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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).
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 & Middl.............
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