Solving the Medical Predicaments of Rogers - Case Study Example

Cliniсаl Sсеnаriо Name Affiliation Introduction Mr. Richard Rogers is a patient who has been in several medical problems over the last 6 years. He has been facing constant arthritis problems that eventually have led to undertaken of operation. According to his medical records he has been facing severe pains as a result of the ailment making him a regular patient. Proper medication and follow up as well as generation of proper interventions could be a good tool Rogers’s better medical health (Bernabei et al 1998). The paper seeks to indentify the best interventions that could be used to solve the medical predicaments of Rogers as well as draw relevant problems that could be used override the medical concerns. The causes and signs/symptoms of the problems are also going to be highlighted in the paper so that the difference between the problems could be seen. Nursing problems: this is a statement that explains as well as describes the potential and actual health problems that are related to nursing and can be able to identify relevant orders for nursing intervention so as to maintain the health and reduce the alteration as well as the changes that face Rogers. There are two problems that were identified from the medical records of Rogers. These three problems are linked to each other but placed in the order of priority. i. Arthritis: this is the highly prioritized problem that nurses have identified as per Rogers medication processes. It has been noted to be a key nursing problem with reference to the number of post visits encountered by Rogers. ii. The other prioritized problem identified is pain. As a result of arthritis and the post operation conducted the patient developed resultant pains that ended up making up on pain killers like panadol. iii. A change in the osmotic balance is another problem that faces Rogers in his daily medical routine or life. The fluid rate was determined and found that due to accumulation and elimination of water as a result of arthritis from the legs the water level in Rogers’s body reduced hence led to difference in osmotic problems. Problem 1: Arthritis Rheumatoid arthritis is a serious inflammatory disease from unknown characterized by persistent stiffness and swelling in the synovial joint leading to disability and early mortality. According to Rogers’s case the problem has resulted to reduced locomotion and disabilities since he is not able to undertake other duties that he was doing early in life before the onset of this problem (Cousins & Bridenbaugh, 2008). This problem is considered as of first priority since it is identified first during diagnosis and is also the cause of all the other problems. It is ranked has high risk problem since it can lead to modality in a short time of ailing. Nursing long attendance to this case of found that the problem the patient has developed progressive disease with joint destruction and functional disability. Signs/symptoms i. Joint pains: with reference to Rogers, he experienced painful joint which varied on the types of activities he undertook. The p[type of pain felt was a sensational pain rather than sharp pain. ii. Joint Stiffness: The stiffness of Joints is one of the earliest signs of arthritis. Rogers usually felt this type of stiffness in every morning. As the movement increased during the day the level of stiffness reduced. The level of stiffness extended for a period like 1 hour. iii. Tenderness of Joints: Joints were painful on the touch. The tenderness was always on the top of every joint most specific the knee. iv. Limited motion Range: Rogers found and was also noted to have limited range of motion for limb joints. This led to trouble to the day to day activities. This limitance was evident during bending and stretching. v. Warmthness at the Joints: due to the rate of inflammation from arthritis the joints were very hot and warm. The patient also experienced fever, rashes, weight loss and fatigue. Evidence-based nursing care A rheumatology nurse plays a critical role in training and educating of patients- this may include provision of information concerning medication. During nursing care of Rogers the nurse should play the role of making sure that he is aware about their drugs. The better informed the patient with respect to the type of medication and drugs to be used the better the adherence (Fainsinger & Bruera, 2004). The nurse should be able to have in depth understanding of the medication therapies as well as their mode of action so that they could be able to inform Rogers’s adequately on the correct procedures of medication. The ability to be well groomed and to have basic knowledge in grooming is an important maintenance and patient’s self-esteem and dignity. The nurse with occupational therapy skills needs to identify the patients dressing code that can reduce the impacts of arthritis as well as attain the medical goals that both the medical practitioner and the patient have. For example, the nurse should be able to advice the patient on the best kind of shoes to ware as raised shoes are not best for leg related arthritis. As for the case of Rogers he should not use raised shoes since from his experience it reduces his locomotion and also intensifies joint pains and stiffness. Restricted movement or mobility can cause several problems for Rogers including: breakdown of the skin, problems with manual handling, restricted joint movement, vein thrombosis, pulmonary embolism and elimination problems. The last three problems are linked to bed-bound patients but as for Rogers the condition has not reached that far but he has also started experiencing restricted joints. The nurse should be able to take not and advice a patient like Rogers on the best form of having correlation relationship with the immediate neighbor who can be able to come in and assist in terms of mutual help during problems with mobility (Hochberg et al 2005). Through practice the nurse should come up with ways that can help Rogers improve his mobility skills keeping in mind the present predicaments. As for Rogers he can even not be able to drive his own care due to stiffness of the limbs as for this he should undertake physicio-therapy. Nursing intervention The use of bone up on arthritis program a home self care education program has been developed and plays an important role in curbing arthritis (Lorig & Holman, 2007). The program consists of 2 hour lesson from trained individuals mostly nurses and public health officers. The intervention is intended to improve self management skills and knowledge to Rogers through his community so that he could be able to understand the best way to manage the problem as well as get the best ways of curbing transition of the problem. Though, Rogers is a patient the program uses him as an agent of informing others with the same problem to get proper self management practices. This intervention also plays the role of making follow up activities so as to reduce post operation services due to negligence and hygiene. Another intervention that is going to be used to solve the problem of Rogers and other patients with arthritis is the use of Self Management Arthritis Treatment program (SMART). The program is based on management of the problem through the use of educational models as a self health group. The group is brought on board to discuss the problem hence able to solve the problem of the diseases among its people such as Rogers. The program is to be conducted in terms of intervals that include self care activities that can be able to bring on board medication compliance methods and also to reduce medication side effects so that the treatment and management of the disease could be sustained. Assessment Criteria The problem is going to be monitored and assessed using several method both individual and nursing methods. Through several clinical checkups an assessment is going to be met hence able to monitors the progress of medication. Individual plans that can be used to monitors the progress of medication and treatment arthritis is also going to be a ways that the diseases can be evaluated and assessed. The individual is expected to give feedback on his progress in terms of treatment and diagnosis of arthritis. Problem 2: Pain Millions of people suffer from chronic and mild pains. It is noted that chronic pain is one that has lasted for a long period of time. Chronic pain can be considered as continuous or totally incapacitating (Smolen et al, 2010). With reference to Rogers he was not facing chronic pain since he only used simple pain killers like panadol. The signals of pain according to Rodgers remained passive in the nervous system for months and weeks but did not qualify to be regarded as chronic pain. The type of pain that Rogers faced was Joint Pains and headaches. Signs/symptoms Rogers was diagnosed but pain was evident from him as it was able to show some signs and symptoms as was seen by the nurses. One of the signs was that pain ranged from mild to severe that did not go away, it caused a lot of tightness, soreness, stiffness along the limb joints and discomfort during locomotion. According to clinical analysis of Rogers case pain as a problem was not a symptom that existed along but it was associated with other problems such as sleeplessness and withdrawal from active participation to activities and actions. It’s ranked as lower risk problem as it was easily managed and its interventions were obvious. In addition is also a problem caused as a result of other problems. Evidence-based nursing care A nurse plays a significant role in management and control of pain to his/her patients. For example, in the case of Rogers it was of great concern that nurse was able to determine the root cause of all the pain that Rogers went about with. She was able to advise him on the best methods of preventing pain even though there was also diagnosed with arthritis as pain was a sign and a problem of its own nature. Nursing intervention Screen all the patients that are at risk with pain at least twice a day by asking the individual and the person or caregiver about the presence of pain or any related pain signs/symptoms. A standardized tool that contains established validity should be used to measure the intensity of pain thus extent at which pain has bodily imbalance. Proper type and the nature at which medication is supposed to be undertaken is a key aspect that a nurse should be able to advice Rogers as well as other patients with similar complications. Assessment Criteria According to pain as a problem the following assessment procedures and actions is supposed to be undertaken: physical examination and diagnostic tests should be done on the patient so as to evaluate the understanding and effect of current illness, coping response to distress and pain should be conducted. Problem 3: Osmotic Imbalance leading to dehydration As a result of the accumulation of water in the legs due to arthritis the patient was faced with imbalance of osmotic standards in the body. Elimination of the accumulation of water through physical means such as using of syringe to eliminate water lead to dehydration as seen from Rogers medical report. This is considered as a high risk problem as it can lead to malfunctions of other body organs since all body organs depend of water- water covers more than 70% of the body. Signs/symptoms At Rogers’s middle age he is not supposed to develop body weakness and dryness of the skins which was evident with Rogers’s case. Dehydration caused Rogers to develop skins briskness that caused wound as a result of dry skin. Evidence-based nursing care As a nurse, advice should be given to patient with arthritis problems to take a lot of water as compensations of the one lost so as to control dehydration. The nurse should also provide relevant education on importance of control of osmotic balance of the body through intake of enough fluids (Spangler et al 2004). Nursing intervention The patient in this case Rogers should be admitted back to the hospital so that the control of dehydrations is maintained so that he could be able to restore body osmotic balance. Intake of more fluid should be taken so restore the balance. Assessment Criteria Through constant skins specialty checkups and normal functioning of other body parts the assessment of this problem will be complete as normal body functioning means that the osmotic balance of Rogers’s body is maintained. Conclusion According to Rogers’s case all the other two problems respectively are as a result of arthritis and management of Arthritis using the prescribed intervention will also in some sense able to control and manage the other problems. Best nursing interventions and care practice are source of Rogers’s medical success. References Bernabei, R., Gambassi, G., Lapane, K., Landi, F., Gatsonis, C., Dunlop, R., & Mor, V. (1998). Management of pain in elderly patients. JAMA: the journal of the American Medical Association, 279(23), 1877-1882. Cousins, M. J., & Bridenbaugh, P. O. (2008). Neural Blockade in Clinical Anesthesia and Management of Pain, 3e (No. 494). Lippincott Williams & Wilkins. Fainsinger, R., & Bruera, E. (2004). The management of dehydration in terminally ill patients. Journal of palliative care, 10(3), 55. Hochberg, M. C., Altman, R. D., Brandt, K. D., Clark, B. M., Dieppe, P. A., Griffin, M. R. & Schnitzer, T. J. (2005). Guidelines for the medical management of osteoarthritis. Arthritis & Rheumatism, 38(11), 1535-1540. Kori, S. H., Miller, R. P., & Todd, D. D. (1990). Kinesiophobia: a new view of chronic pain behavior. Pain management, 3(1), 35-43. Lorig, K., & Holman, H. (2007). Arthritis self-management studies: a twelve-year review. Health Education Quarterly. Lorig, K. R., Mazonson, P. D., & Holman, H. R. (2003). Evidence suggesting that health education for self‐management in patients with chronic arthritis has sustained health benefits while reducing health care costs. Arthritis & Rheumatism, 36(4), 439-446. Peters, M. J. L., Symmons, D. P. M., McCarey, D., Dijkmans, B. A. C., Nicola, P., Kvien, T. K., & Nurmohamed, M. T. (2010). EULAR evidence-based recommendations for cardiovascular risk management in patients with rheumatoid arthritis and other forms of inflammatory arthritis. Annals of the rheumatic diseases, 69(2), 325-331. Smolen, J. S., Landewé, R., Breedveld, F. C., Dougados, M., Emery, P., Gaujoux-Viala, C.& van der Heijde, D. (2010). EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs. Annals of the rheumatic diseases, 69(6), 964-975. Spangler, P. F., Risley, T. R., & Bilyew, D. D. (2004). The management of dehydration patients. 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