Why the Physician Performs a Limb Length Disparity and External Rotation Test - Case Study Example

Mrs. Gibson’s Health Case Study Student’s Name: Tutor: Course: Date: Introduction A local nursing home has presented Mrs. Gibson for an investigation towards confusion, inconsistency, and a suspected urinary tract infection. Mrs. Gibson is an elderly woman 84 years of age and, her age can be a predisposing factor to many conditions. Usually, urinary tract infections in older people often do not reveal common symptoms because older people have weakened immunity (Van 2012). It may also be difficult to ascertain if an elderly person has urethral tract infection since senior citizens do not reveal their condition to physicians as they find it embarrassing and usually associate it with aging (Van 2012). Common symptoms of urethral tract infection in the elderly are confusion and inconsistency, and physicians may misdiagnose these symptoms for delirium (Bates & Bates 2013). Nevertheless, a report of pains in the hip region may be interpreted for bone fracture as osteoporosis is common with old age. Also, research has associated delirium to existing or previously treated neck fracture or femur (Ouellet et al., 2016). A combination of the factors stated above may cause physicians to conduct structural body deformity tests even when the underlying condition is urethral tract infection. Therefore, this document observes reasons why the physicians performed a limb length disparity and external rotation test to the patient. Additionally, in the second part, this paper checks into the right treatment for the patient considering her age and social-economic situation and post-operative measures required for the patient. Osteoporosis Risk Factors As stated in the introduction, pain in the hip region may be associated with fracture due to osteoporosis for the elderly (Johansson et al., 2014). In this case, Mrs. Gibson is an older woman at age 86, and this fact predisposes her to osteoporosis. Osteoporosis is a condition that results in weakening of one’s bone weight density (Liu et al., 2015) and thus exposing them to fractures and femurs. As such, various factors increase one's risk of encountering osteoporosis, among them, include gender, age, lifestyle especially smoking and the use of certain treatments for gastroesophageal reflux disorders (Hudec & Camacho 2012). However, the number one factor that predisposes Mrs. Gibson to osteoporosis is age. Indeed, research has associated age with a reduction in bone weight density and it increases one’s risk of encountering fractures and femurs (Seriolo et al., 2013). Reasons that cause age to be a predisposing factor for osteoporosis include the fact that age comes with a reduction of a person’s sexual hormones (Hoermann et al. 2014). Apart from age, another factor that causes one’s bone weight density to reduce at a higher rate is gender; sexual hormones tend to decrease faster in women especially after menopause than they do in men (Labrie 2015). Other factors include dietary problems and improper body mass index. Since Mrs. Gibson is an elderly woman who is post menopause, it is logical to say her hormone levels have reduced significantly, and thus, she is a potential victim for osteoporosis. Further research has associated neck fractures and femurs with delirium. Research in 2003 by Lundstram et.al, which involved 78 respondents, showed that there indeed exists a connection between delirium and neck fractures. Indeed, the study included 78 patients who were above 65 years of age were treated for neck fractures. However, 40 % of the patients did not suffer from any form of dementia before the treatment, but after five years of follow-up, 35% of the patients developed dementia. Still, the research is not clear whether the outcome was as a result of an underlying delirium disorder that had not been detected before the patient’s operation; or as a consequence of a direct relation between neck fractures and dementia (Ouellet et al., 2016). Mostly, the fact that the patient, Mrs. Gibson, portrayed symptoms of dementia followed by a consideration of her age, and a complaint about pain in her hip region influenced the physician's decision to carry out a limb length disparity and rotational observation. Hormones that affect bone strength in humans include estrogen, testosterone and other hormones from the thyroid gland (Khosla 2013). As mentioned earlier, sexual hormone levels in women tend to fall faster compared to how they fall in men. One explanation for this difference is that after women undergo menopause they bodies gradually begin to reduce the number of sexual hormones they produce especially estrogen (Jones et al., 2013). Hormones in the body work to regulate operations throughout the body, and they have a significant influence on growth, energy, weight maturation and bone strength. Estrogen is the hormone that controls a female’s ability to reproduce and effects bones strengthening and other factors that favor reproduction (Bartell et al., 2013). Other hormones from the thyroid and parathyroid glands control the body’s ability to absorb nutrients such as calcium, and they are thus important in determining a person’s bone strength level (Moser et al., 2011). Age effects hormone production and nutrient acquirement and thus weakens a person’s resistance to diseases including osteoporosis. Next, we check the particular influence of hormones on bone strength. Estrogen plays a vital role in the growth and maturation of bone and also in the rate of bone replacement during old age (Khosla 2013). However, during the process of bone growth, estrogen is a requirement in the closure of epiphyseal growth plates. When estrogen is not sufficient during the development of young skeletons, it results in increased formation of osteoclasts and thus increased bone absorption. In post-menopausal women the level of estrogen reduces and this causes cancellous and cortical bone loss. To this effect, the increased rate of bone resorption that happens in cancellous bones causes general bone loss. As a result, it destroys the structure of bones through penetrative resorption, which results in microfractures (Khosla 2013). In essence, the reduction of estrogen in cortical bone leads to endocortical resorption, and with time intracortical porosity starts. However, the combination of the stated factors results in decreased bone mass, distorted bone structure and diminished strength of the bones. At the cell level, estrogen hinders separation of bone cells, in this manner diminishing their number and decreasing the measure of dynamic rebuilding units. Eventually, this impact most likely intercedes through a few chemicals, IL-1, and IL-6. Estrogen influences the statement of the chemicals in the bone marrow cells, by a so far ambiguous system. Nonetheless, we are not sure if the impacts of estrogen on osteoblasts is immediate or it is because of integral marvel between bone arrangements to resorption (Khosla et al. 2012). Thyroid hormones are required for skeletal improvement and foundation of crest bone mass. Indeed, hypothyroidism in kids results in development hindrance with deferred skeletal advancement while thyrotoxicosis quickens bone development. However, in grown-ups, T(3) controls bone turnover and mineral bone thickness, and typical euthyroid status is crucial to keep up ideal bone quality. Further, populace contemplates indicating that hypothyroidism and hyperthyroidism are both connected with an expanded danger of fracture (Zhang et al. 2014). The process of aging influences the entire endocrine framework firmly. Consequently, the thyroid organ is likewise affected. One ought to underscore that thyroid ailments related side effects in the elderly individuals are fundamentally the same as side effects of the typical maturing. Corticosteroid Therapy and Osteoporosis Additionally, corticosteroid therapy is another factor that predisposes one to osteoporosis. Identifying Mrs. Gibson had used corticosteroid therapy at one time of her life. Also, she used other reasons stated in the paper that would necessitate doctors need to perform a limb length disparity and external rotation tests. Glucocorticoids are essential drugs used by physicians for calming inflammations and reducing patients sensitivity for more than 50 years. According to research done in the UK, 1 out of 100 people among grown-ups is taking oral steroids at one point in life, and this percentage increases with age to 3 out of 10 by the age seventy to seventy-nine years (Sagoe et al. 2014). Indeed, corticosteroid therapy related osteoporosis is an actual outcome of glucocorticoid treatment prompting fractures in 30 % of patients. Consequently, an extensive variety of defensive prescriptions has been concentrated including; calcium, vitamin D, vitamin D analogs, oral and intravenous bisphosphonates, sex hormones, anabolic operators and calcitonin. The component of the activity and proof for these treatments are inspected concentrating on imperative trials and a new confirmation. Of late physicians recommend bisphosphonates as the first-line treatment for the counteractive action and treatment of corticosteroid therapy related osteoporosis They have appeared to expand bone mineral thickness at the spine and hip and to decrease the rate of bone cracks particularly in women who are beyond menopause (Yoon et al. 2016). Why The Patient Experienced Fracture without Trauma A cervical fracture called a broken neck, is a calamitous fracture of any of the cervical vertebrae on the bone. Cases of common causes in people are car accidents and jumping into the shallow water among other causes of trauma. For Mrs. Gibson, several factors would have caused her to experience a neck fracture without trauma. First was her age; we have explored that period through a combination of factors usually leads to weakened bone density. There is also the aspect of being female; we see that estrogen levels in women drop incredibly after menopause and through a combination of processes reduces the individual's bone density. Indeed, it is documented that the bone density of most women drops by 2 % per year from the time they hit menopause (McNabb et al. 2013). Another factor that may have resulted in the doctors concern about a broken neck without tremor is exposure to corticosteroid therapy. In essence, it reduces the bone mass of women especially those who are postmenstrual and thus, it would have resulted in further weakened bones structure. Indeed, a combination of these factors may have led to the physician’s assumption that the patient experienced a neck fracture without trauma. Reasons that Necessitated LLD and Rotation Tests Further, the doctors may have attempted the limb length disparity and external rotation tests to account for the hip pain experienced by the patient. Though available literature is a bit ambiguous on this issue, a study has shown that LLD seems to influence the lumbar spine, in any event to a limited extent, by making lumbar scoliosis (Izumi et al., 2014). Also, it has been demonstrated that LLD prompts pelvic obliquity on the frontal plane inciting scoliosis. There is also a relationship between spinal cord deformities and urethral tract infections (Nicolle 2014). Individuals who have experienced spinal cord injury to an extent that it blocks their ability to empty their bladder exposes them to urethral tract infections. Therefore, these studies may have prompted the action by the physicians to order for a limb length disparity and rotational analysis. Diagnosis, Treatment and Post-Operative Measures Based on the patient’s assessment data, Mrs. Gibson is suffering from a case of a Urethral Tract Infection. Her urine sample has tested positive for E. Colli bacteria, which is the most common bacteria that causes UTI. In most cases, physicians use antibiotics to treat urethral tract infections. Mrs. Gibson is also suffering from a broken neck femur on her left greater trochanter. As already stated in this document, old age is a common cause of fractures in the elderly. Hence, the physician has decided to use a regional analgesia to reduce the patient’s pain, followed by a hip replacement surgery to replace the fractured neck. For the treatment of the urethral tract infection, several nursing care priorities can be awarded to this patient. In fact, one of the priorities is to ensure the patient completes her medication dosage. Considering UTI’s are bacterial caused infections, it is important to make sure that the patient finishes her medication. Mostly, bacterial infections have a tendency to acquire immunity when one does not complete an antibiotics dosage. Antibiotic resistance results when bacteria alter themselves in a way that reduces or eliminates the effectiveness of a drug. In reality, they achieve this resistance by means such as one bacteria surviving from uncompleted antibiotic dosage and thus gaining resistance to antibiotics. Eventually, this bacterium mutates and multiplies, in the end, it causes the patient to suffer consistent infections, as antibiotics cannot work for them (Rodríguez-Rojas et al. 2013). However, the second action necessary for the patient is proper hygiene practices. Urethral tract infections, especially in women, may come as a result of poor hygiene practices. One practice is the wrong wiping of bowels from back to front. Considering that the patient is elderly and requires some assistance going to the toilet, the nurse should advise her caretakers in the nursing home to practice proper hygiene factors when handling the patient. Other hygiene practices include regular baths since it has been documented that regular baths can help reduce the chances of getting urethral tract infections. Moreover, so, the caretakers should be advised to observe hygiene avoid reinfection of the patient (Lal 2015). Another necessary measure to help the patient recover quickly from the urethral tract infection is water consumption. As such, the patient’s caretakers in the nursing home should ensure the patient takes substantive amounts of water per day. Study show that bacteria that cause urethral tract infections could be washed away by urinary and mucous flow in the patient’s urethra. Undoubtedly, from the results of the patient’s diagnosis, it is evident that the patient is suffering from dry mucous membranes. Water intake will also work to improve the patient’s conditions. Additionally, several researchers advocate for water consumption as an antimicrobial solution in UTI therapy. The importance of water should be made clear for the patient and the caretakers. Moreover, the caregivers should be advised on the benefits of a shower as opposed to regular bath for UTI patients (Lal 2015). Post-Operative Measures After Surgery For the treatment of the fracture neck femur on the patients left greater trochanter, a hip replacement surgery is required. Surgery for the old is a quite critical issue because seniors have a tendency to recover relatively slowly compared to younger people (Lal 2015). In this case, a health practitioner needs to assess the post-operative measures that the patient will need after the surgery. One of the post-operative steps necessary for the recovery of hip replacement surgery includes avoiding infection of the surgical wound. Indeed, her caretakers should practice hygiene to ensure the patient’s wound is not infected. Considering the need for showers in cases of UTI’s the surgery should be performed after the patient has healed from the UTI as patients are discouraged from bathing until a surgical wound has completely healed. Another postoperative measure is to ensure the patient does not suffer from allergies resulting from drugs given to aid the healing of the patient. It is thus important the pharmacists check the patient’s history before prescribing the patient any drugs for the condition. Also, the patient should be accorded the help of a therapist until she recovers from the operation and has learned to walk without the need for assistance. Definitely, before cumulative recovery, the patient should not bend to pick items or squat too low in the toilet; the facility should offer the patient an elevated toilet to observe this requirement. Essentially, post-operative measures are to avoid dislocation of the fixed hip due to unfamiliar actions before the patient learns to walk with the new hip. The other post-operative measure can be to prepare for the patient’s requirement especially if the surgery results in a limbs length disparity. Here, the facility should take charge and make special shoes for recovering patients to compensate for the limbic length difference. Since an older person may take long to learn and resume ordinary activities, the facility should ensure the availability of a therapist until the patient has recovered satisfactorily. Having carried out the mentioned post-operative and rehabilitation measures, the patient would recover from their former pain. 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