John Grant’s Medical Condition

In this essay, a case of John Grant is discussed. He is suffering through bilateral knee osteoarthritis, hence he is at the risk of development of deep vein thrombosis. He is also suffering through other complications like metabolic, cardiovascular and psychological   disorders. In this essay John’s current condition is discussed considering his medical history and family situation. Pathophysiology of deep vein thrombosis is also discussed. Tests to be performed in John for assessment and interventions to be performed for the problems identified in the assessment, are discussed. Incorporation of different professionals in the care of John is also discussed.

John Grant is 63 year old and suffering through bilateral knee osteoarthritis. He is prescribed with Endone 5 mg and suggested to have both the knees replacement surgery. He is also associated with other complications like angina, hypertension (HTN), hyperlipidaemia, type 2 diabetes (T2DM), and depression. He reduced his workload form 6 days per week to 2 days per week due to knee pain. He is performing his daily activities on his own, however few times his family members are assisting him in performing his daily activities. Deep vein thrombosis can occur due to reduced blood flow. Venous stasis can happen due to reduced blood flow, dilated vein and reduced contraction of skeletal muscle. This can lead to damage to intimal lining of the blood vessels which act as site for thrombus formation. Inflammation of the vein walls is called as phlebitis and it occurs immediately after thrombus formation. Venous thrombi occur due to aggregates of platelets attached to vein wall. Venous thrombi have tail like structures which comprises of fibrin, white blood cells and red blood cells. Fragmentation of the thrombus can occur naturally or due to increased venous pressure. After acute episode of deep vein thrombosis, reestablishment of lumen of vein occurs (Houshmand et al., 2015; Nisio et al., 2016).

John should be assessed for musculoskeletal system as he is suffering through osteoarthritis. Functional assessment should be performed to assess strength, balance and joint range of motion for performing his daily activities. There should be inspection of the movement, body posture and symmetry. This assessment can be performed by observation and helpful in understanding strength of joint and muscles. There should be assessment of spine contour and tenderness. This assessment can be done by visual observation of spine through posterior and lateral view. This assessment is useful for examination of configuration and range of motion of the John’s spine. Gait and balance should be assessed in case of John. For the assessment of gait nurse should ask John to walk for 5 to 6 steps in the room. Nurse should ask John walk in different ways like heel-to-toe walking and steps on tiptoe walking, to evaluate gait. Balance testing should be done in John by using Romberg testing (Almoallim and Gelidan, 2012; Maricar et al., 2016).

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Pathophysiology Of Deep Vein Thrombosis

For the assessment of diabetes in John nurse should check for body weight changes, sweating and weakness. Nurse should also assess John for Polydipsia, polyphagia, and polyuria.  John should be assessed for cardiovascular parameters like blood pressure and heart beat. John should be assessed for vision impairment using ophthalmoscopy. Neuropathy should be evaluated for ankle and knee reflexes by the application of tendon hammer. Blood glucose level test and HbA1C test should be performed in John for assessment of diabetes. Blood glucose level should be estimated in John by using glucose oxidase method and HbA1C level using ELISA kit. His family members should visit him on regular basis to take him to hospital for assessment of his health. Clinical laboratory scientist and dietician should be incorporated in the assessment of John (Pagana and Pagana, 2014; Selph et al., 2015).

There can be increased risk of fall in John due to his age and osteoarthritis. Fall risk can be evaluated by gathering information about the fall in terms of number of fall and frequency of fall in last 6 months. Information should also be gathered for activities or positions responsible for fall. Fall risk also be assessed by frequency of bowel and urine elimination because it is evident that majority of the elder patients fall in the bathrooms. Fall risk can be evaluated using gait and visual or auditory impairment. Fall risk can be evaluated by assessing cognition. Cognition can be used understand knowledge about surrounding environment and obstacles (Suman et al., 2013). There are more chances of infection due to surgery. Risk of infection can be assessed by observing purulent drainage from surgery site and culture examination of fluid or tissue. Risk of infection can also assessed by observing symptoms like pain, swelling and redness (Cheng et al., 2015).

Intervention should be provided to John to improve mobilization because in osteoarthritis mobilization can be reduced. Warm compress or warm water blanket should be applied, so that joint stiffens reduces and muscle gets relaxed. Gentle massage can be helpful in movement of fluid into the lymphatic system and movement of fluid to central compartment from the extremities. This would be helpful in improving mobilization. Passive range of movement or stretching should be performed to improve functioning of the affected joints and muscles. This would also be helpful in pain free movement, building strength and limb usage (Musumeci et al., 2014).

Assessment For Musculoskeletal And Endocrine Systems

Gliclazide and acarbose should be administered in patients like John. These two medications are useful in the management of type 2 diabetes mellitus. Gliclazide exhibits inhibitory action on the sulfonylurea receptors (SUR-1) on the pancreatic beta-cells. Acarbose exhibits inhibitory action on enzymes like alpha-glucosidase in small intestine and alpha amylase in the pancreas. It is useful in facilitating carbohydrate digestion and reducing HbA1C level (Singla et al., 2016; Singhand Singh, 2016).

For deep vein thrombosis, nursing interventions should be provided for increasing blood flow in the leg. Blood flow in the leg can be increased by changing position of the leg and by using compression therapy. John’s legs should be elevated and slight knee flexion should be maintained. Warm and moist compresses should be applied to the leg. Graduated compression stockings are helpful in reducing superficial veins caliber in the leg and increasing blood flow in the leg. External compression devices and wraps in a 50 % spiral wrap should be applied from the toes to the knees. These are short stretch elastic wraps. Use of intermittent pneumatic compression devices in John would be useful in increasing blood velocity. Research indicates that application of these devices are useful in preventing formation of blood clot. These devices are more useful than medications for preventing blood clot because there are less chances of bleeding with use of these devices. However, it should be noted that chances of blood clotting are less with consumption of medications as compared to the use of compression devices (Blann, 2015).

Upon consultation with the doctor, nurse should provide and maintain optimum perfusion in John. It would be helpful in preventing clot formation in case of John. Nurse should give education about the medications to the John. Nurse should incorporate pharmacist and clinical pharmacologist to provide education about medications to John. John should be taught with consumption of correct dose of anticoagulant and consumption at the scheduled time. Nurse should incorporate clinical laboratory scientist to inform John that he should perform blood tests on regular basis to change medications or to change dose of existing medications. Nurse should take help of family members of John to prevent him from consumption of alcohol because alcohol intake can reduce effectiveness of anticoagulants. Nurse should take help of physical trainer to educate him about the movement of legs to increase blood flow to the legs. Nurse should take help of dietician to plan proper diet for John because John is associated with cardiovascular and metabolic complications like hypertension and type 2 diabetes mellitus. In this disease, diet has as significant role. Psychologist should be incorporated in management of John because he suffering through depression. Psychologist would be helpful in counselling John (Blann, 2015).

Nursing Interventions For Improvement Of Mobility And Glucose Levels

I described the condition of John considering his current condition and medical history. I can understand form the collected information that John is going through very complicated medical condition. He is having complications of different systems like musculoskeletal system, cardiovascular system, endocrine system and nervous system. I assessed condition of John to understand his major problem. From the assessment, I interpreted that immobilization due to osteoarthritis and high glucose due to diabetes are the problems, which needs to take care. I provided nursing intervention to John for improving mobilization and reducing blood glucose level (Papathanasiou et al., 2014).

Conclusion:

Bilateral knee osteoarthritis in John is very painful and he should undergo knee replacement surgery. One of the prominent risk factors for knee replacement surgery is deep vein thrombosis. Assessment for musculoskeletal system and endocrine system should be provided in John. Nursing intervention to improve mobilization and to decrease glucose level should be provided for John. Nursing intervention to John for deep vein thrombosis should be provided by incorporation of different professionals like pharmacist, dietician, clinical laboratory scientist and psychologist. In summary, accurate assessment of John and provision of targeted intervention to John would definitely improve his condition.

References:

Almoallim, Hani., and  Gelidan, A. (2012).  Musculoskeletal Examination Skills: Are We Still Interested? International Journal of Clinical Medicine, 3, 335-340.

Blann, A.  (2015). Deep Vein Thrombosis and Pulmonary Embolism: A guide for practitioners.

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Cheng, K., Jiawei, L., Qingfang, K., Changxian, W., Nanyuan, Y., and Guohua, X. (2015). Risk factors for surgical site infection in a teaching hospital: a prospective study of 1,138 patients. Patient Preference and Adherence, 9, 1171–1177.

Houshmand, S., Salavati, A., Hess, S., Ravina, M., Alavi, A. (2014). The role of molecular imaging in diagnosis of deep vein thrombosis. American Journal of Nuclear Medicine and Molecular Imaging, 4(5), 406–425.

Maricar, N., Callaghan, M.J., Parkes, M.J., Felson, D.T., and O’Neill, T.W. (2016). Clinical assessment of effusion in knee osteoarthritis-A systematic review. Seminars in Arthritis and Rheumatism, 45(5), 556-63.

Musumeci, G., Mobasheri, A., Trovato, F.M., Szychlinska, M.A., Imbesi, R., and Castrogiovanni, P. (2014).  Post-operative rehabilitation and nutrition in osteoarthritis. https://dx.doi.org/ 10.12688/f1000research.4178.3.

Nisio, M. D., van Es, N., and Büller, H.R, (2016).  Deep vein thrombosis and pulmonary embolism. Lancet, 388(10063), 3060–3073.

Pagana, K.D., and Paganam T.J.  (2014). Blood studies. In: Pagana KD, Pagana TJ, eds. Mosby’s Manual of Diagnostic and Laboratory Tests. 5th ed. St Louis, MO: Elsevier Mosby; 2014:chap 2.

Papathanasiou, I. V., Kleisiaris, C. F., Fradelos, E. C., Kakou, K., &Kourkouta, L. (2014). Critical thinking: The development of an essential skill for nursing students. ActaInformaticaMedica, 22, 283. https://dx.doi.org/10.5455/aim.2014.22.283-286

Singla, R.K., Singh, R., and Dubey, A.K. (2016). Important Aspects of Post-Prandial Antidiabetic Drug, Acarbose. Current Topics in Medicinal Chemistry, 16(23), 2625-33.  Assessment And Interventions For John Grant’s Medical Condition Discussion Paper