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case study is a 53 year old white female Nursing Case study updated
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case study is a 53 year old white female Nursing Case study updated
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1Nursing Case Study
I. ASSESSMENT
1. Description of client
The patient I am using for my nursing case study is a 53 year old white
female. She weighs 210 pounds and her height is 67” tall. She is a well-developed,
well nourished female. My patient had been a smoker for ten years; she is currently
a social drinker, and wears glasses for driving. She is not very active and has
difficulty walking for long distances. Her father had a myocardial infarction (MI)
and rheumatic fever. Her mother has hypertension (HTN), cancer, arthritis, and
asthma. My patient is a homemaker, married to a police officer, and has grown
children that are out of the house. Her medications were Prozac 20mg/PO/QD for
depression, Hydrochlorothiazide 25mg/PO/OD for HTN, and a multivitamin 1
dose PO/QD.
My patient was admitted to the hospital for degenerative joint disease (DJD),
otherwise known as osteoarthritis (OA) in both knees, and she had gotten to the
point where she felt she needed to have right total knee replacement (TKR)
surgery. She had a cortisone injection 2 weeks ago, and was taking prednisone last
summer for knee pain. She had right knee arthroscopy in 2005, but she has not had
much relief from the pain. She said her knee was painful enough on a daily basis
that she wanted to proceed with right TKR surgery. The surgeon explained to her
the risks and benefits, problems with phlebitis and she desired to proceed. My
client’s TKR surgery was scheduled for 1/30/06.
2. Assessment of client
A summary of my patient’s initial interview by an RN includes the
following. My patient has a drug allergy to codeine, and develops a rash from
adhesive tape. She has known food allergies. She has motion sickness, only in the
back seat. She has arthritis in her knees and back. She has a chronic cough in the
morning usually productive. She currently has an eleven year old nephew living
with her and her husband. She is concerned about his behavior because is bipolar.
My patient’s preoperative laboratory values were; Hematology: White
blood cells (WBC): 11,700/mm² (high), Neutrophils: 82.5% (high), Lymphocytes:
11% (low), Monocytes: 1.5% (low). Prothrombin time: 13.3 seconds (high),
International normalized ratio (INR): 1.3 seconds (low). Urinalysis: Color: yellow,
Appearance: clear, Specific gravity: 1.020, pH: 7.5, Leukocytes: negative, Nitrite:
negative, Protein: negative, Glucose: negative, Ketones: negative, Urobilirubin:
0.2, Bilirubin: negative, Occult blood: trace A, WBC: 1-3, Red blood cell (RBC):
3-5, the urine source was via Foley catheter.
, 2
3 & 4. Medical/surgical diagnoses & Pathophysiology
My patient also has a history of degenerative joint disease (DJD), otherwise
known as osteoarthritis, hypertension, obesity, depression, and rheumatoid
arthritis. She has had the following surgeries; arthroscopy in 2005, pneumonia in
2004, left foot bone spur removed, bilateral carpal tunnel surgery, breast reduction
surgery in 1997, and a hysterectomy in 1995.
“Osteoarthritis is a disorder of a synovial joint characterized by loss of joint
function, shape, and stability due to erosion of the articular cartilage and
weakening of viscous and shock absorbing properties of the synovial joint fluid. As
the cartilage deteriorates, areas of bone are often left unprotected, causing further
deterioration of articular cartilage that comes in contact with the rough bony
surface (causing significant pain).” “Clinically, OA can be diagnosed most
conclusively with a simple x-ray.” “In the later stages, some of the joint space may
completely collapse, resulting in direct bone on bone contact.”(visco article)
Taber’s states, that “risk factors include aging, obesity, overuse or abuse of
joints as in sports or strenuous occupations, and trauma. Treatment is supportive,
using exercise balanced with rest, heat, weight reduction if needed, and analgesics.
Joint replacement surgery may be required if these measures were unsuccessful in
controlling pain, depending on the joint involved. Patient care includes activities
that are paced to prevent excessive fatigue or irritation of the joints, and rest is
provided after the activity.”
Hypertension (HTN), Taber’s states, “is a condition in which the blood
pressure (BP) is higher than 140 mm Hg systolic or 90 mm Hg diastolic on three
separate readings recorded several weeks apart. Hypertension is one of the major
risk factors for coronary heart disease (CAD), congestive heart failure (CHF),
stroke, peripheral vascular disease (PVD), and kidney failure.” “Hypertension
results from many different conditions, many are not curable. Excess alcohol
consumption (more than two drinks per day) is a common cause of high BP;
abstinence or drinking in moderation effectively lowers BP in these cases.
Pregnancy, aortic valve stenosis, and the use of “recreational drugs” may also
lead to hypertension.
The goal of treatment is to reduce BP to below the normal range of 120/80 in
all patients with hypertension. Lifestyle modification are usually required to help
lower BP. Patients are restricted to a diet that is low in sodium diet, low in fat and
in cholesterol. Patients should also quit smoking, reduce their alcohol
consumption, and begin an exercise regimen. In conjunction with these lifestyle
modifications, medications can be used. “Drug therapy may include low-dose
thiazide diuretics; beta-blockers, and calcium-channel blockers. Patient care
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