LAB : CBC, U/A, FBS, BUN, Cr, Electrolyte, G/M § Film : CXR, Knee AP/lat § EKG § Drug Reconcilliation § ยาทตองงดกอนผาตด Warfarin Plavix ASA NSAIDs § Pre op exercise § Consult med § Consult pain clinic

Post operation

Post operation § V/S, I/O § Observe shock : NEWs score, Hct, record RD § pain management § cold compression: Cryocuff, cold pack § exercise : ankle pumps

Post operation day-1 § V/S, I/O § Assess. Complication: Venous. Thromboembolism, Infection, Periprosthetic fractures § pain management § cold compression : Cryocuff, cold pack § exercise : Quadriceps exercise, ankle pumps

Post operation day-2 § V/S, I/O § Assess Complication: Venous. Thromboembolism, Infection, periprosthetic fractures § pain management § exercise : active ROM (CPM) 0 -90° : ambulate walker

After TKA Discharge Exercise/ROM : § Quadriceps Sets : เกรงกลามเนอตนขา sec § Straight Leg Raises: 5 -10 sec 5 -10

§ Ankle pumps: 5 -10 ครง (American Academy of Orthopaedic Surgeons: AAOS, 2011)

§ Knee Straightening Exercises (American Academy of Orthopaedic Surgeons: AAOS, 2011)

§ Bed-Supported Knee Bends (American Academy of Orthopaedic Surgeons: AAOS, 2011)

§ Sitting Supported Knee Bends (American Academy of Orthopaedic Surgeons: AAOS, 2011)

§ Sitting Unsupported Knee Bends (American Academy of Orthopaedic Surgeons: AAOS, 2011)

After TKA Discharge Follow-up Appointments : นดประมาณ : เตรยมใบนด 2 -4 wks (FU Film knee) , ใบ Film , ใบสงตว

• Osteoarthritis hip) OA hip( & Avascular necrosis (AVN) hip

Operation : • Total hip arthroplasty )THA( • Hemiarthroplasty with Bipolar

Pre operation § PE § Inform consent § LAB : CBC, U/A, FBS, BUN, Cr, Electrolyte, G/M § Film : CXR, Both hip AP/lat § EKG § Drug Reconcilliation § ยาทตองงดกอนผาตด Warfarin Plavix ASA NSAIDs § Pre op exercise § Consult med § Consult pain clinic

Post operation § V/S, I/O § Observe shock : NEWs score, Hct, record RD § pain management § Hip abduction § exercise : ankle pumps

Post operation day-1 § V/S, I/O § Assess. Complication: Venous. Thromboembolism, Infection, Hip dislocation § pain management § Hip abduction § exercise : Quadriceps exercise, ankle pumps

Post operation day-2 § V/S, I/O § Assess Complication: Venous. Thromboembolism, Infection, Hip dislocation § pain management § Hip abduction § exercise: ambulate walker

After THA Discharge

After THA Discharge Follow-up Appointments hip) : นดประมาณ 2 -4 : เตรยมใบนด wks (FU Film Both , ใบ Film , ใบสงตว