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Osteoarthritis Essay


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Post-operative pain depicts the most undesired series of surgery and if never treated well, could lead to a delayed return to normal activities and augmented hospital stay. Post-operative pain management has received huge interest currently. The postoperative pain intensity depends on numerous aspects like duration and type of surgery, anesthesia used and anesthesia type, and the emotional and mental state of the patient. Post-operative management is the key element in the Tom Bing case study, an 84 years old man who had surgery for severe osteoarthritis. Osteoarthritis depicts the case of the spine, hip, and forearm injuries and fractures that are chiefly found in older individuals, unless otherwise. There is a surge in these injuries, morbidity, mortality rates, and fractures in older people. Numerous kinds of arthritis could affect the hip joint. The most prevalent kind is osteoarthritis that some people regard as a degenerative joint illness. Osteoarthritis is present when the articular cartilage or joint surface cartilage is worn away making the raw bone beneath exposed. Hip osteoarthritis is a serious condition. It could take months or years to appear. Whereas it is never curable, it most surely is treatable utilizing medications, activity modifications, or injections. Thus, the assignment specifically outlines the significance of pain management in post-operative care and also outlines the possible impacts of unrelieved pain in the Tom Bing case. The essay further outlines the procedure of making clinical decisions utilizing various models.

General points

Hip osteoarthritis results in stiffness, joint deformity, and pain. Osteoarthritis symptoms could affect one’s capability to work, walk and enjoy life. For numerous patients having mild arthritis, pain could be managed with rest, pills, activity modifications, joint infections, or ice. Consequently, for patients having severe arthritis, the pain might not respond to those types of interventions. Patients having severe arthritis at times could benefit from total hip replacement surgery (Allen and Golightly, 2015). The usual pain linked to hip arthritis is located in the buttock or groin thigh. The pain is commonly worse with weight-bearing activities like twisting, walking, or standing.

Following ward admission, Tom is subjected to a thorough assessment that comprises the collection of his data comprising sex, age, pre-fracture functional status, chronic medical conditions, weight, cognitive status, type of operation, and fracture and pain perception. The essay takes into account Tom’s physical, social and psychological preparation as all have a huge role in his recovery after surgery. The physical preparation or assessment will permit her to comprehend what he will experience during the recovery process and the surgery’s acute phase. That offers him enough time to prepare ahead and understand what will follow. Physical preparation is regarded as a key life event and impacts the operation’s outcome. That procedure underscores the point that the patient is more depressed before the surgery to possess poorer pain relief after the operation (Berenbaum et al., 2020). Patients having positive expectations before the hip operation possess better physical results and those that work hard aid the multidisciplinary team in attaining such results.

Social assessments focus on Tom’s home circumstances and his management abilities after the hip replacement operation. The patient’s home atmosphere is very vital in the recovery process and there lacks a need for Tom to struggle in getting up from bed, a chair, going to the toilet, visiting the kitchen during the period his muscles are healing. There is a requisite for support in the areas of cleaning, shopping, laundry, cooking from the accessible friends or relatives around him on daily basis. Chen (2017) alleged that the entire path of care from patients being outlined for surgery, to the surgery time and recovery process is very hard and comprise numerous health professionals. Generally, before a patient is sent for hip replacement, ought to have some compression of what the surgery comprises. That offers them the chance of considering it or not. Some general practitioners do guarantee that patients are fit physically before making any referral to the orthopedic consultant.

The surgery preparation at the preoperative evaluation clinic is regarded as long and ought to be undertaken earlier. That is, just after the name of the patient is entered into the waiting list. Generally, the procedure comprises giving out a complete booklet to Tom at home to uplift their comprehension of what is needed alongside the care path (Conner-Spady et al., 2015). In some cases, DVDs or videos comprising information of the surgery should be given for home watching. The last phase of evaluation is the preoperative evaluation in the ward. It is a kind of educational evaluation, where any professional or nurse guarantees earlier conditions never change. That is when they screen for MRSA to look for infection and to verify if Tom could cope with the surgery. The nurses in the ward or unit are there to ensure that Tom is well prepared for surgery through the aid of the surgical safety checklist.

With regards to osteoarthritis care, the patient needs, as in the case with Tom, is attained from the integrated care pathways that are controlled multidisciplinary care plan that illustrates in detail every phase in the care procedure. Inputs are never only from nurses, but from administrative and paramedics staff as well. In-hospital care for a hip replacement team effort is present, though nurses are viewed to be playing the all-embracing part throughout that period (Cope et al., 2019). Generally, nurses are comprised of emotional support, family members’ involvement, assessment, coordination, physical and technical care, and therapy and communication integration. That thus Dahlberg (2016) made to assert that the requisite for nurses to work efficiently within the multi-professional squad is becoming progressively critical, just as their help towards rehabilitation leading to the independent living of patients.

Daivajna (2015) is of the aspect that the human body is always vulnerable to medical, traumatic, and physical situations that do harmfully affect the breathing procedure. As an outcome of this, breathing and airway must be managed effectively and quickly to enhance the continuous oxygen flow, thus preventing deaths.  Airway administration is the physical procedure the airway is clear and open to permit respiration to happen. Becoming or mastering proficiency in the tools and methods for airway administration by health specialists certifies the patients’ odds of survival after surgery. Nurses ought to observe for inspiratory crackles, shallow respirations, coughs, and reduced chest inspirations. Additionally, look out for pale mucous membrane since they are a sign of pneumonia that normally lead to ineffective airway clearance. 

Breathing comprises the procedure of oxygen or air entering the body and then debarred back to the atmosphere. The channel for such a procedure is via the airway. Such key methods of managing airways by health specialists comprise the delivery, opening, and cleaning of supplementary oxygen for artificial ventilation in situations of ineffective breathing by Tom after the surgery (Favero et al., 2015). Post-operative surveillance in accordance to circulation generally looks at the key symptoms and signs of bleeding as soon as Tom after surgery is brought to the ward. Issues like a hypovolemic shock after fluid and blood loss are present. Surgery in the hip replacement needs bed rest post-operatively and typically places the patients at danger of association to attaining blood clots in their legs. When that happens, the reduced volume in the circulating system can never offer the much requires nutrients and oxygen to the tissues and could at times lead to death if never solved (Fibel, Hillstrom, and Halpern, 2015). As a precaution, a health specialist or nurse ought to administer intravenous fluids to substitute the blood or lost volume, packed platelets, and red blood cells ought to be ordered for Tom immediately.

Gebhart (2016) outlined that pain and its results, normally functional restrictions that interfere with individual normal undertakings that inhibit an individual’s normal activities and leading to poorer life, bother 30-80n%bof elder individuals within communities globally.  For pain administration to be efficient there has to be accurate pain evaluation. Numerous upheld the fact that pain self-reporting is a personal subjective view and that might offer adequate information for its administration. With the elderly, the pain is normally undetected due to increased cognitive impairment. Khurana (2015) contends that efficient post-operative administration relieves suffering and tips to not only reduced hospital stays but similarly declined normal hospital exposes times as well as initial patient mobilization. On objections in the administration of post-operative pain is to generally decline the medication dose as a way of lessening side effects.

Opioids are observed to be the initial line treatment for austere acute postoperative pain and a similar case ought to apply to Tom after undergoing the surgery. They are subscriptions utilized to reduce pain and utilize merely to infiltrate against pain relief and to reduce unwanted impacts to the patients (Lankhorst et al., 2017). Other general methods utilized for the management of post-operative effects comprise codeine taking, ibuprofen, and intravenous narcotics such as paracetamol, opiate fentanyl, and morphine sulfate. Opioids side effects comprise respiratory depression, vomiting, itching, and constipation that are normally common (Lespasio et al., 2017). In such cases, healthcare specialist can decline the impacts by altering the patients dosing schedule, in Tom’s case, maintain continuous blood levels via checking the model in which drugs are offered and extra drugs to counteract any impacts.

Aware of the notion that generally when physiological care in hospitals is addressed, it regards what health specialists except the patient to require instead of knowing the view of the illness and individual experience. Such care ought to focus on the evaluation of Tom’s comprehension of his illness and the impact it will have on his life. Whenever psychological care in hospitals is addressed, it regards what health specialists want the patient to exhibit instead of the patient’s perspective and the experienced illness (Loeser, Collins, and Diekman, 2016). Such care ought to focus on the evaluation of Tom’s comprehension of his illness and the impact it might have on his life. Supporting that perspective, an individual is to draw their attention to the contention that evaluation of the patient illness beliefs as the normal practice can chiefly augment their wellbeing sense on discharge. After the hip replacement surgery, a patient could immediately commence psychical therapy and a portion of the psychological care. That is generally a minor exercise, comprising sitting in a chair, and hours after the surgery (Mobasheri et al., 2017). What trails are walking, climbing, and stepping, with supportive gadgets such as crutches. In that situation, Tom is being scrutinized during those exercises, as most common, there is some discomfort degree. Psychological requirements of hip replacement patients such as after surgery pain acute could be addressed after the phase of physiological care. During the pre-operative phase, the patient possesses some time to scheduled time regarding such pain and coming to terms with it at that phase (Palazzo et al., 2016). 

Discharge depicts the procedure as not an entailed thing and in that regard, ought to be planned for the initial opportunity. As per the health department, the above outlook is to certify that careers and their patients comprehend and feel comprised in the discharge arrangements. For whatever discharge to be complete, the planning ought to comprise education, collaboration, communication, coordination, and patient participation (Pereira, Kerr, and Jolles, 2016). All such comprehensive planning ought to be instituted by tom. Effective communication is essentials between the patient, the health care specialist, and Tom for any meaningful discharge to be effective. That kind of communication specifically comprises asking queries to their relatives to attain answers. Through that procedure, inconsistencies are outlined, clarified, and brought to light. At that discharge planning phase that might be written or verbal, information such as patient’s social support, functional status, and environmental status, are entirely addressed. Communication is regarded as the complete circle as it regards the community team in the outpatient appointment preparation and the general specialist and linking over to the distinct nurse (Piazzolla et al., 2018).

Education entirely a portion of communication, believed that instruction leaflet provision to the family or patient sums the whole procedure. Illustrated of such leaflets to comprise vital information of the patient’s requirements and at similar times how to cope with their ongoing care at home (Rillo et al., 2016). Patients’ collaborations and involvement in their discharge are very critical as it comprises their practice schedules for physically getting back to their management homes, homes, and health specialists making them feel they are controlling their lives. Such information is key and using it jointly with Tom makes the discharge preparations very successful. All that has been utterly discussed will be meaningless with no precise coordination. For, there ought to be an inter-professional association between the doctors and nurses for triumphant discharging planning.

The problem of discharge is to be dispersed within the precise way where shorter hospital stays could lead to older individuals experiencing hip replacement being cleared in a state of incomplete recovery. Roos (2016) goes on to suggest a precise timetable for such an action and to be agreed upon by both the patient and hospital authorities. Contemporary social and health care policies around Europe for instance are focused on care provision in the community for older individuals with chronic diseases and eventual surgery. To that end, Schnitzer (2019) contemplated that perceptions, awareness, and expectations of community services are steadily rising in older individuals. Research has illustrated that more accountability for care provision is currently placed on informal caregivers like unpaid family friends, neighbors, and members. That is because older individuals are viewed as an informal segment as their precise option as contrasted to formal support-services offered by social and health care in the society. Consequently, state that the claim older individuals living alone and rarely visited by family members are more probable to have poor results after discharge (Shirley and Hunter, 2015). Relating to Tom, proper arrangements ought to be made for community care as that averts the case of having a bad outcome. Illustrates that after hip replacement surgery, patients generally encounter issues like climbing stairs, walk, and lie down in bed and that affects their activities of normal living. As a consequence of those issues and more, outlined that care continuity is to be offered in their communities or homes. Such community care highlighted individualism so that Tom could attain independence in his activities of daily living (Springer et al., 2017).

Early in the arthritis course, symptoms could be intermittent, probably associated not only with specific activities or sustained activities. Rest and averting the triggering activities will augment the symptoms. As arthritis worsens, symptoms could become more severe and more persistent like walking on the level ground could lead to pain. Whenever arthritis is severe, the activity pain could linger after stopping the activity (Strotman et al., 2019). With the worsening of the condition, it becomes less receptive to medical treatments like injections or pills. In numerous patients with advanced arthritis, specifically, if those medical methods are no longer beneficial, surgery could give relief of symptoms. Several patients with severe osteoarthritis could gain from total hip replacement surgery (Thysen, Luyten, and Lories, 2015).

It is never probable to predict the next osteoarthritis patient. However, various factors might lead to the hip being arthritic comprising genetics, acquired conditions like avascular necrosis, hip anatomy variations, childhood illnesses like slipped capital femoral epiphysis, obesity, and severe trauma. Simple methods could be taken that do not have increased risk comprise avoidance of the activities that might lead to symptoms and weight loss (Thienpont et al., 2016). Some patients denote nutritional supplements like chondroitin and glucosamine, to be beneficial. Should that intermediation not be satisfying, in discussion with one’s physician, the subsequent steps might comprise over-the-counter pain medication like anti-inflammatories like ibrufen and acetaminophen or naproxen. However, those pills are not for all, and if an individual has never used them before one ought to regard consulting the family physician first (van Schoor et al., 2016). At times non-steroidal, anti-inflammatory, and prescription-strength drugs could be prescribed. Generally, narcotic pills such as Tylenol ought to be averted for numerous patients with hip osteoarthritis. Joint injections comprising intra-articular corticosteroid injections could be beneficial for some patients. Consequently, joint injections normally appear to be less beneficial for hip arthritis compared to other joint arthritis, in part due to the complexity of accurately injecting the hip joint (Vina, and Kwoh, 2018.). Patients having severe arthritis who have attempted the above remedies severally could gain from total hip replacement surgery.

Several methods could be utilized to manage the pain linked to osteoarthritis comprising nutritional supplements, non-narcotic tablets like Tylenol, activity modification apt type of exercise and weight loss, prescription-strength drugs, join injections, and total hip replacement surgery (Quinn et al., 2018). Checking one’s weight proportional to an individual’s height could decline the likelihood of contracting osteoarthritis of the hip and could decline the symptoms of the condition after it sets in. Generally, staying height-weight proportionally and fit could also help. Some of the medications offered comprise nutritional supplements, narcotic painkillers, non-narcotic pain tablets, and non-steroidal, prescription-strength drugs (Zhang et al., 2015).


Elderly patients having hip fractures both in the society and hospital post-operative care could be undertaken out efficiently when they are immediately recognized at admission to being high-risk patients. With that attained, their discharge planning could be undertaken early and communicated well to the individuals comprised in the care process. That is to permit them to move back positively to their societies. The role of nurses in the whole care process appears to be widespread and always in a role of influencing patient care. That is why it is anticipated of them to make a complete evaluation of the patient comprising their social, mental, and physical conditions immediately. Such a clinical history could aid the nurses to alter care from a defensive position to more progressive care. Consequently, even though evaluation is a key part of hip replacement caring, the majority have regarded it to be of less significance where nurses undertaking it never informs their superiors in the process of care planning. Away from the hospital atmosphere, the significance of support offered by the society and other family members during post-hospitalization, more son in the medication release ought to be highly regarded.  Nevertheless, total hip replacement is becoming widely common. All that is needed from those taking it is psychological, social, and physical preparation.


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