Nursing Care for Patients with Knee Osteoarthritis and Comorbidities Undergoing Total Knee Arthroplasty

Abstract

This study aimed to examine nursing problems, nursing diagnoses, nursing interventions, and care outcomes, as well as to compare health status, comorbidities, complications, and nursing outcomes between two patients with knee osteoarthritis and comorbidities undergoing total knee arthroplasty. A comparative descriptive case study was conducted in Special Ward 4–5 at Ranong Hospital from April to August 2026. Data were collected from medical records, nursing records, patient and family interviews, physical examinations, and laboratory findings. Gordon’s 11 Functional Health Patterns and the nursing process were used as frameworks for data collection and analysis.

The findings showed that Case 1, a 72-year-old patient with multiple comorbidities, developed postoperative hypotension, oliguria, and pre-renal azotemia. Her hematocrit (Hct) decreased from 36.5% to 30.9%. Her condition improved following intravenous fluid therapy; she achieved knee flexion of more than 90 degrees and had a hospital stay of 5 days. Case 2, an 87-year-old patient with a preoperative Hct of 30.3%, developed postoperative pre-renal azotemia, and her Hct decreased to 24.8%. She received one unit of packed red blood cells, after which her Hct increased to 28.0%. Her maximum pain score was 7–8, knee flexion reached approximately 80 degrees, and her hospital stay was 7 days. Neither patient developed infection, thromboembolic complications, or falls, and both were able to ambulate before discharge. These findings indicate that nursing care for older patients with comorbidities undergoing total knee arthroplasty should emphasize individualized risk assessment, close monitoring of blood loss, hemodynamic status, renal function, and pain, together with continuous rehabilitation and comprehensive discharge preparation.