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1. In relation to your chosen patient, discuss the pathophysiology of the condition using evidence-based practice explore current treatment options for your patient’s condition, include any pharmacological and non-pharmacological considerations.
Arthur is an 83 years old gentleman and his medical history include osteoarthritis, hypertension and deficiency of Vitamin D. Therefore, osteoarthritis is a joint disease that causes chronic disability in elderly. 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).
Arthur 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 varies in the volume of water content as well as the proportion of chondroitin-sulfate to keratin sulfate components (Moscato, O’Brien-Jnr, Dryjski, Dosluoglu, Cherr, & Harris, 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 (Brewster, S & Biers 2005).
Also, another important condition is that Arthur is a long term smoker, therefore researches had stated of the derivative enzyme activity increases in osteoarthritis as opposed to normal aging cartilage resulting in Arthur Jones’s total hip replacement. Researchers have identified failures as a result of infection, of the bone to grow to porous metal or hip breakages linked to smoking (Nepple, Thomason., An, Harris-Hayes., & Clohisy, John, 2015).). Nicotine constricts blood vessels resulting to the wounds getting lesser oxygen and healing nutrients, which slows the healing process (Jane, Hochberg, Nevitt, Simon, Nelson, Doherty & Flechsenhar, 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).
Most the time hypertension is usually linked to cardiovascular disease that lead to coronary heart diseases and renal diseases. As a person gets older there is increased systemic vascular resistance and increased stiffness of the vasculature which increase hypertension. Due to the α-adrenoceptor stimulation the vascular tone increases (Moscato et al., 2015). Also, increase in cytosolic calcium in the vascular smooth muscles cause vasoconstriction. When this pressure and stiffness is exerted on the left ventricle muscles it results to diastolic dysfunction. Prevention of hypertension in the elderly can be through administration of calcium channel blockers. This help in the decrease of peripheral vascular resistance (Daivajna & Villar, 2015). Dietary measures such low salt intake, weight loss management, and low alcohol intake, physical exercises are effective for prevention and treatment of hypertension.
Another pathophysiology of Arthur’s condition is vitamin D deficiency. Deficiency in vitamin D has been reported previously in patients with osteoarthritis undergoing hip replacement surgery. For adults treatment is through administration supplements and also a proper diet. Also, exposure to the sun every day for 10-15 minutes will help curb the deficiency (Daivajna & Villar, 2015).
To hasten Arthur’s recovery, certain assessments should be assessed such as vital signs, respiratory status, pain status, the incision and drainage for at least hourly during the first eight hours after surgery and also assess respiratory rate, oxygen saturation, depth and breaths sounds should be monitored for any signs of complications and atelectasis (Lambie, 2010). To enhance good respiratory to the lungs, his head should be elevated of the bed 30 degrees of higher; this will necessitate lung expansion and decrease the diaphragm at the same time.
Also, it is reported that Arthur’s oxygen saturation was 93% after his surgery. Oxygen therapy is necessary to help him reach above the standard 95% level. This will help him maintain he required level of oxygenation and at the same time preventing hypoxia (Lambie, 2010). He can also perform other respiratory exercises using the spirometry. Furthermore, Arthur’s vital signs should be assessed 15 minutes in the first hour of surgery, after half an hour in two hours and then every four hours (Lambi.............
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