Osteoarthritis is very common among the old age people. It is also termed as wear and tear arthritis as it occurs when the protective cartilage, surrounding the bones, wears and tears down. In the present case study, an old woman, 87 years of age, is admitted into the hospital as she was found near her bed. Although she was lucid and conscious, she was incapable to walk on her own. This report studies intensively the case of Mrs. Mabel and outlines the problems faced by patients like her, who have had past history of osteoarthritis. The report also identifies the potential treatment options and the interventions necessary in such cases.
The two basic nursing assessment tools for assessing the health condition of Mrs. Mabel are the Brief Pain Inventory (BPI) and the Geriatric Depression Scale (GDS). In the former, an intensive analysis of pain including its location, history and interference with activities (Seyed K. Malakouti et al. 2006). The pain is recorded on a scale of 10, with 0 representing no pain and 10 representing pain as bad as you can imagine. The latter tool was designed to assess the depression score in the older patients. Score 11 or greater than 11indicates severe depression. This tool has screening efficiency as it relies on affective rather than the physical symptoms (Tito Mendoza 2006).
CLIENT’s HEALTH PROBLEMS
Studying the case of Mrs. Mabel, it is evident that the three health problems related to her are the inflammation, severe joint pain and cold and cough. Inflammation occurs when the chemicals from the body are released to the site of infection or injury. Mrs. Mabel was found to have inflammation in her lower leg i.e. swelling and persistent pain, possibly due to leakage of fluid into the tissues. Since cold and cough is generally a symptom in every old patient, in case of Mrs. Mabel it is important to treat the joint inflammation first, followed by the pain and eventually the medications for addressing cough and cold. The pain in osteoarthritis is generally caused when the wear and tear of the cartilage, that surrounds the joint, is to a great extent, such that the ligaments and the tendons are completely stretched out, causing pain. The cartilage acts as a shock absorber and also reduces friction in the joints. Lastly, since we know that Mrs. Mabel had been a smoker in the past, the chances of suffering from cold and cough are pretty high. It is therefore necessary to address the inflammation first, so that the pain in that area is comparatively reduced and then give pharmacological or non pharmacological assistance in reducing the pain in other joints as well. To ensure safe and quality care of Mrs. Mabel, these problems should be addressed in accordance with their priorities. The age factor of Mrs. Mabel should also be taken into consideration as many treatment options, even most of the medications, will prove to be harmful for her age. She should be given the support to move along and also be encouraged to participate in daily activities.
The major goals of osteoarthritis treatment include alleviation of pain and restoring the normal functioning of the person. Since Mrs.Mabel has a serious pain issue such that she complains about it frequently and it is hampering her normal being, it is important to address and treat her pain and reduce her discomfort. Another goal should be to restore her normal functioning. As we know that the right leg of Mrs. Mabel is comparatively shorter than the left leg, she faces problem in moving around and needs a constant support to assist her mobility. Therefore, it is important to address the inflammation in her lower leg and prevent its reoccurrence. To address these goals, the patient generally receives both pharmacological and non pharmacological treatment, the former comprising of drugs and NSAIDs, while the latter comprising of therapies and the physical exercises. Surgical interventions have also suggested that if the joints are severely damaged, then the only option available for treatment is the partial or complete replacement of the joint.
The first and the foremost goal is to relieve pain and that can be mediated by psychological intervention techniques like providing education through various programs, coping skills training (CST) and cognitive behavioral therapy (CBT). These techniques help in enhancing self efficacy, help in managing stress, reduce helplessness and catastrophizing. Most patients have easy access to the basic medical care but the psychological aspects are generally neglected. The most commonly used educational intervention is the community based Arthritis Self Management Program, which targets the self efficacy skills and helps in management of arthritis symptoms (Catherine Backman 2006). On the other hand, CBT and CST approaches include cognitive and behavioral exercises like guided imagery or relaxation, changing activity patterns, etc. These exercises help in active coping and alleviation of pain in the osteoarthritis’ patients.
The second goal is t restore the normal functioning of the joints and this can be achieved by rehabilitation program that helps in motion of the knee and thereby reduces pain also. The patient is advised to do regular exercises including heel prop exercises, prone hang exercises and also the towel extension stretches. These exercises help in knee extension which is opposite and equal to the normal knee. If the patients do not receive any help from this exercise regime then a hyperextension device (Elite Seat, manufactured by the kneebourne Therapeutic) can be used along with other devices that are used for extension purposes (K. Donald Shelbourne 2007). The rehabilitation program also aims in educating the patients about their daily habits and they should change them in order to relieve tension on the knee and relax. Certain aerobic exercises like bike, stair stepping machine or elliptical machines are also the part of the program. The patients are also encouraged to maintain complete motion so that the non pharmacological approach provides relief that is permanent as compared to the relief obtained via pharmacological drugs and other analgesics (K. Donald Shelbourn 2007).
There are various problems faced by the elderly patients post discharge after getting the treatment for osteoarthritis done. Like in case of Mrs. Mabel, even after getting the surgery for arthritis done, she still complains of persistent pain in her legs. Post discharge issues generally include comorbid physical health problems, depression, and limitation in the functional capacity and improper dietary regulation (T. James 2005). Among all the patients of osteoarthritis, majority of them report persistent pain, even after the surgery. Another issue is the tight check on the weight because osteoarthritis can be severely influenced by obesity and can prove fatal. Next problem or issue faced by the patients post discharge is the intake of medications on a regular basis. Post discharge medications like Acetaminophen and NSAIDs are generally given to the patients. The former is used to reduce pain if taken in prescribed dose and the latter helps in providing relief from swelling and the pain due to it. Apart from the medications, the doctors generally advise regular physiotherapy exercises that will help in keeping the join in motion and gradually provide the necessary extension to the joints such that the normal functioning is restored. Therefore there are many issues governing the discharge from the hospital. In order to address these issues it important to discuss the problems with the health care specialist first. Older people find it very difficult to cope with the pain and the reduced mobility. They have to keep themselves dependent on various analgesics and the anti inflammatory medicines that help in relieving pain and providing the necessary comfort. In case of Mrs. Mabel she was detected with an inflammation on her lower leg. Likewise, post discharge, there is high risk of inflammation, blood clots and swelling. Even after being treated, the patient may encounter situations of helplessness and depression, which may arise as a result of incapability to participate in the routine or daily activities and thereby developing high levels of anxiety. In order to avoid or prevent these issues, the family must take the responsibility of their older loved ones, once they are discharged. Their support, care and continuous monitoring will enable the patients to cope with the prevailing situation and help in quick recovery.
This report gives a detailed description about the symptoms, causes and the crises faced by Mrs. Mabel. It outlines the major interventions and strategies that will her cope with her situation. Techniques like education through various programs, coping skills training (CST) and cognitive behavioral therapy (CBT), work on the psychological aspect of the patient. Along with these the rehabilitation regime also aids in helping the patient by reducing pain and swelling. The major goals of the patient care have also been outlined in this report like the goals of alleviating the pain and restoring the normal functioning of the joints. To summarize, this report is important as it throws light on the condition of the patient and the necessary plan of action that is adopted for the care. It also draws attention towards the post discharge problems, that the patient will face and lists out the strategies that can help and address those issues.