For older people, multiple chronic diseases lower quality of life, and increases frailty and prolonged illness. This essay is grounded on the case of 63 year old man, John, who is a widower. Based on the information provided in the case study, John suffers from type-2-diabetes, angina, hyperlipidemia, hypertension and depression. He has undergone total knee replacement surgery and shifted to ward. John requires high-quality care, physiotherapy and prevention strategies. Prophylactic regimes to prevent blood clots are essential just in case he has medical history of clot. According to Medicare survey reports usually 1.8 % of patients get infection within ninety days of knee replacement surgery (Greengard, 2015). The probability of getting an infection is very rare, in case of blood clot formation in veins; this is known as deep vein thrombosis. It causes pain and swelling in the leg. Patient-associated factors such as smoking which is reported to delay wound healing, frailty, obesity, diabetes, and depression contribute to joint infections after surgery (Kunutsor et al., 2016). The risk of developing an infection is also influenced by post-operative care. If these risk factors are considered and altered accordingly, only then the chances of infections can be minimized. Prior to surgery, John was getting help from his son and daughter-in-law with cooking and household work. His eldest daughter was taking care of his café. After discharge from hospital, John will need a full time nurse to take care of his day-to-day life activities. Post-operative care is essential to avoid any other health complication or infection, at least for the next few months of surgery.
Previously it was reported that diabetic patients undergoing surgery are at higher risk of heart, respiratory and brain related morbidity which affects mortality in an adverse manner (Duncan, 2012). It is expected that patients with diabetes are prone to get infection or it may affect the outcomes of surgery negatively. Contrary to this, it has been reported that diabetic patients with total knee replacement surgery are not subjected to any possibility of deep vein thrombosis. The study also emphasized that the percentage of people with diabetes having arthritis is 52, and they are eventually expected to be obese (AAOS, 2013). Inactivity or bed rest due to surgery, family history of inherited clot disorder, vein injury, health issues such as obesity, age-related, cardiovascular, and respiratory or bowel movement troubles are the reasons which increase occurrence of clot formation (Patel, 2016). If the clot shifts position by travelling throughout the body, towards heart or lungs then it becomes a serious health trouble. The main treatment is to prevent pulmonary embolism, reduce mortality and minimize the threat of getting post-thrombotic syndrome.
The measures advised to prevent such deep vein clots are blood-thinning medicines or anticoagulants which are prescribed by the physicians and exercises to enhance blood circulation such as elevated position of leg, calf muscle exercises and specially designed gradient stockings for support (Patel, 2016; Greengard, 2015). After discussion with the physician, anticoagulants have to be given on time and foot exercises have to be taught in collaboration with the physiotherapist. He has to raise his foot end of the bed at an elevation in comparison to the pillow end; this in turn helps to reduce clot formation. Available reports suggest that health conditions such as diabetes, heart-related and mental disorders are observed to co-occur at higher rates (Windle and Windle, 2013). Diabetes is associated with obesity (Sue Kirkaman et al., 2012), type- 2- diabetes is known to adversely affect cardio vascular system. It is also associated with depression both in men and women. Similarly, patients with osteoarthritis are linked to be at greater risk of cardiovascular diseases (Rahman et al., 2013). Therefore, increased deaths rates among aged people are due to numerous health problems which are interlinked. This is evident in John’s case who is suffering from heart problem- angina, diabetes, arthritis as well as depression and many more.
Now-a-days, person-centric care and involvement of patients during delivery of care is universal. A patient-centric care focuses on patient’s preferences, social and cultural values and spiritual needs in addition to medical interventions (Greene et al., 2012). It also demands for a strong bonding between patient and physician or care provider. The main feature of patient-centric care for John is to communicate with him about care planning and health management. To understand his doubts and fears regarding his health and then support him to build up his management schemes for his chronic diseases such as diabetes, hypertension, and depression. Majority of the aged people suffering with considerable pain in their body parts are deprived of quality of life, due to emotional distress and impaired physical activity (Dansie & Turk, 2013). Consequently, patient-centric care and management of pain can enhance survival rate, health outcome and better care process. John is recommended to attend self-management training for his chronic disease which will include behavioral and psychological changes. He needs to monitor his health especially diabetes and hypertension which require regular check-up, hence maintaining desired levels of blood glucose and pressure. It will be better for him to get connected with community-based centers offering emotional and social support so that he can manage his health in a better way. Because of his age, diabetes and other health problems, John is more prone to additional dangers such as visual impairment and obesity, which eventually affects physical activity (Sue Kirkaman et al., 2012).
Majority of the patients do receive physical therapy or other therapies post-operation in the hospital or at home. Inter-professional team includes physiotherapy, occupational therapy, dietician, weight trainer or management professionals, and nursing care. Cooperation and coordination among the team members will help to improve surgical outcomes. Post-surgery, physicians are mostly concerned regarding mobility and fixation of implants of the patients whereas patients need emotional support to boost up their mental energy level. Patients think about participation in life activities, social involvement, and health-related quality of life. After or prior to surgery, patients are anxious and fear surgery, some might be under depression (Theunissen et al., 2014). Consistent and high-quality care from inter-professional team is required under such circumstances. Effective communication and involvement of family members aid to gain confidence and satisfaction. Hospital environment should be salubrious enough to provide effective and safe care to the patients. A well-developed delivery system and support are of utmost importance for patient-centric care which focuses on patient’s needs and values. Patient must also develop trust on health care providers which finally ensures better health outcome (Greene et al., 2012).
Clinical nurses implement a care plan with treatment procedures/ preventive measures to moderate the health conditions of patient. Nurses assess the symptoms of the patients critically, and apply their experience, knowledge, and skills to deliver safe care to the patients by keeping scientific data as evidence and converting them into practice. Therefore, nurses play a vital role in enhancing health outcome with due compassion towards patients and their profession (Lucatorto et al., 2016). Nurses develop a care plan to manage acute pain, sleep disturbances and mental stress post-surgery to be followed by patients for many weeks. Strategies are to be used to improve self-confidence and empower patients so that they can participate in the therapy session with positive mental attitude and enthusiasm. Follow-up sessions with physicians are to be scheduled for few months till mobility and patient satisfaction is assured. Health outcome measures are to be constantly evaluated so that delivery of care and treatments during the hospital stay are monitored and modifications can be made to improve patient satisfaction. John has to be taught regarding his blood glucose and pressure monitoring machine, medications prescribed for diseases (how and when to take), his diet chart prepared by dietician is to be explained and a pharmacist who can train him to store medicines for longer duration. He should stick to proper medicines as prescribed by the physician and should follow it without fail.
To summarize, diabetes seems to be the root cause of a wide range of health troubles in older people. Blood clot or infection is rare in knee replacement surgery but if clot occurs, it can be prevented or treated. Deep vein thrombosis and pulmonary embolism can be prevented by practicing prophylactic regimes. Management of pain in a holistic manner is to be considered while delivering care to aged people. Post-surgery, patients are to be given continuous support, and care in addition to medical treatment which helps to enhance recovery process. Care plan has to be built by the inter-professional team of healthcare members in collaboration with the patient’s family. For the positive health outcome of the patients, nurse has to advice alterations in the lifestyle of patients. Healthy aging is to stay active physically and socially. Community-based care settings will assist aged people to continue social integration within their community. Awareness on health conditions will facilitate them to manage their symptoms, and self management plan will aid to attain the preferred health result. An integrative and comprehensive approach with consistent practice to provide care delivery in a patient-centric manner will surely enhance health outcome.
References
American Academy of Orthopaedic Surgeons. (2013). Patients with diabetes at no greater risk for infection or other complications after total knee replacement. ScienceDaily. Retrieved from: www.sciencedaily.com/releases/2013/02/130227134421.htm
Dansie, E. J., & Turk, D. C. (2013). Assessment of patients with chronic pain. BJA: British Journal of Anaesthesia, 111(1), 19–25.
Duncan, A. E. (2012). Hyperglycemia and Perioperative Glucose Management. Current Pharmaceutical Design, 18(38), 6195–6203.
Greene, S. M., Tuzzio, L., & Cherkin, D. (2012). A Framework for Making Patient-Centered Care Front and Center. The Permanente Journal, 16(3), 49–53.
Greenguard, S. (2015). Risks and complications of total knee replacement surgery. Retrieved from: https://www.healthline.com/health/total-knee-replacement-surgery/risks-complications#3
Kunutsor, S.K., Whitehouse, M.R., Blom, A.W., Beswick, A.D., & INFORM Team (2016). Patient-related risk factors for periprosthetic joint infection after total joint arthroplasty: A systematic review and Meta-Analysis. PLoS ONE 11(3), e0150866.
Lucatorto, M. A., Thomas, T. W., & Siek, T. (2016). Registered nurses as care givers: Influencing the System as Patient Advocates. The Online Journal of Issues in Nursing, 21(3) doi: 10.3912/OJIN.Vol21No03Man02
Patel, K.K. (2016). Deep venous thrombosis treatment & management. Retrieved from: https://emedicine.medscape.com/article/1911303-treatment
Rahman, M.M., Kopec, J.A., Anis, A.H., Cibere, J., & Goldsmith, C.H. (2013). Risk of cardiovascular disease in patients with osteoarthritis: a prospective longitudinal study. Arthritis Care Research, 65, 1951-1958.
Sue Kirkman, M., Briscoe, V. J., Clark, N., Florez, H., Haas, L. B., Halter, J. B., … & Swift, C. S. (2012), Diabetes in Older Adults: A Consensus Report. Journal of the American Geriatrics Society, 60, 2342–2356.
Theunissen, M., Peters, M. L., Schouten, E. G. W., Fiddelers, A. A. A., Willemsen, M. G. A., Pinto, P. R., … & Marcus, M. A. E. (2014). Validation of the Surgical Fear Questionnaire in Adult Patients Waiting for Elective Surgery. PLoS ONE, 9(6), e100225.
Windle, M., & Windle, R. C. (2013). Recurrent Depression, Cardiovascular Disease, and Diabetes among Middle-Aged and Older Adult Women. Journal of Affective Disorders, 150(3), 895–902.
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