This essay will explore two case studies based around orthopaedic and gastrointestinal nursing. Claire is a 61 year old female who has been admitted with a Tib/Fib fracture of her right leg and a left colles’ fracture, with a past history of osteoarthritis and recently osteoporosis. Justin is a 33 year old male admitted with gastro oesophageal reflux disease plus or minus peptic ulcer disease prepping for a gastroscopy and colonoscopy. Clinical presentations and nursing management as well as disease processes will be made evident throughout. 1 (a)
Arthritis is the common word used to describe inflammation of joints in the human body. Osteoarthritis is the most common form of this, known for creating wear and tear. The physiology affects all joint tissues and in particularly, cartilage, causing structural and biochemical modifications before finally destroying. Most commonly affects weight bearing joints such as hips, knees, and spine but can affect others if previous injury or excessive stress has occurred. (Pesesse et al., 2014) Osteoporosis is a complex condition in which the skeletal system’s bone strength is compromised leading to increased fragility and bone fractures. This occurs when bones lose minerals quicker than the body can replace them, for example, calcium. Therefore bone density and strength decreases, holes form and bones are susceptible to breakage. (Becker, 2008) (b)
Examples of modifiable risk factors include dietary intake involving varied fruit and vegetables for example a calcium rich diet including dairy products or spinach. Other methods of obtaining sufficient calcium include supplements in the form of tablets. Increasing the level of physical activity such as weight bearing exercises and activities to strengthen bones is very important and reduces the risk of development or disease progression. (Cech, 2012) Non-modifiable risk factors for osteoporosis include advanced age in both men and women with an increased risk factor associated with genetics and family history. All ethnic groups are effected but in particularly European and Asian ancestries are predisposed. People who have had a bone fracture are twice a likely to have another fracture when compared with someone of the same age and sex. (Cech, 2012) c)
Clinical manifestations in relation to Claire’s diagnosis of Osteoarthritis in both her hip and knees would have most commonly included pain and stiffness of the joints. Muscle weakness especially in the knee on ambulation as well as swelling of the joints may be present. Reduced range of motion and creaking of the joints may have been noted on further assessment. (Steinhilber et al., 2014) d)
Osteoporosis is often not manifested until a fracture occurs however, Claire was diagnosed before her current fractures presented. She may have accessed health services recently with a minor fracture and ongoing pain or possibly reduction in her height. Back pain is a classic symptom possibly affecting Claire, fractures also occur more easily when osteoporosis is present (Becker, 2008) e)
The post-operative care of a colles’ fracture includes elevating the wrist above the elbow and encouraging Claire to make passive movements with her fingers and thumb regularly. This reduces oedema and promotes venous return as well as rotating the shoulder to prevent stiffness and contracture. Apply ice regularly for the first 24 hours to reduce pain and swelling and commence half hourly neurovascular observations for the first four hours post operatively to monitor for any signs of post-operative complications such as pain, numbness and poor capillary return. (Brown and Edwards, 2012) Claire’s Tib/Fib fracture with external fixation will have half hourly neurovascular observations for the first four hours to monitor for post op complications. These may include a fat embolism, severe pain, redness and swelling or numbness for example. Monitor external fixator sites for signs of...
Please join StudyMode to read the full document