Osteoarthritis Nursing Care Plan - Term Paper Example

Osteoarthritis Nursing Care Plan Osteoarthritis Nursing Care Plan Franklin Powell is a retired Military officer aged 75 years. The patient has experienced arthritic pain for 15 years now, with the pain eventually becoming severe recently, particularly in his right hip. The patient is fully aware of his condition and has over the years tried to maintain a healthy weight. Mr Powell stated that he takes his daily doses of medication and has recently carried out therapeutic solutions such as the intake of nutritional supplements. The severity of his pain coupled with stiffness and locking of joints is what prompted the patient to seek medical attention. The medical examination conducted on the patient revealed significant degenerative changes in both hip joints, which were observed on the X-ray films. The surgeon recommended a total replacement of the right hip coupled with a total replacement of the left hip to follow in a period of 6 to 12 months. This article contains a comprehensive nursing care for a resident who has osteoarthritis and undergoes joint replacement surgery. The RN completed a nursing history and examination of Mr Powell on admission. The medical records indicate that the patient suffers from mild Parkinson’s disease. Mr Powell is currently taking carbidopa/levodopa (Sinemet 25-100) four times a day to control his symptoms. There have been no other reports of chronic medical conditions. The RN reported that the patient been essentially healthy his entire life. Moreover, Mr Powell has no known allergies to medications, has no history of smoking, and consumes small amounts of alcohol. The medical examination conducted by the RN notes that the patient is alert and oriented. Mr Powell’s medical examination reported vital signs at BP 116/64, P 68 regular, R 18, T 97.4°F (36.3°C) PO. Marginal pulses are strong and equal in the upper extremities and slightly weaker but equivalent in the lower extremities. The patient’s feet are cool to the touch but have an immediate capillary refill. Mr Powell’s shoulders, wrists and elbows indicated full ROM. On the other hand, the ROM of both hips is significantly restricted. The pain on both sides in prompted by hip flexion beyond 90 degrees. Also, both flexion and extension of the knees are slightly limited. Mr Powell has a shuffling gait and walks with a limp, favouring his right hip. Preoperative laboratory studies and CBC were conducted on the patient. The coagulation studies and urinalysis show a serum creatinine of 1.7 mg/dL and BUN of 30 mg/dL, with no other noted abnormal values. His ECG and chest X-ray indicate no apparent pathologies. Once the surgery is complete, the patient is expected to deal with acute pain, impaired physical mobility such as weight-bearing restrictions. Moreover, the patient may face ineffective tissue perfusion, which is on the right leg and immobility, predominantly in carrying out activities. Currently, the patient is taking a number of prescribed medications. Mr Powell has been using acetaminophen, which is a very effective pain reliever, coupled with NSAID (Non-steroidal anti-inflammatory drugs). The patient also uses duloxetine for chronic musculoskeletal pain. Recent research links traditional NSAID medications to gastrointestinal side effects (Bjordal 2006). The rising concern accrued to NSAID drugs contributed to the development of new and effective drug treatments, for example, the COX-2 medicines [Celebrex]. The COX-2 drugs have fewer reported gastrointestinal side effects. However, they have similar results compared to the typical NSAIDs. The addition of opioid analgesics was considered due to the prevalence of pain. However, this treatment comes with a plethora of risks, particularly to older people. The patient is confident that joint replacement therapy is the best solution to eliminating the problem and he is ready to undergo the medical procedure. Mr Powell is widowed. However, he has the support of his family, particularly his two children who visit him regularly together with the grandchildren. Mr Powell is expected to undergo joint replacement surgery that is scheduled the following morning. The patient has already undergone preoperative teaching and tests the afternoon prior to his surgery. The postoperative nursing diagnosis includes acute pain, which is related to the surgical incision and impaired physical mobility in terms of activity and weight-bearing restrictions. The patient also faces risk of infection and ineffective tissue perfusion, particularly on the right leg. The expected outcomes include maintaining an adequate level of comfort postoperatively. The achievement of this goal will be determined by the patient’s ability to move with ease within the restrictions, verbal expressions of comfort and compliance with instructions to cough and breathe deeply. The second outcome is to ensure that the patient remains free of infection. The patient should remain free of the outcomes of immobility that include thromboembolism, pressure areas or contracture. Moreover, the nurse should maintain adequate perfusion of the affected leg and ensure that the patient remains free of injury postoperatively. Planning and implementation of the set goals will be carried out in a number of ways. First, the patient’s pain will be assessed at least hourly during first 24 to 48 hours postoperatively, and as needed thereafter. Aid in changing the patients position at least every 2 hours and encourage the use of trapeze to shift the patient’s position frequently. Lastly, the pulse, color, movement and sensation of the right foot should be assessed on an hourly basis for the first 24 hours, then 2 hours for 24 hours then for every 4 hours. Lastly, the surgery site should be assessed frequently so as to check for any signs of inflammation or excess bleeding. Osteoarthritis (OA) is a disease that significantly disrupts an individual’s mood, relationship, quality of life and leisure activities. Through joint replacement surgery, individuals who were unresponsive to the standard treatments of OA can effectively curb the impacts of this complication. In this case, there are three integral interventions. The first intervention is to monitor the patient’s health postoperatively. The second intervention is to assess the surgical site frequently. The third intervention is to assist the client with range of motion active / passive and resistive exercise or isometric when possible (NANDA 2015). Maslow’s hierarchy of needs is an effective model which is used in developing priorities for care. According to Maslow’s theory, human beings experience five levels of need. The human needs are social, physiological, safety, security, self-esteem and self-actualization (Delaune & Ladner 2010). Maslow argued that physiological needs are integral in order to meet the higher levels of needs. In our case, the patient faces impaired physical mobility related to pain, decreased muscle strength and discomfort. Second, the patient suffers from acute pain related to the surgical procedure. Lastly, the patient faces two risks, and that is the risk of infection and the risk of ineffective tissue perfusion. The proposed interventions strive to meet the needs of the patient as stated on the established goals. For example, the first intervention ensures the health of the patient is monitored. This intervention entails assessing the pain; note the location and intensity of pain (scale 0-10) and writing down the factors that accelerate and signs of non-verbal pain (NANDA 2015). This intervention safeguards Mr Powell’s health by ensuring the pain is reduced or controlled. The second intervention is geared towards assessing the surgical the frequently. This is carried out by checking the surgical site frequently and reporting any signs of excess bleeding or inflammation. The expected outcome of the third intervention is to enable the patient to maintain or improve strength and function of the compensation part of the body (NANDA 2015). The postoperative recovery was uneventful. Mr Powell became confused and disoriented during the first 36 hours after surgery. However, this orientation and cognitive process gradually cleared after 36 hours. His family was supportive and stayed with him after the surgery and he has not experienced injury or any other adverse consequences accrued to his confusion. The patient is expected to participate in rehabilitation therapy six days after surgery so as to enable him to ambulate with partial weight bearing on the affected leg. The set goals were successfully met throughout the process without any significant consequences. There were several ethical and legal considerations which were considered while providing care. Ethical considerations such as no-maleficence which means to avoid harm. The principle of beneficence aims at promoting good acting in the best interest of the patient. These ethical duties become legal duties particularly if any legislation is breached during practice. In conclusion, ethical standards of moral judgement and professional conduct are detrimental in the nursing care. References Bjordal, J. (2006). NSAID in Osteoarthritis: Irreplaceable or Troublesome Guidelines? The Journal of Sports Medication 4(40), 285-286. DeLaune, S., & Ladner, P. (2010). Fundamentals of nursing. Cengage Learning. NANDA (2015). Nursing Care Plan for Osteoarthritis. Retrieved from http://nanda-nursing.blogspot.com Read More