A Reflective Report on Osteoarthritis and Cartilage Damage

Introduction to Jim Laverty

Jim Laverty is a farmer who rare sheep, and he is the sole caregiver to his mother who has started to show early signs of dementia. The arthroscopy report shows that Jim has significant osteoarthritis and cartilage damage from the injury he had. Jim has concerns about who is going to manage his farm and take care of his mother. The orthopaedic surgeon advised Jim to prepare for undergoing orthopaedic surgery. The surgeon speculated that Jim would have his mobility impaired, and the recovery period will be a minimum of five weeks.

The paper will put more emphasis on the pre-operative assessment and potential postoperative complications. Pre-operative education, stress, and pain management are the focus of the nursing interventions in line with PCC. The pre-operative interventions that are chosen are aimed at reducing the negative impacts of biopsychosocial determinants of activity on the life of the patient (Tanzer & Makhdom, 2016). The paper concludes by offering opportunities to further the studies in the domain of pre-operative care. The pre-operative interventions that are used in this paper focus on pre-operative pain management, education, and awareness. Many patients who experience post-surgical complications are usually unfamiliar with the offering of self-managed care. Evaluation and analysis are done via adopting the CRC approach to problem-solving to present a discussion on the relationship of the presented case study and the concepts of applying PCC. The paper will adopt the Gibbs Reflective Cycle to evaluate and reflect upon the experiences of developing a comprehension of PCC.

Identification of the Biopsychosocial Determinants

Age is a major contributing factor for OA; prior studies have shown how OA is common in subjects aged 50 years and above. Jim is 65 years old and has an increased risk of developing OA. Although OA is generally prevalent amongst the women, men also have increased chances of developing it depending on the compounding effects of biopsychosocial determinants of the patient. Furthermore, occupation is another likely contributor to the development of OA. The development of osteoarthritis is expected due to the wear and tear that the knee was undergoing given the strenuous nature of the patient’s occupation. Obese individuals face the most risks for developing cartilage damage because of physical stress, breakdown, and inflammation. Besides that, family history plays a critical role in this case, given that Jim’s mother was recently diagnosed with dementia. Jim being her sole caregiver, will be absent due to scheduled surgery. The emotional stress that Jim has to bear is potentially catastrophic. Cognitive-based therapy is a long-term goal that is chosen for dealing with coping issues. Therapy helps in the identification and collection of more cues that are important in the formulation of nursing plans.

Jim’s mother was previously diagnosed with onset dementia; a mental illness that has historical determination on the biological set up or predetermination of the patient’s genetic make-up. Presence of mental illness issues in the family tree necessitate differential diagnosis. The differential diagnosis will help eliminate the chances that the osteoarthritis is caused by a compound of other factors. If biological comorbidities like possession of mental illness are discovered, the patient should be prepared for therapy. Otherwise, therapy is still necessary given the long-term need of preparing the patient for the possible physical, emotional, and mental changes that will accompany the post-operative care.

Information Processing: Osteoarthritis and Cartilage Damage

The risk and complications that can occur during post-operative surgery are most significant. Commonly undesired clinical outcomes are Surgical Site Infection (SSI) and the development of ischemia. Another risk factor is a pulmonary embolism blood clot in the lungs; which might include Deep Vein Thrombosis (DVT). Physical risks have the potential accrual of scars, excess bone-forming, instability, and dislocated kneecap. Furthermore, there are considerable chances for potential nerve damage that may lead to numbness. There are potential chances for the continuation of pain from acute to chronic type. Hence, offering pain management informational content, in this case, has both short-term and long-term benefits. There is a significant impact of preoperative education on the perception and actual postoperative pain as postulated by Barry (2017). Research by Lemay et al. (2017) found out that 44% of the patients used in the study reported that prior education regarding postoperative pain management was not offered to them. Therefore, the lack of pain management information is critical for overall recovery; both prescription and non-prescription drugs may be used. Patient-Controlled Analgesia (PCA) is commonly used these days for managing chronic pain, and proper informational content should be provided to Jim beforehand. Patient optimal analgesic regime is of crucial importance during the pre-operative patient prepping period (Byrne, & Clark, 2015; Golladay et al., 2017).

The application of evidence-based approaches as a construct in this case to expedite the post-operative recovery process is reducing potential organ dysfunction, improving postoperative recovery, and response to stress. The constructs mentioned above will mainly focus on patient education and awareness, as recommended by PCC. Additionally, effective pain control is equally important before and after surgery. In this case, the pain that Jim is in because her mother being diagnosed with dementia and the chances of being partly physically impaired. The reduction of post-operative complications depends on the effectiveness of pre-operative planning and execution of interventions.

Identification of the Problem: Osteoarthritis and Cartilage Damage

Post-operative pain is prevalent among patients that have undergone both knee and hip replacement surgery as found out by Wells & Fleshman (2020). It is important to note that the pain that is in the subject is the one caused by biological, psychological, and physical factors that were identified. Jim is vulnerable to anxiety and depression, given that he was the sole caregiver to her mother, who has been confirmed to exhibit the onset of dementia symptoms. Mental illness like dementia can have genetic significance in the family tree in determining biological determinants. Jim is already predisposed to external factors that might trigger stress and anxiety. Pre-operative patients commonly undergo anxiety, given the uncertain outcome of going to surgery and the associated potential outcomes. Hence, anxiety and pain ought to be managed given the significant stakes that the constructs play in determining not only other pathophysiological determinants; but also, the overall wellbeing and status of the patient. Physical pain will be expected from the disruption of the skin tissue because of the surgical incisions. Also, the comorbidities mentioned above together may exuberate the levels of pain (Darbari & Brandow, 2017; Lovich-Sapola, Smith, & Brandt, 2015). Therefore, psychological distress may root from anxiety and fear of possibilities of readmission and lack of informational content regarding the medical issues.

The enhancement of the educational goals for the management of pain caused by either eternal or internal factors should focus on discrete timing of the education. It is appropriate to provide multiple sessions after surgery that are time-cased to coincide with particular outcomes as the recovery process continues. The materials ought to be tailored to the age, language, literacy, and culture of the patient. Possible methods for the delivery of the educational content could be via web-based education or offering custom interviews. The American Pain Society advocates for pre-operative pain management education using some of the strategies mentioned herein (Chou et al., 2016). The enhancement of delivery of post-operative pain management focuses on preoperative and post-operative pain management, planning, pharmacological, and non-pharmacological methods of interventions, and transitional care. Gordon et al. (2016) illustrated the evidence gaps in the literature on matters regarding post-surgical pain management. Hence, the effective use of EHR should be used in the entire CRC process to tailor the educational contents and needs in line with the spirit of PCC.

Justification and Establishing Goals: Osteoarthritis and Cartilage Damage

Coping with the biopsychosocial determinants of essential health for the patient will prove a worthwhile endeavour to make sure that the overall effectiveness of the multifaceted intentions produces optimal output. Of particular importance is how to cope with the potential physical changes that were mentioned earlier. Social stigma often comes with the possession of physical comorbidities, and this may influence the recovery process in the long-term. The influence of stigma on a patient with physical disabilities is a matter of concern that necessitates the offering of coping strategies to Jim. As mentioned earlier, one of the undesirable clinical outcome of undergoing osteoarthritis surgery or THR; is the potential physical changes such as reduced activities, and locomotion.

Given that Jim is the sole provider in the household, the lack of intense physical activities may have a toll on his socioeconomic status in society. The stigma that may be associated with social rank and physical abilities is immense. Therefore, targeted coping strategies are justified particularly those that are aimed at reducing stress and relaxation techniques. Stigma causes the depletion of confidence and self-esteem; in this case, therapy sessions that are geared towards the strengthening of self-esteem will prove to contribute to the expediting of the period of recovery (Goebel-Fabbri et al., 2019). As mentioned earlier, although the patient has no prior medical history of cardiovascular diseases, the justification for the application of therapy sessions help in augmenting other pre-operative interventions that have been set up for Jim.

Alternative treatment methods should be looked into that could augment the surgical approach chosen. Non-surgical procedures of treatment or conservative treatment better output in most of the patients. This intervention often involves special exercises, and Non-steroidal anti-inflammatory drugs maybe use steroid injections when conditions permit. The importance of warming up before exercise, as a non-pharmacological intervention should not be overlooked. A prior systematic review in the area of land-based activities show that it is effective in the reduction of pain and promoting functionality in patients with knee and hip osteoarthritis. Hence, the merits mentioned above make the interventions optimise pain and overall functionality leading to the improvement of health outcomes. The benefits of optimising pain and functionality for pre-surgery for correcting knee osteoarthritis patients are also beneficial for patients awaiting to undergo Total Joint Replacement (TRJ) surgery. Exercises that include calisthenics and programs that the patient can both conduct individually and while under guidance by the professional. The most appropriate exercises to strengthen the affected part is necessary. The strength exercises are strategically designed to stimulate muscle growth in the joints.

Future research should focus on non-pharmacological methods of offering medical interventions such as therapy sessions, patient education, and awareness to augment pharmacological interventions (Lemay, Saag, & Franklin, 2019). The provision of the constructs mentioned above increases the quality of care resulted in cost-effective intervention methods for both the patient and the hospital. Therefore, this will result in the focus of preventive measures for averting asthma rather than curative measures. The development of professional standards for the diagnosis of knee OA via conducting epidemiological research and clinical studies is beneficial. Additionally, the result of a pre-operative pain scoring system for effective diagnosis of knee OA. In line with offering PCC interventions, determining the cost-effectiveness of ultrasonoscopy in both diagnosis and prognosis has mutual benefits. Pre-operative education is warranted because of the many benefits that it will accrue to Jim; particularly on the reduction of pre-surgery anxiety. Pre-operative education provision has determined pre-operative pain perception.

Action Plans on Jim Laverty Case Study 

Discharge planning and transitional care management provide the opportunity for evaluation, assessment, and review that is necessary for PCC. Advances in this area have culminated in the development of Electronic Healthcare Records (EHR). Generally, these interventions aim at increasing medical adherence reducing possibilities of readmission (Nordmark, Zingmark, & Lindbergh, 2016). Transitional discharge that automatic flows from inpatient to outpatient is vital for offering PCC. Informational content about the program detail is disseminated in real-time amongst the involved parties. Essential health care plans, in this case, will be augmented by the utilities EHR in the CRC process. In this case, the therapist should focus on the use of physical exercises and relaxation procedures to deal with stressor and anxiety. Anxiety, stress, and depression are comorbidities that should be averted, considering that the patient has confirmed cardiovascular disease. Prognosis complications for asthma are sleep interference, heightened risk of readmission, and reduced freedom to perform demanding physical exercises.

The delivery of therapy, particularly Cognitive Behavioural Therapy (CBT) during the pre-operative regime will help reduce the psychological pain that the patient is already exposed to (Saito, Shiraishi, & Yoshinda., 2019). Similar studies by Philip, Kannan, & Parambil (2018) have also illustrated the efficacy of the cognitive method. As mentioned earlier, the improvement of coping methods as a pre-surgery non-pharmacological intervention has long-term benefits on the recovery process. It fosters the management of other pre- and post-operative complications that may arise (Farah et al., 2016). There is a mutual benefit when there is a conducive information dissemination platform since it helps reduce informational gaps that present a barrier to personal health promotion (Palermo et al., 2018). In contemporary society, the reduction of informational asymmetries between the patient and the provider is essential given the increasing importance of health promotion approach to essential health (Chan, 2016). Health promotion is always at the centrepiece of the provision of patient-centred medical interventions.

The offering of pain management education is justified by the need for ensuring that medication adherence is taken seriously given the possibilities of Jim is prescribed to use PCA and opioids as pharmacological interventions. The educational platform could be used strategically to improve provider-patient rapport as well as helping with the provision of pain monitoring as recommended by Aziato et al. (2016) and Nursing and Midwifery Council (2015). Moreover, monitoring the patient is essential because of the need to classify each category of pain during the pre- and post-operative period (Orhurhu et al., 2019). Moreover, pre-operative pain information provision is vital, given the side-effects of some pain management medications such as narcotics and opioid. The administration of the medication mentioned above necessitates monitoring and assessments using continuous data logging.

Conclusion on Jim Laverty Case Study 

In summary, pre-operative assessment, evaluation, and analyses using the CRC can avert most of the problems that are usually encountered as postoperative complications. Although osteoarthritis poses considerable health risk to the patient, both during and after surgery. The execution of the plans mentioned above proves to be strategic in determining a significant portion of success in the medical interventions applied. The identification of the risk factors and the potential occurrence of most of the post-surgical complications following OA are identified to guide the setting of plans and goals for the subject. Post-surgical complications can range from depression, SSI, DVT, ischemia, pulmonary embolism, and chronic pain. Strength-based exercises, pre-operative education, pain management. Offering pre-operative education and awareness content, CBT and pre-operative pain management are selected as the top priority in this case, given their combined efficacy in improving the overall quality of service and utility. Both non-pharmacological and pharmacological interventions are -used in the pre-operative and post-operative processes to increase general usefulness. Improvement and better output of the interventions can be obtained by the use of EHR in the entire CRC process to offer personalised care service.

References for Jim Laverty Case Study 

Barry, M. A. (2017). The effect of preoperative education on postoperative pain after joint surgery: An integrative literature review. Creative Nursing, 23(1), 42-46.

Byrne, K., & Clark, J. (2015). Total knee arthroplasty–The optimal analgesic regime. Trends in Anaesthesia and Critical Care, 5(4), 104-110.

Chan, M. (2016). The relevance and importance of promoting health in national SDG responses, Keynote address at the 9th global conference on health promotion. Retrieved from https://www.who.int/dg/speeches/2016/shanghai-health-promotion/en/

Chou, R., Gordon, D. B., de Leon-Casasola, O. A., Rosenberg, J. M., Bickler, S., Brennan, T., ... & Griffith, S. (2016). Management of Postoperative Pain: a clinical practice guideline from the American pain society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists' committee on regional anesthesia, executive committee, and administrative council. The Journal of Pain, 17(2), 131-157.

Darbari, D. S., & Brandow, A. M. (2017). Pain-measurement tools in sickle cell disease: where are we now?. Hematology 2014, the American Society of Hematology Education Program Book, 2017(1), 534-541.

Farah, W. H., Alsawas, M., Mainou, M., Alahdab, F., Farah, M. H., Ahmed, A. T., ... & Mohammed, K. (2016). Non-pharmacological treatment of depression: a systematic review and evidence map. BMJ Evidence-Based Medicine, 21(6), 214-221.

Goebel-Fabbri, A., Copeland, P., Touyz, S., & Hay, P. (2019). Eating disorders in diabetes: Discussion on issues relevant to type 1 diabetes and an overview of the Journal’s special issue.

Golladay, G. J., Balch, K. R., Dalury, D. F., Satpathy, J., & Jiranek, W. A. (2017). Oral multimodal analgesia for total joint arthroplasty. The Journal of Arthroplasty, 32(9), S69- S73.

Gordon, D. B., de Leon-Casasola, O. A., Wu, C. L., Sluka, K. A., Brennan, T. J., & Chou, R.

(2016). Research gaps in practice guidelines for acute postoperative pain management in adults: findings from a review of the evidence for an American Pain Society Clinical Practice Guideline. The Journal of Pain, 17(2), 158-166.

Lemay, C. A., Lewis, C. G., Singh, J. A., & Franklin, P. D. (2017). Receipt of pain management information preoperatively is associated with improved functional gain after elective total joint arthroplasty. The Journal of Arthroplasty, 32(6), 1763-1768.

Lemay, C. A., Saag, K. G., & Franklin, P. D. (2019). A qualitative study of the postoperative pain management educational needs of total joint replacement patients. Pain Management Nursing, 20(4), 345-351.

Lovich-Sapola, J., Smith, C. E., & Brandt, C. P. (2015). Postoperative pain control. Surgical Clinics, 95(2), 301-318.

Nordmark, S., Zingmark, K., & Lindberg, I. (2016). Process evaluation of discharge planning implementation in healthcare using normalization process theory. BMC Medical Informatics and Decision Making, 16(1), 48.

Nursing and Midwifery Council (2015). Professional standards of practice and behaviour for nurses, midwives, and nursing associates. The Code, 1-23.

Orhurhu, V., Urits, I., Orman, S., Viswanath, O., & Abd-Elsayed, A. (2019). A Systematic

Review of Radiofrequency Treatment of the Ankle for the Management of Chronic Foot and Ankle Pain. Current Pain And Headache Reports, 23(1), 4.

Palermo, T. M., Dudeney, J., Santanelli, J. P., Carletti, A., & Zempsky, W. T. (2018). Feasibility and acceptability of internet-delivered cognitive behavioral therapy for chronic pain in adolescents with sickle cell disease and their parents. Journal of Pediatric

Hematology/Oncology, 40(2), 122.

Philip, P. M., Kannan, S., & Parambil, N. A. (2018). Community-based interventions for health promotion and disease prevention in noncommunicable diseases: A narrative review. Journal of Education and Health Promotion, 7.

Saito, Y., Shiraishi, Y., & Yoshinaga, N. (2019). Cognitive-behavioral therapy for anxiety in dementia caregivers: A review of the foreign literature in English. Japanese Journal of Nursing and Health Sciences, 17(2), 28-36.

Tanzer, M., & Makhdom, A. M. (2016). Preoperative planning in primary total knee arthroplasty. JAAOS-Journal of the American Academy of Orthopaedic Surgeons, 24(4), 220-230.

Wells, K., & Fleshman, J. (2020). Laparoscopy versus open colorectal surgery: how strong is the evidence?. In The SAGES Manual of Colorectal Surgery (pp. 77-85). Springer, Cham.

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