1. In relation to your chosen patient, discuss the pathophysiology of their condition and using evidence based practice explore current treatment options for your patient’s condition, include any pharmacological and non-pharmacological considerations.
Osteoarthritis is a joint disease that causes chronic disability in adults of over 70 years of age. It is a degenerative condition resulting from the biochemical breakdown of articular or hyaline cartilage found in synovial joints. It also involves the whole joint organ as well as a sub-chondral bone as well as synovium (Tibor and Ganz, 2015).
Jones osteoarthritis is seen as a consequence of aging, he is 83 years of age. Many differences between the aging cartilage as well as the osteoarthritis have been defined, indicating the former. For instance, though denatured type II collagen is found in osteoarthritis cartilage and normal aging, it is exceedingly predominant in osteoarthritis. Osteoarthritis together with the normal aging cartilage vary in the volume of water content as well as the proportion of chondroitin-sulfate to keratin sulfate components (Jämsen et al. 2015). The manifestation of a chondroitin-sulfate epitope, epitope 846 in osteoarthritis cartilage, is only present in neonatal and fetal cartilage that proves that osteoarthritis cartilage is a different pathologic process. Another important decision is that the derivative enzyme activity increases in osteoarthritis as opposed to normal aging cartilage resulting in Arthur Jones’s total hip replacement (Nepple et al. 2015).
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Researchers have identified failures as a result of infection, of the bone to grow to porous metal or hip breakages linked to smoking. When considering only smoking-related catastrophes, the catastrophes rate was 9% in smokers and 3.6% in nonsmokers. Nicotine constricts blood vessels resulting to the wounds getting lesser oxygen and healing nutrients, which slows the healing process, as Adolph V. Lombardi, MD, confirms smoking results to less oxygen in the wound compared to nonsmokers (Lane et al. 2015). Carbon monoxide affects blood cells, hence decreasing oxygen distribution to tissues. The tissues are now prone to death. Smoking also causes blood platelets to stick, causing a blood clot (Daivajna & Villar, 2015). Elderly men who have low serum intensities of vitamin D are at greater risk of getting hip osteoarthritis.
Hypertension is also linked to Hip replacement. Most the time the disease is usually linked to cardiovascular disease that lead to coronary heart diseases and renal diseases. In addition, hypertension has been said to be the third leading cause of disability. The risk of hypertension increase with age. Jones therefore, has a high risk of hypertension being the fact that he is 83 years of age. There is therefore the need for preoperative evaluation and optimization of the patient (Kordic et al., 2012).
Another pathophysiology of Jones condition is vitamin D deficiency. Deficiency in vitamin D has been reported previously in patients with osteoarthritis undergoing hip replacement surgery. There is also high vitamin D prevalence in elderly patients with advances osteoarthritis. Vitamin D deficiency has been associated with preoperative functional state. Vitamin D is important for the regulation of calcium metabolism. According to (Jansen, 2013), there is a relationship between Vitamin D and the progression of knee osteoarthritis and that lower intakes of vitamin D increases the condition.
For hip osteoarthritis, stress management is encouraged to hasten post surgery healing. According to OARSI, hip treatment should first focus on patient-driven and self-help modalities as opposed to patterns given by health professionals. The ACR recommendations for the hip osteoarthritis include aquatic exercise, weight loss mainly for overweight patients and cardiovascular as well as land-based resistance training. Other measures include walking aids as required, thermal agents, programs regarding self-management, psychological interventions and manual therapy coupled with supervised practice (Daivajna & Villar, 2015). Pain management should be done through use of prescribed prescription of pain killers. The wound should be checked on a daily basis by the wound nurse.
2. Critically discuss four (4) components of the PACU discharge criteria outlined in the Aldrete Scale. Utilize the scale provided on LEO as a resource in your case study.
First, the processes ensure that there is a safe as well as an appropriate patients’ discharge to their home. This is done by the written policies and procedures of the facility which are put in place to discharge appropriately their patients to their homes and with an active collaboration of anesthetics, surgeons and qualified peri-operative nurses to ensure guidelines and safe practice has been accomplished and followed. Therefore, is very crucial for the nurse to observe intensively patient recovery to detect any sort of possibly complication from the surgical episode (Phillips et al. 2013).
Jones has to be also met with some outcomes such as obstructive sleep apnea, pain, difficult intubation, and vomiting. The discharge order is written by the most accountable physician who can be a surgeon or anesthesiologist. PACU as well may be delegated the decision to remove base on an objective discharge scoring system to the RN (Wainright & Middleton, 2015).
Secondly, an RN has to observe patient for respiratory depression at least for 20 or 30 minutes after taken the last dose of parental narcotic to make sure that patient can breathe without any difficulties. The respiratory exercises are conducted to prevent occurrence of infections such as pneumonia, and prevent imperative blood clots and keeping the lungs clear. Another importance of the respiratory tests is that it helps keep the pain under control. Some of the respiratory exercise performed include, taking deep breathes, coughing and incentive spirometry which are done every two hours (Daivajna & Villar, 2015).
Thirdly, Jones has to be fully orientated and aware of person, a place and time. It will indicate if patient has the readiness to be discharge or has some impact of its cognitive recovery. Before discharge the patient is informed that they will be in charge of their medication and respiratory exercises. They should be able to take care of themselves.
Lastly, stability of vital signs and stable capillary oxygen saturation are monitored after the first 24 hours. The RN is required to monitor the incision and dressing for any amount of drainage and any signs of infections. If a change of dressing is needed it should be done using the sterile technique. In addition, respiratory exercises are performed every two hours. Consequently, the bowel sounds are monitored and the diet of the patient is increased gradually according to the RN orders. Evidence of any potential complications is quickly corrected by the surgeon.
Furthermore, a responsible adult accompanies patient from the hospital. In the events where the patient is not willing for accompaniment from the hospital by a responsible adult, extra measures are taken. Some of the additional steps include and are not limited to patient’s being advised on the significance of an adult companion. Determination of the patient’s physical and cognitive parameters exceeding minimum requirements for discharge and that he or she can operate independently by the responsible physician. He also ascertains the mode of transportation the patient reports if it is allowable. He further can write a discharge order including the patient’s discharge without a responsible adult. This decision is not delegated to PACU RN. Further, arrangement is organized for patients who do not meet physical and cognitive parameters regarding discharge to undergo care (Weingarten & Middleton, 2015).
3. Develop a discharge plan to support your patient on discharge. Include any education you deem relevant, any referrals to allied health professional/s required, and discuss your rationale.
The goal of a discharge plan is to prepare the patient for discharge within a short time. It results in better comfort in the patient; reducing hospital acquired infections as well as costs. The patient can be discharged home after meeting the discharge criteria. Hip replacement discharge for Jones will include what is expected at his home, the home set up, and the activities involved, wound care and self-care, and when the doctor is required (Nakamura et al. 2015).
Education of patients suffering osteoarthritis of the hip can reduce their pain and improving the quality of life. Jones should be educated during the discussion with the doctor, through user groups or being delivered with written material (Stambough et al. 2015). He should frequently peruse materials from the Internet; join the Osteoarthritis Self-Management Program (OSMP), which is a peer-led and community-oriented program where patients are educated as on skills for self-management of osteoarthritis. The Osteoarthritis Foundation of Australia is one such example that organizes the administration of these courses. The courses are led by trained volunteers. A randomized attempt have revealed that members have lessened joint pains, fewer osteoarthritis-related consultations with the doctors, improved physical activity as well as enhanced quality of life. A methodical assessment of published attempts of the entire types of education packages regarding self-management of osteoarthritis certifies clinically minor, but significant decreases in pain coupled with a disability (Nakamura et al. 2015).
If Jones experiences continuous pain, and advanced limitation of activities of the day despite medical management. He can be referred to an orthopaedic surgeon to be assessed. To be an appropriate candidate for surgery, Jones needs to be medically suitable and able to take part in rehabilitation programs post-operatively. Complete joint arthroplasty releases pain as well as improve function for at least ten years. Full joint arthroplasties are deteriorating with time, hence need revision (Nakamura et al. 2015).
Referral to the Occupational therapist is necessary for the safety assessment of his house. The bed should be as low as possible to allow his feet touch the ground while sitting on the edge. His mattress has to be firm since he will not need a hospital bed. Uneven flooring found in doorways should be fixed, and good lighting installed (Stambough et al. 2015). The bathroom should be made safe by installing handrails as well as the commode. Putting things where they are reachable such as chairs placed firmly back in the Kitchen, bedroom and other rooms he is likely to use and no stairs in the house (Wylde et al. 2015).
This part involves keeping the bandage on the wound clean as well as dry. He is supposed to change the dressing in accordance with the physician’s directions when it is dirty or wet (Wainwright et al. 2015). The wound nurse is supposed to prescribe for the pain medicines. He should ensure his prescription is filled when he gets home and have it when need be. He is expected to take pain medicine when he begins feeling pain. He should not wait too long to take his medicine as that will result in severe pain. In the initial stages of recovery, taking pain medicine 30 minutes before he increases his activity helps reduce pain. He may be requested to put on special compression stockings for approximately six weeks. The importance of this is to prevent the formation of a blood clot (Stambough et al. 2015).
Referral to a nutritionist is necessary to ensure that Jones adheres to a certain diet to ensure proper healing. His diet should include foods full of calcium and vitamins to hasten the healing process. In addition there is need for referral to a wound nurse who would clean and dress Jones wounds daily. Since Jones has no relative thee is need to refer him to a personal care giver who will assist him in the bathroom, cooking and shopping to avoid injuries. Jones appears to be stressed by the surgery and would therefore need a councilor who will help him in the healing process (Lane et al. 2015).
Jones should be referred to a general Practitioner who will follow up on his recovery. He is supposed to call the doctor in case of blood in his stool or when it turns dark. A swelling in one of the legs could also prompt him to call the specialist. Performing respiratory exercises help in preventing breathing complications. These include deep breathing as well as coughing and encouraged spirometer exercises. The processes speed up recovery as it lowers the risk of lung problems for example pneumonia (Daivajna & Villar, 2015).
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