Caring for the Patient Diagnosis with Osteoarthritis - Case Study Example

Reflective nursing practice: Caring for the patient diagnosis with osteoarthritis. The nursing profession involves quite a lot of components as opposed to just practicing what the field demands. There are other requirements in this particular field all of which are supposed to make an individual a better player. Some of these include professional development, reflections, and not forgetting important clinical activities. This paper will focus on a patient who was suffering from the disease osteoarthritis. The main aim of the paper is to examine the disease starting from the history, the modalities involved, and the interventions that can be used among others. Through this reflective paper, it is hoped that practitioners in the nursing profession are able to develop themselves even further with regards to this and the many other diseases. The approach that will be taken in this reflective case would be to conduct an overview of the patient’s condition. It will be essential to assess the situation and the characteristics of the patient, some of which would have had a significant influence on the interventions that may be put in place in this particular case. The next step is to find out some of the modern treatment techniques (Evidence based practice) and modalities which are being applied in dealing with such cases. There will also be a reflection with regards to the treatment and handling of the patient whom I care for. The ANMC standards will also come into perspective in this case. The negatives and the positives that come into play with regards to the case will also be highlighted. Finally, there will be the expression of thoughts and feelings about just how the practice of good nursing can lead to further developments in the field (Australian Nursing & Midwifery Council, 2008). One of the diseases which affects members of the society, especially the elderly is Osteoarthritis. It is a disease occasioned by functional failure of the joints at the knees. The abnormalities that come up in this case are majorly of a mechanical nature and entails the degradation of the knee joints with time. As a becomes old, the water content in the cartilages goes down, making them more prone to friction. During my placement period, there was a patient whose case can be used. This was Mrs. M. Her complains of pain on the knees had led to surgery being conducted. After the surgery, I was the nurse charged with the responsibility of taking care of her at the ward. After the handover, I was gives some instructions by the doctor in charge. For starters, the patient was to be left to get some rest. This would also be important for the purpose of letting the patient get some rest. After this, the post operation care mainly entailed physiotherapy for the purpose of bringing the patient back to functional capacity (Seed, et al. 2010). This method of post operation care was deemed effective especially bearing in mind that the operation was done on a rather extremely functional part of the body. Aside from the physiotherapy, there was also the admission of medication for the purpose of pain alleviation. In the process, I got to understand the patient more together with what she was going though. This would go on until the patient was in the course of recovery. Mrs. M, the patient in this particular case had been complaining about pain being experienced on her knees. This was not the only condition she was reported to be suffering from. There are other conditions which she has encountered, some of which are related to her old age. She is an 80 year old widow. All of her children are grown up and she lives alone in a house which she owns. In the recent past the pain has increased tremendously to such an extent that she cannot even do the most basic things on her own. These include taking strolls and even just going out of the house. It is even more concerning to note that she was having problems standing up especially after she had sat or laid down for quite some time. During an interview which was conducted on Mrs. M, she revealed that she had been suffering from the pain for a period of close to two years. However, in the past three months the pain has increased so much and was becoming unbearable. On a pain scale of 1 to 10 she revealed that the pain which she felt on her knees, especially the right one was in the region of 8. Her left one was not so badly off as she put it halfway at 5. As mentioned earlier there are times when the pain is just too much. This is especially during the morning hours. At times it becomes so bad that she finds it difficult getting out of bed and standing up. This is exhibited during the times when she has sat on the armchair and doing crosswords for a long time (Eriksson, et al 2011) The revelations that came from Mrs. M made it clear that medical intervention had to be effected. For this reason, medical examinations followed thereafter. Examinations used radiographic film. This is an important tool in pointing out the various intricacies of the affected area (Eriksson et al, 2011). It showed that there had been a reduction in the height of the knee joint and there was also evidence of osteophyte forming in that particular region. As a result of this, there was subsequent diagnosis of osteoarthritis in her knees. The disease was still in the early stages but a proper and timely intervention was proposed. This is especially keeping in mind just how much the pain was affecting Mrs. M’s personal life. If this was not to be done soon then chances were high she could have end up having restricted mobility. There are quite a number of factors that come into play when trying to examine the aetiology of osteoarthritis. This even hinders the efforts that are made to gain an understanding of the problem. To a greater extent it can be termed as a disease that is associated with age. It commonly starts from the age of fifty years but it is a very common disease in people who are aged seventy and above. Other factors that come into perspective in relation to the disease include health-related factors such as trauma and fall which the patient may have received particularly around the affected area (Kalunian, 2011). This trauma may arise as a result of collision with a hard surface among others. Another factor is the probability of the disease being hereditary in the family and finally there is the aspect of obesity, a phenomenon related to a person’s lifestyle and feeding habits which end up affecting his or her weight. This disease affects women rather than men. It is rather unclear just how these factors come together to have an effect on the health of a person with regards to the disease. As with the case of Mrs. M, she happens to fall in some of the areas of interest here. To begin with she is an old person with the age of eighty years and at the same time she has slight weight issues (Buckwalter, 2004) One of the key indicators which may serve to let a person know that there are chances of osteoarthritis is the fact that in most cases the joints cease proper functioning. This is as a result of stress on the cartilage. The result of this is that the enzymes around this region become worn out and end up being released into the cartilage (Buckwalter, 2004). The automatic response of the cartilage is to have reparation of the damaged regions. However, in the case of a person with the disease such as Mrs. M, this reparation does not take place and as a result the cartilage continues to deteriorate. The enzymes that are supposed to prevent this wearing out from happening are actually inhibited and that is why this is happening (Buckwalter, 2004). There are other physical conditions that come into effect as a result of this degradation. An example of such a phenomena in this case is the friction which will be exhibited in the cartilage. The cartilage will tend to be resistant to the friction. This friction is supposed to be limited by the tissues around the region. However, the fact that they are degrading means that there will be more friction in this region, bringing about more pain. The excessive friction has the effect of wearing out the cartilage even more and brings about the swelling which eventually causes the pain which the patient experiences (Santaguina et al, 2009). The severity of this disease is further encouraged by the wearing out of the cartilage hence losing its ability. This is the primary factor which is behind the aetiology of the disease. It is important to come up with ways of intervening in this situation before it is too far gone. If these are not instituted, the pain experienced is set to increase since the cartilage continues to degrade even more, bringing about even more friction (Santaguina et al, 2009). When it comes to the treatment modalities of the disease, the provision of a pain reliever to the patient is the primary method. There ought to be a way to keep the pain which the patient is experiencing. Pain management is a strategy which should be employed in this case. It is this pain which is experienced in the body parts that are affected which curtails the movements of Mrs. M and subsequently her life also becomes affected. There are several levels of pain which a patient suffering from osteoarthritis may be experiencing. These various levels have their own prescribed interventions. In the case of the higher level pain which happens to be the most serious, opioid and narcotic type of medication is required. In the case of the mid-level pain, oxycontine or ibuprofen medication is what is prescribed for the patient (Seed et al, 2010). The lower type or mild pain situation requires paracetamol or panadol osteo to curb the pain. All of these prescribed medications have side effects which are felt by the patient. In almost all the cases these side effects happen to be negative ones. The scale which was used to describe the pain felt by Mrs. M did not give a result that was on the extreme. For this reason, opioid medication should be avoided under all circumstances. Oxycontine or ibuprofen can just serve the purpose of alleviating the pain. I also came to the realisation that Mrs. M was not even aware of the strategies which she could use in curbing the condition. This clearly pointed out that health education to the patient with regards to the disease was of the essence. The education that is to be provided in this case is to do with a deeper understanding of the disease, the role which she is to play when it comes to handling and managing the disease and not forgetting the different alternative interventions that are there in relation to the disease. The role of managing and being aware of the disease is not just something that should be left to the patient. However, the patient should also be put in the know with regards to those factors that are important when it comes to the disease (Seed et al, 2009). In most cases, pain is something that is associated with the disease. The patients ought to be aware of the way forward when they are faced with situations associated with extreme pain. This will do away with the need of going to the doctor every time pain is experienced. The other form of intervention that should not be downplayed is to do with the nutrition of the patient. As already highlighted, the weight of the patient has a role when it comes to the disease. This is particularly to do with the overweight patients. Being overweight means that the weight of the patient exhibits some stress on the areas of pain and this increases the painful feeling bringing about more discomfort on the patient (Mehrotra et al, 2005). Mrs. M was slightly overweight and for this reason it made even more sense if she was made aware of the importance of nutrition in relation to her disease. There are some benefits that come about as a result of having nutritional plans. The first one is that the patient is able to gain the nutrients which are more beneficial to her body. The other point is that she will be able to watch her weight so that it does not increase to levels that cannot be managed. This has the implication of giving the patient even more control over her life (Maetzel, et al, 2007). This is because weight is more of a limiting factor when it comes to mobility. Carrying out exercise that involves regular movement of the affected joints can also be of benefit to the patient. Physiotherapy is actually an intervention which is also advocated for. It serves several functions. The first one is that it decreases the pain and stress which the affected area experiences. Secondly it serves to strengthen the affected joint and finally it increases the functioning of this region together with its mobility. A therapist is supposed to be involved in this type of intervention (Altman, 2009). As a result, he or she will develop a program which will have to be followed by the patient. It is worth noting that Mrs. M was made aware of this and she gladly accepted the option. The acceptance of the patient is one of the primary things when it comes to this type of treatment. The option of surgery when it comes to alleviating the pain is one which cannot be left out under any circumstance. This approach should be viewed in two ways. First, the benefits, then next the side effects that will be experienced later on by the patient. Even though there are more benefits, it should not be forgotten that there are many side effects which are usually experienced when dealing with surgery (Altman, 2009). In some cases these effects may end up tailing the patient all their life (Altman & Barkin, 2009). This is even made worse on the case of elderly patients, a category which Mrs. M falls. The knowledge of this should obviously come in handy when trying to figure out the best possible intervention for the disease. It should actually come as the last resort. It is also worth noting that at the stage in which Mrs. M was in there would be no need of surgery but other methods could be used to ease the situation. The case scenario that has been under focus in the above discussion serves to point out some of the issues that are particularly relevant to the nursing profession. The first one is that there are conditions that may require practitioners in the different disciplines of health to come together in a bid to help Mrs. M, who is the patient in this case. Despite all these people being involved the nurses still play a vital role in this whole process. The first one is that they are the people who serve as coordinators of all the players involved (multidisciplinary team) in the treatment. At the same time they are the people who ensure that the prescribed treatment is delivered in time and in the appropriate way. Competency 10.3 according to the ANMC clearly stipulates that nurses should be at the forefront of coordinating the care which is rendered to the patients (ANMC, 2008). This is in accordance with the ANMC framework when it comes to leadership and collaboration. However, even though the role of nurses is one which always comes out regardless of the situation. On the other hand, there are some limitations that come into play. One of this is particularly to do with the scope of a person’s career. It is imperative to note that there is a scope that comes by when offering services and this scope should not be surpassed. In the course of Mrs. M’s treatment the role of the nurse was one which could not be downplayed especially with clinical leadership. This is despite the fact that it was not even part of the modalities of treatment that were used. There are several variations when dealing with cases that are related to osteoarthritis. These include the geographical location, the socio-economic status and ethnic background among various others. This proved to be rather challenging when examining it in relation to domain 5 of the ANMC. This is the domain dealing with the provision and coordination of due care given to the patient (ANMC, 2008). Mrs. M’s condition made it rather difficult to provide the assessment required since her condition came within some of these variables. These variables are however important for the purpose of establishing just which type of healthcare is to be given to the patient. According to the ANMC nurses must prove their competence when it comes to the collection of data relation to the patient’s economic well-being, personal lifestyle, the culture and religious views among other things (ANMC, 2008). The competency which is exhibited by nurses in this case is very much essential when it comes to deciding the intervention which is to be rendered on the patient. It is also important for the nurse to learn of the various interventions that may be there in order for them to deduce which intervention is suited for which patient basing on the social affiliations or the background of the patient. There are various negative and positive issues that are to be considered in the case of Mrs. M. one of the notable positives in this case is with regards to the engagement with the various individuals who are associated with the various disciplines. This is totally in line with the provisions of the ANMC framework relating to working with different teams. This brings about the element of responsiveness and dynamism when faced with various environments (ANMC, 2008). The condition in which Mrs. M is in can provide the perfect different environments which nurses require in the course of their duties. In relation to the treatment administered to the patient, there is improved mobility. At the same time, there is a better quality life. This is because the pain which was initially experienced is done away with. A negative aspect which was experienced was to do with the various boundaries that were present in the course of delivering the medical duties. There were quite a number of boundaries and in most cases overstepping these boundaries would bring rise to a situation where it was seen that one member of the interdisciplinary team was overstepping the boundaries of the other members in the team. It is important to note that the nursing profession requires going beyond that which is required by this particular profession in the medical field. There is the need for coordination among other requirements when working with teams that involve members of different disciplines. Another negative that features from the treatment is that there will be significant short term pain experienced by the patient from the surgery. An aspect that involves both the negative and the positive is to do with my relations with Mrs. M. it is important to deal with Mrs. M as a whole person because her problems were not entirely understood. This would ease the difference which she had when it came to taking care of herself. This is in relation to the positive side of this interaction. The negative aspect comes about as a result of the continued relationship with the patient even after the placement was finished. It is of great importance to understand that in nursing it is very important to have only therapeutic relationships as opposed to those that may go personal. This knowledge will be essential in future practice. This paper has been developed for the purpose of reflecting upon the nursing care of a patient with osteoarthritis .The discussion above points out clearly that the nursing profession is more than just what happens in the clinic during treatment. The element of reflection nursing serves to provide the vital information which may be of great use in getting to know about the profession’s demands and all of these may be of great benefit in the future of the profession. This piece of writing also serves to show how the various methods of providing healthcare can actually be learning experiences for a person in the medical field. References Altman R, Barkin RL (2009). "Topical therapy for osteoarthritis: clinical and pharmacologic perspectives". Postgrad Med 121 (2): 139–47. Australian Nursing & Midwifery Council. (2008). National competency standards for the registered nurse. Australian Nursing and Midwifery Council. Retrieved from http://www.anmc.org.au/userfiles/file/competency_standards/Competency_standards_RN.pdf Bosomworth NJ (2009). "Exercise and knee osteoarthritis: benefit or hazard?". Can Fam Physician Buckwalter JA, Saltzman C, Brown T. The impact of osteoarthritis. Clin Orthoped Rel Res 2004:427S: S6–S15. Conaghan, Phillip. "Osteoarthritis - National clinical guideline for care and management in adults" . Retrieved 2008-04-29. De Silva, V; El-Metwally, A, Ernst, E, Lewith, G, Macfarlane, GJ, Arthritis Research UK Working Group on Complementary and Alternative, Medicines (2011 May). "Evidence for the efficacy of complementary and alternative medicines in the management of osteoarthritis: a systematic review". Rheumatology (Oxford, England) Eriksson, K., Sadr-Azodi, O., Singh, C., Osti. L. & Bartlett, J. (2011). Stress radiography for osteoarthritis of the knee: a new technique. Knee Surgery, Sports Traumatology, Arthroscopy, 18(10), 1355-10. Hagglund KJ, Clark MJ, Hilton SA, Hewett JE (2009). Access to healthcare services among persons with osteoarthritis and rheumatoid arthritis. Am J Phys Med Rehabil ;84(9):702–711. Kalunian KC. Diagnosis and classification of osteoarthritis. http://www.uptodate.com/home/index.html. Accessed Aug. 16, 2011 Mehrotra C, Remington PL, Naimi TS, Washington W, Miller R (2009). Trends in total knee replacement surgeries and implications for public health, 1990–2000. Public Health Rep ;120(3):278–282 Maetzel A, Li LC, Pencharz J, Tomlinson F Bombardier C (2008). The economic burden associated with osteoarthritis, rheumatoid arthritis, and hypertension : a comparative study. Ann Rheum Dis ;63(4):395–401. Moseley JB, O'Malley K, Petersen NJ et al. (2008). "A controlled trial of arthroscopic surgery for osteoarthritis of the knee is proven to bring an improvement lasting for about two years". The New England Journal of Medicine Osteoarthritis. Natural Medicines Comprehensive Database. http//www.naturaldatabase.com. Accessed Aug. 16, 2011 Osteoarthritis of the Knee. JAMA. February 26, 2003 - Vol. 289. No.8. http://jama.ama-assn.org/cgi/content/full/289/8/1068 Page CJ, Hinman RS, Bennell KL (2011). "Physiotherapy management of knee osteoarthritis". Int J Rheum Dis 14 (2): 144–153. Santaguida, PL; Hawker, GA, Hudak, PL, Glazier, R, Mahomed, NN, Kreder, HJ, Coyte, PC, Wright, JG (2008). "Patient characteristics affecting the prognosis of total hip and knee joint arthroplasty: a systematic review". Canadian journal of surgery. Journal canadien de chirurgie 51 (6): 428–36 Seed, S., Dunican, K. & Lynch, A. (2010). Osteoarthritis: A review of treatment options. Formulary, 44(5), 142-152. Sturnieks DL, Tiedemann A, Chapman K, Munro B, Murray SM, Lord SR. Physiological risk factors for falls in older people with lower limb arthritis World Health Organization, (2008). The global burden of disease: 2004 update. Geneva, Switzerland Zhang W, Doherty M, Peat G et al. (2010). "EULAR evidence-based recommendations for the diagnosis of knee osteoarthritis Read More