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  • Subject Name : Nursing

A case study of Total Hip Arthroplasty

1. Introduction

Mrs Rose Halpern is a 62 years old woman suffering from obesity and osteoarthritis. Her condition caused her immense pain in her hip and this made mobility immensely challenging. For treatment, she has received a total hip arthroplasty. Total hip arthroplasty can be defined as replacing the entire hip joint through the use of surgery (MayoClinic, 2018).
This essay would discuss the pathophysiology of osteoarthritis along with its clinical manifestations. In addition, a discussion would be provided for the treatment of the patient which would be evidence-based. Furthermore, the assignment would provide a summary of the nursing process along with its application while also talking about three high priority nursing problems. The proposed plan would consider holistic care of the patient including spiritual, cultural, physical, emotional and psychosocial.

2. Pathophysiology

As per Ashkavand, Malekinjad, and Vishwanat (2013), Osteoarthritis is a joint disease which is degenerative and affects a lot of people. Pathogenesis of this condition includes changes in the bone and cartilageaposs tissue homeostasis and severity can be affected by factors such as injury, obesity, physical activity, occupation, diet, age, hormones and genetics, and gender. Some factors result in disability and they include weakness in muscles, pain and stiffness of joints (Man amp Mologhianyu, 2014).
Osteoarthritis is a disorder of the complete joint. Few of the changes that come with osteoarthritis occur in articular cartilage, subchondral bone and synovial membrane. Degeneration of the cartilage happens with time, first there is softening and in the end, it results in exposing the subchondral bone. Li et al. (2013) mentioned the changes which occur in the bone which include the development of lesions in the bone marrow and sclerotic changes. Modifications and remodelling of bone occur leading to decreased absorption of forces causing more pressure to the joints. According to Mathiessan and Conaghan (2017), the inflammation of the synovial membrane is related to the progressive failure of joints. The changes which can be seen in this include thickening of the layer of synovial lining and increased production of cytokines which are referred as messenger cells and are secreted in case of inflammation (Eustice, 2018).
Obesity has been defined as a complex disorder which involves the presence of excess body fat and results in an increase in various problems including high blood pressure, heart disease and diabetes (MayoClinic, 2015). The main reasons for obesity are the lack of activity and bad eating habits.

3. Clinical Manifestation

According to the Arthritis Foundation (n.d.), the symptoms of osteoarthritis vary according to the affected joints and their severity. The symptoms include stiffness of joints mainly in the knees, lower back and hips, joints could be swollen, while there could also be cracking sounds when bending from joints. For hips, pains might be felt in the groin region and inside of thighs or knees.

4. Evidence-based treatment

Osteoarthritis Treatment involves exercising and stretching in moderation, along with physical therapy, weight reduction and so on (Lespasio et al., 2018). Pharmacological treatments consist of drug use such as nonsteroidal anti-inflammatory drugs like capsaicin and acetaminophen, and Duloxetine for treating pain (Lozada, 2018).
Obesity can be treated with changes in the lifestyle like a healthy diet and exercises. There are medications such as orlistat and liraglutide for weight loss and even surgery for highly obese people (Mayoclinic, 2015).

5. Nursing Process

Toney-Butler and Thayer in 2019 explained that the nursing process is a systematic method for providing care to the patients. This process consists of 5 steps namely assessment, diagnosis, planning, implementation and evaluation. Assessment involves data collection and critical thinking skills and is important for this case study as it helps in availing medical information of the patients. The second step in the nursing process is diagnosis assists in formulating plans for the care of the patient. Maslowaposs Hierarchy of Needs which talks about different needs of a person such as food, water, air, sleep, security and safety, belonging and social relations, and even self-actualization and self-esteem (Toney-Butler and Thayer, 2019). It is relevant to this case study as understanding the needs of the patient is important in order to provide the best care possible.
Planning is the third step in the nursing care and involves planning and developing goals which would be impacting the patient care. In addition to planning, there is an implementation step that is concerned with the actions and performing interventions that are involved in the planning.
The final step is evaluation which is crucial for any patient care system as it allows the nurses to determine the condition of the patient after receiving patient care.

6. Application of the nursing process

Hagos, Alemseged, Balcha, Berhe, and Aregay (2014) stated that a nursing process is an appropriate approach for explaining the essence of nursing including the scientific information, the technologies and the role of the human hypothesis. It allows the healthcare system to provide the best service to its patients by solving problems as a result of creativity and critical thinking. The nursing process is used worldwide and is defined as a science-based method allowing the delivery of nursing care in a dynamic and systematic way. The nursing process is implemented through five steps which are interrelated and are assessment, diagnosis, planning and evaluation. As per NursingProcess (n.d.), assessment involves information gathering in which holistic information about the patient is collected. The diagnosing involves judgement making about the health problems of the patient. Planning is about creating a plan of action for providing healthcare to the patient. The implementation phase is about the nurse following the plan. The final phase, evaluation, is about analysing patientaposs health after providing the planned healthcare.
When the nursing process is implemented effectively, it results in improved quality care and helps in improving scientific knowledge on the basis of best practice for the healthcare of the patients. Semachew (2018) mentioned that the key caregivers in any hospital are the nurses and they have a high influence in the quality-care being provided to the patients. Even when the nurses have the knowledge of the nursing process, factors such as high volume of patients, high turnover, and lack of time can affect their ability to utilise the nursing process effectively. The processes application is defined by the professionals ability to use their scientific knowledge and prove individual assistance.

6.1 Nursing Care Plan

According to Papandrea (2018), a nursing care plan assists communication among nurses and their patients, and other providers of healthcare. Furthermore, it provides the necessary documentation of the patientaposs care which is needed by health insurance organisations and also for keeping health records of the patients. A nursing care plan consists of nursing problems, information about the interventions for that particular nursing problem, a rationale or reasons for selecting the intervention, and finally the outcome of the use of the respective interventions.
Ballantyne (2016) mentioned the role that a nursing care plan plays in the healthcare system. At first, it facilitates holistic care which is standardised and evidence-based. Secondly, it allows recording the care administered to the patients. Finally, it allows the measuring of the care in the form of evaluation.
According to the given case study of Total Hip Arthroplastyapos, the three high priority nursing problem pertaining to Mrs Rose Halpernaposs case of osteoarthritis is immense pain, impaired mobility and the risk of injury.

6.1.1 Immense pain

Mrs Halpern suffers from immense pain which results due to her osteoarthritis and obesity. First possible interventions for this nursing problem can be an evaluation of the painaposs description of the patient. The patient, in this case, is old and can have trouble conveying the intensity of pain and the affected area. Furthermore, there could be multiple causes of pain which would need to be evaluated (Martin. 2018). The second intervention can be the use of walking aid like a walking cane or walker. Walking or mobility devices like these help alleviate the pain that they are suffering. This is because, the mobility devices distribute the load that the joints are suffering and thus reducing pain (Leonard, 2017). The third intervention for this nursing problem can be the use of cold or hot pack.
Cold packs help reduce pain by decreasing the activity of chemicals which induce pain, while hot packs alleviate pain by improving the blood flow (Martin, 2018). The expected outcome for this nursing problem is a reduction in the pain levels that the patient is experiencing.

6.1.2 Impaired mobility

The patientaposs mobility has decreased because of her medical condition. The first intervention can be about assessing the patientaposs range of motion. Due to stiffness, deformity, or pain, the motion of joints can get limited (Morrison, 2016). Therefore, an assessment would help the nurse understand the issue more clearly. The second intervention can be encouraging the patient to perform passive exercises because if joints remain inactive they can lose their mobility (Martin, 2016). Furthermore, the third intervention can be an assessment of the patientaposs weight. Osteoarthritis affects the joints, and obesity deteriorates the problems by putting increased pressure on them and decreasing mobility (MayoClinic, 2015). The expected outcome after the use of interventions is increased knowledge about patientaposs problem along with improved joint mobility.

6.1.3 Risk of Injury

Mrs Halpern is old, suffers from pain, has decreased mobility which can contribute to the risk of injuries. Promoting weight loss can be the first intervention as it decreases pressure on joints. Increase in weight elevates the pressure on joints deteriorating their condition (MayoClinic, 2015).
Another intervention can be instructing the patient to use walking aids as walking aids function to increase mobility while decreasing the risk of injuries (Leonard, 2017). The expected outcome is the reduced risk of injuries.

7. Holistic considerations

Wallace (2013) suggested considering the holistic assessment of patients as it allows the nurse to provide better overall care to the patients. The holistic care needs of a patient include emotional, physical, psychosocial and spiritual needs. In accordance with the current case study of Mrs Rose Halpern, she is a widow and is stricken with old age and lives with his son who is 24 years old. It can be said that she feels alone and has been feeling a lack of companionship after the loss of her husband. Patients like need to be listened to, they should be acknowledged and given importance. Her son is the only family left so he should be consulted to spend more time with her mother to provide emotional support to her all the time. In addition, meeting the social needs of the patient is also important as it provides them with a sense of association with the community and its people (health.vic, n.d.).
A patient like Mrs Halpern would need physical assistance in every way possible even after she is discharged, and needs like this must be met, which can be ensured via private nurses and consultancy can be done by physiotherapists. Mrs Halpern is a follower of Judaism and attends multiple worship services, this suggests that the patient has spiritual needs as well. The spirituality of the patient is something that the nurses should be aware of, so that can provide them assistance which promotes their beliefs (Wallace, 2013).

8. Conclusion

The essay discussed the pathophysiology of osteoarthritis which starts with degeneration of the cartilage present around bones, after which, subchondral bones are affected, along with synovial membrane inflammation. There are different factors which affect its severity such as age, diet, genetics, obesity, injury and so on causing immense pain to the person and can also result in reduced mobility. Identified symptoms include stiffness of joints, cracking sound when bending from joints and all of this is accompanied by pain. Treatment includes increasing joint mobility, plus medicines such as Acetaminophen are also available.
Nursing process was analysed which consists of assessment, diagnosis, planning, implementation and evaluation, A nursing plan for the patient was provided which interventions, rationale and outcome of using these interventions. In addition, holistic considerations when providing nursing care to the patient which included needs such as physical, emotional, spiritual and psychosocial of the patient were also discussed.


Arthritis Foundation. (n.d.). Osteoarthritis symptoms. Retrieved from https//www.arthritis.org/about-arthritis/types/osteoarthritis/symptoms.php
Ashkavand, Z., Malekinjad, H., Vishwanat, B. S. (2013). The pathophysiology of osteoarthritis. https//doi.org/10.1016/j.jopr.2013.01.008Ballantyne, H. (2016). Developing nursing care plans. Nursing Standard, 30(26), 51-57. DOI 10.7748/ns.30.26.51.s48
Eustice, C. (2018). Cytokines and how they work. Retrieved from https//www.verywellhealth.com/what-are-cytokines-189894
Hagos, F., Alemseged, F., Balcha, F., Berhe, S., amp Aregay, A. (2014). Application of nursing process and its affecting factors among nurses working in Mekelle zone hospitals, Northern Ethiopia. Nursing Research and Practice, 2014(2014), 675212. doi 10.1155/2014/675212
health.vic. (n.d). Managing personal, emotional, cultural and spiritual needs in palliative care. Retrieved from https//www2.health.vic.gov.au/hospitals-and-health-services/patient-care/older-people/palliative/palliative-emotional
Leonard, J. (2017). Mobility aids Types, benefits and use. Retrieved from https//www.medicalnewstoday.com/articles/318463.php
Lespasio, M. J., Sultan, A. A., Piuzzi, N. S., Khlopas, A., Husni, M. E., Muschler, G. F., amp Mont, M. A. (2018). Hip Osteoarthritis A Primer. The Permanente Journal, 22, 17-084. doi 10.7812/TPP/17-084
Li, G., Yin, J., Gao, J., Cheng, T. S., Pavlos, N. J., Zhang, C., amp Zheng, M. H. (2013). Subchondral bone in osteoarthritis insight into risk factors and microstructural changes. Arthritis Research amp Therapy, 15(223). https//doi.org/10.1186/ar4405Lozada, C. J. (2018). Osteoarthritis treatment amp management. Retrieved from https//emedicine.medscape.com/article/330487-treatment
Man, G. S. amp Mologhianyu, G. (2014). Osteoarthritis pathogenesis a complex process that involves the entire joint. Journal of Medicine and Life, 7(1), 37-41. Retrieved from
Martin, P. (2018). 4 osteoarthritis nursing care plans. Retrieved from https//nurseslabs.com/osteoarthritis-nursing-care-plans/
Mathiessen, A. amp Conaghan, P. G. (2017). Synovitis in osteoarthritis current understanding with therapeutic implications. Arthritis Research amp Therapy, 19(18). doi 10.1186/s13075-017-1229-9
MayoClinic. (2015). Obesity. Retrieved from https//www.mayoclinic.org/diseases-conditions/obesity/symptoms-causes/syc-20375742
MayoClinic. (2018). Hip replacement. Retrieved from https//www.mayoclinic.org/tests-procedures/hip-replacement/about/pac-20385042Morrison, W. (2016). What causes limited range of motion Retrieved from https//www.healthline.com/symptom/limited-range-of-motions
NursingProcess.(n.d.). The 5 steps of the nursing process. Retrieved from https//www.nursingprocess.org/Nursing-Process-Steps.html
Papandrea, D. (2018). Nursing care plans What you need to know. Retrieved from https//nurse.org/articles/what-are-nursing-care-plans/Semachew, A. (2018). Implementation of nursing process in clinical settings the case of three governmental hospitals in Ethiopia, 2017. BMC Research Notes, 11(1), 173. doi 10.1186/s13104-018-3275-z
Toney-Butler, T. J. amp Thayer, J. M. (2019). Nursing process. Treasure Island, Florida StatPearls.
Wallace, S. (2013). The importance of holistic assessment A nursing student perspective. Nuritinga. 24-30. Retrieved from https//www.researchgate.net/publication/275893594_The_importance_of_holistic_assessment_-_A_nursing_student_perspective


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