Osteoarthritis Care and Management | Case Study

Osteoarthritis C ar and Management Case acceptINTRODUCTIONOsteoarthritis is a case of rose hip, spine and forearm interrupts and injuries which is predominantly found in ripened mickle, unless otherwise. There is an increase in these fractures, injuries, unwhole fewness and mortality rates in honest-to-god people. In the 1990s, these numbered around 1.7 meg worldwide and with rapid increases in the years that followed, it has been estimated around 8.2 million cases by 2050 (Cooper, 2006). Yaban (2006) make the staggering conclusion that 95% of hip fractures or injuries in old age people ar ca subroutined by f solelys. Supporting these views, Arinzon (2007) went a little further by stating that post hip fracture impairment among tolerants that initially survived infirmaryisation is in the midst of 32-80% and that those in need of longsighted barrier caring by skilled absorbs is 6-60%.MeeK et al (2002) and Abudu et al (2002) preserve the series of complications that unremarkably develop in patients later on hip fracture or injury due to old age and that 10-35% of such(prenominal) patients died inwardly the first year after an injury and 30% do live on another fracture at bottom a year. Mitigating these appalling problems, surgical operation is unremarkably recommended for a total hip switch (THR), especially in old and secondary Osteoarthritis. Following mathematical operation, many patients encountered problems, especially in their activities of daily purport (ADL) as they atomic number 18 no longer able to climb chairs, equivocation down in bed, and get on and off transportation without the champion of someone. As a result of this dependency, after pouch, total hip heterotaxy patients need a victorian arrangement of their home considerations.The home setting is in conjunction with their new model of liveliness (TML), which Roper in 1976 defined as those activities of living performed by individuals and business concern be ing provided end-to-end their lives. As Murphy et al (2002) admonished, the model did not scarcely fury on individualism broad(a)ly also facilitates the homework of the thrill as a whole and the achievement of realistic and accessible goals in c be.holistic sagacity of Ms Jane.On admission to the ward, Ms Sutcliffe is give a positive mind that involves the collection of her data regarding age, sex, chronic medical conditions, pre-fracture serviceable status, her type of fracture and operation, weight, trouble oneself perception and cognitive status. The assessment takes into bet her mental, carnal and fond preparation as all will piece of cake a major role in her recovery after surgery.The psychological assessment/preparation tolerates her to understand what she will experience during the acute mannikin of the surgery and during the do work of recovery. This gives her ample snip to prep ar ahead and move up to terms with whatever follows. Banduru (1997) made mentioned of self-efficacy beliefs, which are devising exercises in monastic order to achieve good expiration after surgery. There is also the readiness of verbal and written information by takes to her before the surgery.Ayers et al (2004) regards fleshly preparation as a major life event and affects the outcome of the operation. This process underscores the point that patients that are more depressed before the surgery to flummox poorer inconvenience relief after operation. On the other hand, Holman (2005) exact goted patients with positive(p) expectations before a hip operation remove better physical outcomes and that those that work hard religious service the multidisciplinary team in achieving such outcomes. fond assessment looks at Ms Sutcliffes home circumstances and her baron to manage after the hip substitute operation. Chow (2001) refers to the patients home environment as very crucial in the recovery process and that there is no need for Jane to struggle in get up from a chair, a bed, visiting the kitchen, going to toilet during the boundary her muscles are healing. There is a need for support in the areas of shopping, cleaning, cooking, washables as there are no relatives or friends around her on daily basis.Escobar et al (2007) purported that the whole pathway of allot from patients being listed for surgery, to the time of surgery and the recovery process are very complex and involves a lot of health professionals. Normally, before a patient is referred for hip replacement, should throw some understanding of what the surgery entails. This gives them the chance to consider it or not. round GPs do ensure that patients are physically fit before making a referral to an orthopedical Consultant. In the event the patients hip pain arouse no longer be managed, as in the case of Ms Jane, the Consultant fuel now refer to an Orthopaedic Surgeon.The preparation for surgery at the preoperative assessment clinic is considered to be lon g and should be undertaken earlier. That is, just when a patients name is added to the waiting list (Krouse, 2001). Normally, the process involves giving out a comprehensive cusp to Ms Jane to read at home to enable her understand what is necessitate along the care pathway. In some instances, videos or DVDs containing details of the surgery provided for watching at home as well.The final stage of assessment is the preoperative assessment in the ward. It is a form of educational assessment, whereby the Nurse or any professional ensure earlier conditions do not change. They will screen for MRSA to check for infection and to see whether Ms Jane can cope with the surgery (Losina, 2008). check to Rowley (2001), Nurses in the unit/ward are to make sure that Jane is safely prepared for surgery through the help of a surgical safety checklist.A Medical conditionWith regards to the care the patient requires for Osteoarthritis, as the case with Ms Jane, is derived from the Integrated wield Pathways (ICP), which are structured multidisciplinary care plans that describe in detail each graduation in the care process. Zander (1998) looked at such care plans and concluded that they usually entail treatment protocols with the aim of standardising care. Inputs are not sole(prenominal) from Nurses, only from paramedical and administrative staff as well. Parker et al (2002) maintained that in-hospital care for right hip replacement is a team effort, though Nurses are seen to be playing an all-embracing role throughout this period. In brief, Nurses are involved in assessment, emotional support, involvement of family members, technical and physical care, co-ordination and converse and therapy integration. This therefore made Kirkevold (1997) to conclude that the need for Nurses to work usefully within the multi-professional team is becoming increasingly vital, just as their contributions towards rehabilitation star(p) to the patients license living.Post-operative careTho mas (2002) is of the view that the human personify is forever susceptible to physical, traumatic and medical situations that do adversely affect the external respiration process. As a result of this, air lane and brea affaire must be managed quickly and effectively to enable the continuous flow of oxygen, thereby preventing deaths. airway management is the physical process which ensures the airway is open and clear to depart respiration to occur. Mastering or becoming proficient in the methods and tools for airway management by health professionals enhances the patients (Ms Sutcliffe) chances of survival after surgery. Nurses should observe for coughs, inspiratory crackles, and shallow respirations and decreased chest expansion. In addition, observe for pale mucous membrane as they are signs of pneumonia that usually grow ineffective airway clearance.Breathing involves the process of air (oxygen) entering the body and then (carbon dioxide) expelled back into the environment . The conduit for such a process is through the airway. much(prenominal) complex ways of managing airways by health professionals involves the opening, cleaning and delivering of supplementary oxygen for artificial ventilation-in cases of ineffective breathing by Jane after the surgery.Post-operative observation in relation to circulation normally looks at the main signs and symptoms of bleeding as briefly as Ms Jane is brought to the ward after the surgery. There are tendencies for patients to be at guess after undergoing surgery. Problems such as hypovolenic shock as a result of loss of affinity and fluids. Right hip replacement surgery requires bed rest post-operatively and normally places the patient at risk in relation to developing blood clots in the legs. When this occurs, the decreased masses within the circulating system cannot provide the much needed oxygen and nutrients to the tissues and can sometime results to death if not solved. As a care, the Nurses or health pr ofessionals should administer intravenous fluids to replace the lost volume and if blood is lost, packed red blood cells and platelets must be ordered for Ms Jane straightaway.Pain ManagementHelme and Gibson (2001) asserted that pain and its consequence, especially functional limitations that interpose with individual daily activities and leading to poorer life, afflict active 25%-88% of aged people within communities worldwide. For pain management to be effective there must be accurate pain assessment. Many held the view that self-reporting of pain is an individuals subjective perception and this may provide enough information for its management. With the elderly, their pain is usually undetected due to severe cognitive impairment.Sheppered et al (2010) argues that effective post-operative pain management relieves suffering and leads not only to shorter hospital stay but at the same time reduces hospital costs as well as earlier patient mobilisation. hotshot goal many believe in the management of post-operative pain is to rattling reduce the dose of medications in order to lessen side do.Opioids are seen to be the first-line treatment for severe acute post-operative pain and the same scenario should obtain to Ms Jane after undergoing the surgery. They are drugs use to lessen pain and use practically to titrate against pain relief and to minimise unwanted effectuate to the patient. Other common methods use to manage post-operative pain include the pickings of Codeine, Ibuprofen, intravenous narcotics like Morphine Sulphate, Paracetamol and even Opiate Fentanyl.According to Sheppered et al (2010), some of the side effects of Opiopds include vomiting, respiratory depression, constipation and itching which are approximatelyly common. In such situations, healthcare professionals can reduce the effects by changing the dosing schedule of the patients, in this case Ms Jane, maintain constant blood levels through checking the manner in which drugs are give n out and addition of other drugs to counteract any effects.Psychological CareDavidson et al (2008) are of the view that normally when psychological care is address in hospitals, entails what health professionals expect the patient to need rather than from the side of the individual and illness experience. such a care should focus on assessments of Ms Janes understanding of her illness and the effect it will have on her life. Supporting this view, one is to draw his or her attention to the arrogance that assessment of the patients illness beliefs as a daily practice can significantly increase his or her sense of upbeat on boot out (Lau-Walker et al, 2008).After the surgery, hip replacement patient immediately start physical therapy as part of the psychological care. This is normally a minor exercise, involving sitting in a chair, the day after the surgery. What follows is stepping, walking, and climbing, with positive devices like crutches. In this case, Ms Jane pain is being monitored during these exercises, as most often, there is some degree of discomfort. As Van den Akker-Scheek et al (2007) pointed out, psychological inescapably of hip replacement patients like acute pain after surgery can be addressed during the period of psychological care. At the pre-operative stage, the patient some time has already planned about such a pain and come to terms with it at this stage. set free detailsDischarge is a process and not an isolated thing and in this regard, must be planned for at the earliest opportunity. According to the Department of Health (2003), the above view is to ensure that patients and their carers understand and musical note involved in the discharge arrangements. For any discharge to be detailed, the prep must involve communication, education, patient participation and collaboration and coordination. All such detailed readiness must be instituted for Ms Jane.Olsen and Wagner (2000) maintained that effective communication is needed between Ms Jane, the patient, and the healthcare professionals for any meaning(prenominal) discharge to take place. This kind of communication normally involves asking questions to her or relatives and getting answers. Through this process, inconsistencies are brought to light and clarified. At this stage of discharge planning, which may be verbal or written, information like the patients functional status, social support and environment status, are all addressed (Neuman, 2004). Bull and Roberts (2001) viewed communication as a complete electric circuit as it involve community team in the arrangement of outpatient appointments, the GP and connecting again with the district Nurse.Education is all part of communication but Lin et al (2005) believed that the grooming of instruction leaflets to the patient or the family sums the entire process. Garratt (2009) state of such leaflets to contain specific information of the patients needs and at the same time how to manage their ongoing care at home.Patients involvement and collaboration in their discharge is very essential and consort to Pearson et al (2004) includes their practical arrangements for physically getting back to their homes, management at home and health professionals making them feel they are in see of their health. Such information is vital and discussing it jointly with Ms Jane makes the discharge planning very successful.All what has been discussed above will be meaningless without proper coordination. Therefore, Atwal (2002) purported that a key aspect of successful discharge planning is coordination and that without it, the entire process cannot be effective. For Atwal, there should be inter-professional working relationship between the Nurses and the Doctors for a successful discharge planning. Watts et al (2007) are of the view that there are normally disputes as to who does, and who should, carry out the discharge planning process. But where there is coordination, normally it is the bedside Nurse or primary Nurse that is responsible for coordinating discharge planning process (Gardner (2005).The issue of discharge is to be dealt with in the right manner just as materialization et al (2005) warned, shorter hospital stays can result in older people experiencing right hip replacement being discharged in a state of incomplete recovery. They went on to suggest for a proper time table for such an activity and to be agreed upon by both the hospital authorities and the patient.Immediate care of the patient in the community.Contemporary health and social care policy across europium and in the UK in particular, is focused on the provision of care in the community for older people with chronic illnesses and eventual surgery (DH, 2001). To this end, Themessl-Hubber et al (2007) suggested that awareness, expectations and perceptions of community services are steadily increasing in older people. According to Stoltz et al (2004), research has shown more responsibility for care provision is now placed on informal caregivers-unpaid family members, friends or neighbours. This is because older people perceived this informal segment as their best option as compared to formal support-services provided by health and social care in the community. However, Mahoney et al (2008) caution this claim as they pointed out that older people living alone and infrequently visited by family members are more likely to have poor outcomes following discharge. Relating this to Ms Jane, proper arrangement should be made for community care so as to avoid the situation of having a poor outcome. One is to take not of the fact that she lives alone and not frequently visited by her children relatives and friends.Deniz et al (2005) warned that after hip replacement surgery, patients normally encounter problems such as climbing stairs, lie down in bed, walk and so on and thereby affecting their activities of daily living. As a result of these problems and many more, Bilik (2006) asserted that co ntinuity of care is to be provided in their homes or communities. Such a community care accent on individualism so that Ms Jane can acquire independence in her activities of daily living. The Model of Living, according to Roper (1976), can be used to acquire this independence. In brief, the model focuses on eating and drinking, ain cleansing and dressing, mobilising, working and playing, breathing and control of body temperature. Where this model is decent used by those caring for her in the community, will not only allow her to live independently, assist in focusing on those problems she often experienced while recovering but complications can also be prevented.The removal of the sutures depends which ones are used in Ms Janes operation. If inhumed ones are used by the Surgeon, no need to be removed as they would dissolve in the body. The dressing also depends largely on whether the Surgeon uses stitches or staples. In any case, the wound needs to be kept covered and in the ca se of leakage from Ms Janes covered wound, the community worker should inform the appropriate authorities.ConclusionPost-operative care of elderly patients with hip fracture both in hospitals and in their communities can be carried out effectively when they are identified immediately at admission as high-risk patients. With this achieved, planning for their discharge to be through with(p) early and communicated well to all those involve in the care process. This is to allow them to move back confidently to their communities.Nurses role in the entire process of care appears to be extensive and always in a present to influence patient care. This is why it is expected of them to make a thorough assessment of patients, including their physical, mental and social conditions as soon as possible. Such a clinical history would help Nurses to transform care from justificative status to a more advanced care. However, even though assessment is a vital part of caring for hip replacement, maj ority have considered it to be of less importance wherein Nurses who carry it out do not inform their superiors in the care planning process.Moving away from the hospital environment, the importance of support provided by other family members and the community during post-hospitalisation, more so in the dispensation of medication should be considered highly.Notwithstanding the above, total hip replacement is becoming increasingly common. All that is required from those undertaking it is physical, psychological and social preparation.