DISCLAIMER: All patient information appearing on this document is fictitious. Any resemblance to real persons, living or dead, is purely coincidental.
Proprietary Statement: This document contains proprietary information of the University of Kansas School of Nursing. Such proprietary information may not be used,
reproduced, or disclosed to any other parties for any other purpose without the expressed written permission of University of Kansas School of Nursing.
© KU Center for Health Informatics | Page 1 of 8
PROBLEMS & DIAGNOSES
CLINICAL NOTES
Result type:
Result date:
Result status:
Performed by:
Verified by:
Encounter info:
Operative Report
September 30, 2011 9:45 AM CDT
Auth (Verified)
Ng, Dale J on November 03, 2011 4:55 PM CDT
Ng, Dale J on November 03, 2011 5:38 PM CDT
40000023424, KUMC, Inpatient, 9/30/2011 -
* Final Report *
DATE OF OPERATION: 09/30/2011
DISCLAIMER: All patient information appearing on this document is fictitious. Any resemblance to real persons, living or dead, is purely coincidental.
Proprietary Statement: This document contains proprietary information of the University of Kansas School of Nursing. Such proprietary information may not be used,
reproduced, or disclosed to any other parties for any other purpose without the expressed written permission of University of Kansas School of Nursing.
© KU Center for Health Informatics | Page 2 of 8
SURGEON: Dale Ng, MD
ASSISTANT(S):
Samantha Sterling, MD
Levi Fischer, RN
PREOPERATIVE DIAGNOSIS:
Right knee pain, right knee genu varum, right knee degenerative arthritis.
POSTOPERATIVE DIAGNOSIS:
Same.
OPERATIVE PROCEDURE:
Right total knee arthroplasty.
ANESTHESIA:
General endotracheal.
Components Utilized: DePuy total knee system, size 5 posterior stabilized femoral component, size 4 tibial
component, size 17.5-mm thickness tibial articulated surface, size 38-mm round patella.
FINDINGS:
INDICATIONS FOR OPERATIVE PROCEDURE: Mr. Mickland is a pleasant 64-year-old gentleman with
multiple medical comorbidities and is about a year after his primary knee arthroplasty on the left. He has done
well with that. He presents from the right. He has severe varus deformity and no contracture, but again lot of
varus in addition to his tricompartmental degenerative disk disease. We discussed the risks, benefits,
alternatives, and complications involved with knee arthroplasty again. He voiced understanding and elected to
proceed.
DESCRIPTION OF OPERATIVE PROCEDURE: After being identified in the preoperative holding area, I
marked his right lower extremity. He was then brought back to the operating room. He was intubated by the
Anesthesia Service. He was positioned for surgery appropriately. All bony prominences were checked and
padded. The nonoperative extremity was covered with a foot squeezer and a TED hose to prevent DVT. All the
bony prominences checked and padded. His preoperative antibiotics have been administered previously. No
hair removal was required. I placed a nonsterile tourniquet. We then exsanguinated with an Esmarch. An
anterior skin incision was made and a median parapatellar arthrotomy was performed. He was noted to have
severe tricompartmental degenerative changes. I removed his meniscal tissue in addition to his infrapatellar fat
pad. The knee was again noted to have severe varus deformity. I was then able to perform a very large medial
release. I then cannulated the distal femur. I irrigated and suctioned the femoral canal and then placed the
distal femoral alignment guide. We then sized him to 5 after cutting him to 5-degree of valgus. I performed
anterior-posterior chamfer cuts. The distal femoral lug holes were placed as were the trial femoral component. I
then brought the knee through range of motion and noted that we felt severe varus deformity. I then placed
extramedullary tibial guide after removing the trial femoral component. Having done so, the knee was
osteotomized on the tibia. I resected 2 mm of bone off the most worn side, which was obviously the medial
side. He did have a significant amount of medial wear there. The wound was then irrigated. I performed a tibial
osteotomy. Having done so, the tibia was sized out as a 4. He had a significant amount of posterior
osteophyte. I debrided that away as well. Next, the knee was reduced with the aforementioned trial
components. I assessed the axial, coronal, and sagittal alignment as well as limb and component alignment on
the extremity. The native patella tracked nicely. I then removed 8 mm of bone with patellofemoral reaming
system. It was then sized out as a 38. I placed a 38 mm trial button. Having done so, the patellofemoral joint
tracked perfectly. The trial components were removed. I irrigated and suctioned the femoral canal copiously
and the bone ends as well. Antibiotic impregnated cement was utilized. I then cemented in his definitive
components after administering his first postoperative dose of antibiotic. Once the cement had been placed, I
DISCLAIMER: All patient information appearing on this document is fictitious. Any resemblance to real persons, living or dead, is purely coincidental.
Proprietary Statement: This document contains proprietary information of the University of Kansas School of Nursing. Such proprietary information may not be used,
reproduced, or disclosed to any other parties for any other purpose without the expressed written permission of University of Kansas School of Nursing.
© KU Center for Health Informatics | Page 3 of 8
then removed all residual cement debris and noted that the knee had no more residual cement. The trial
polyethylene tibial component was placed. I then reduced the knee, placed multiple lap sponges, held
compression. I let the tourniquet down. Total tourniquet was less than 50 minutes. The cement was allowed to
harden for 5 minutes. I achieved electrocautery hemostasis. The trial component was removed. I then
reinspected the knee. I found no residual cement debris or bone debris. The wound was irrigated 1 final time. I
then placed the definitive poly and then closed over a medium Hemovac drain with number 1 Vicryl for the
retinaculum, 0 and 2-0 Vicryl on the subcutaneous tissues, and then 3-0 nylon horizontal mattress sutures for
skin. Sterile dressings were applied. He was transported to the recovery room on gurney without incident. On
arrival to the recovery room, he had a normal neurovascular exam.
Attestation: I attest I was present for and performed the entire procedure myself. There were no complications.
Dale Ng, MD
Result type:
Result date:
Result status:
Result title:
Performed by:
Verified by:
Encounter info:
Pharmacy Plan of Care
September 30, 2011 6:16 PM CDT
Auth (Verified)
Medication List
Brown, Benny on November 03, 2011 6:16 PM CDT
Brown, Benny on November 03, 2011 6:16 PM CDT
40000023424, KUMC, Inpatient, 9/30/2011 -
levofloxacin (LEVAQUIN) 250 mg/50 mL IVPB 250 mg Intravenous Q24H*
acetaminophen (TYLENOL) tablet 650 mg 650 mg Oral Q6H
amLODIPine (NORVASC) tablet 10 mg 10 mg Oral QHS
buPROPion SR (WELLBUTRIN-SR) tablet 150 mg 150 mg Oral QDAY
carvedilol (COREG) tablet 12.5 mg 12.5 mg Oral BID w/meals
doxazosin (CARDURA) tablet 8 mg 8 mg Oral QHS
finasteride (proSCAR) tablet 5 mg 5 mg Oral QDAY
lansoprazole DR (PREVACID) capsule 30 mg 30 mg Oral QDAY
loratadine (CLARITIN) tablet 10 mg 10 mg Oral QDAY
pregabalin (LYRICA) capsule 300 mg 300 mg Oral BID
tamsulosin (FLOMAX) capsule 0.4 mg 0.4 mg Oral QDAY after breakfast
docusate (COLACE) capsule 100 mg 100 mg Oral QDAY
levothyroxine (SYNTHROID) tablet 125 mcg 125 mcg Oral BID
losartan (COZAAR) tablet 100 mg 100 mg Oral QDAY
simvastatin (ZOCOR) tablet 20 mg 20 mg Oral QHS
milk of magnesia (CONC) oral suspension 10 mL 10 mL Oral QDAY(21)
enoxaparin (LOVENOX) syringe 40 mg 40 mg Subcutaneous QDAY(21)
insulin aspart (NOVOLOG) flexPEN 14 Units 14 Units Subcutaneous QID
Continuous Infusions:
ropivacaine (NAROPIN) 0.2% PCA PNC infusion (ON-Q) 550 mL (09/30/11 0725)
DISCLAIMER: All patient information appearing on this document is fictitious. Any resemblance to real persons, living or dead, is purely coincidental.
Proprietary Statement: This document contains proprietary information of the University of Kansas School of Nursing. Such proprietary information may not be used,
reproduced, or disclosed to any other parties for any other purpose without the expressed written permission of University of Kansas School of Nursing.
© KU Center for Health Informatics | Page 4 of 8
sodium chloride 0.9 % with KCl 20 mEq/L infusion 30 mL/hr (10/01/11 1000)
DISCLAIMER: All patient information appearing on this document is fictitious. Any resemblance to real persons, living or dead, is purely coincidental.
Proprietary Statement: This document contains proprietary information of the University of Kansas School of Nursing. Such proprietary information may not be used,
reproduced, or disclosed to any other parties for any other purpose without the expressed written permission of University of Kansas School of Nursing.
© KU Center for Health Informatics | Page 5 of 8
Result type:
Result date:
Result status:
Result title:
Performed by:
Verified by:
Encounter info:
Operative Report
October 01, 2011 7:14 AM CDT
Auth (Verified)
POD1 Physician Note
Ng, Dale J on November 03, 2011 5:05 PM CDT
Ng, Dale J on November 03, 2011 5:38 PM CDT
40000023424, KUMC, Inpatient, 9/30/2011 -
* Final Report *
S: No acute events. Patient tolerating current diet. Denies chest pain. Denies SOB.
O: Blood pressure 157/69, pulse 71, temperature 36.5 °C (97.7 °F), height 177.8 cm (70"), weight 121.8 kg
(268 lb) , SpO2 94.00%.
General: AAOx3, NAD
Cardiac: RR
Respirations: Unlabored
Abdomen: soft, nt
Extremities: RLE: DF,PF,EHL intact. SPN, DPN, t nerve intact.
Incisions: C/D/I
A/P: 64M R TKA
- PT/OT
- dvt prophylaxis
- WBAT RLE
- transition to oral pain meds
- renal dose levaquin per cardiology recs
- chronic renal insufficiency. Will continue to monitor
DISCLAIMER: All patient information appearing on this document is fictitious. Any resemblance to real persons, living or dead, is purely coincidental.
Proprietary Statement: This document contains proprietary information of the University of Kansas School of Nursing. Such proprietary information may not be used,
reproduced, or disclosed to any other parties for any other purpose without the expressed written permission of University of Kansas School of Nursing.
© KU Center for Health Informatics | Page 6 of 8
FORM BROWSER
FLOWSHEET
ORDERS
DISCLAIMER: All patient information appearing on this document is fictitious. Any resemblance to real persons, living or dead, is purely coincidental.
Proprietary Statement: This document contains proprietary information of the University of Kansas School of Nursing. Such proprietary information may not be used,
reproduced, or disclosed to any other parties for any other purpose without the expressed written permission of University of Kansas School of Nursing.
© KU Center for Health Informatics | Page 7 of 8
DISCLAIMER: All patient information appearing on this document is fictitious. Any resemblance to real persons, living or dead, is purely coincidental.
Proprietary Statement: This document contains proprietary information of the University of Kansas School of Nursing. Such proprietary information may not be used,
reproduced, or disclosed to any other parties for any other purpose without the expressed written permission of University of Kansas School of Nursing.
© KU Center for Health Informatics | Page 8 of 8