The patient in the given case study is an 80-year-old female who is admitted in the clinical setting for post-operative management after getting right total posterior hip replacement. The patient is residing in her home along with her husband who is 83-years-old. She takes care of herself on her own as well as of her husband. The patient resides in an area which is 65 km away from the city. She is having her daughter who lives nearby and helps her with her daily chores and managing her health. The patient is suffering from multiple ailments, for which she is on medication management. The patient is a known case of osteoarthritis and hypocholesterolaemia since 2001. She is having a surgical history of left total knee replacement in 2017 and right total knee replacement in 2009. Apart from other conditions, patient is also suffering from hypertension, type-2 diabetes and hypothyroidism since 1980. She is having no personal history of smoking; however, she drinks occasionally. The patient is currently suffering from chronic pain in her right hip for which she had been advised to get surgical intervention. The patient case will be pondered upon from the point of view of post-operative management and the nursing care and coordination which will be required to help the patient in recovering from the same. The case will also help in highlighting the concept of defining short-term and long-term goals for the patient, to formulate the basis of treatment. The case will also guide about the discharge planning for this patient, with the help of multidisciplinary approach.
The transition of degenerative changes has been significantly found to be directly associated with aging process in population (Briggs, 2019). This has been caused to find an increased prevalence of problems in elderlies. Musculoskeletal disorders such as degenerative joints as well as arthritic conditions have been defined as the most common cause of chronic pain in elderlies. Some of the other significant conditions include, pain of neuropathic origin, pain of ischemic origin or pain developed from various other chronic and progressive ailments. These degenerative changes have also been found to bring about a huge ordeal of discomfort and pain in the patients (Blyth, 2017). This chronic pain has been found to add to the health burden in elderlies as well, adding to the restriction of the activities of daily living. There has also been a direct linkage observed in elderlies suffering from chronic pain to have cognitive disturbances and adding to the underlying risk factors in these population groups. There are multiple factors that might lead to an increase in pain and pain sensitivity in the elderlies. The primary onset can be defined as the physiological changes in the elderlies. These changes are brought about by a decreased release in neurotransmitters such as GABA, serotonin, noradrenaline and so on (Liao, 2018). Due to a deficiency in production of the same, there is a decrease competence of peripheral nociceptive neurons observed. This mechanism brings about an increased pain threshold and reduces the overall endogenous analgesic response. These actions cumulatively result in paradoxical increase in pain, leading to hampered activity. Another pathophysiological factor can be ascertained as homeostenosis process related with aging (Bolduc, 2019). This process leads to a loss of homeostatic reserve in various body organs systems functioning. Thus, leading to increase decline in liver and renal functioning, decreased muscle frailty causing falls, decreased appetite, depression, delirium and an overall behavioural display of irritability. This chronic pain can bring about an overall increased reported incidence of adverse outcomes. These adverse outcomes can be observed in the form of functional impairments, fall, depression and disturbance in overall living pattern of the patient. Chronic pain management in elderlies can be a challenging task, making it more difficult to manage and evaluate their condition. There is also an added impairment observed in elderlies, which can lead to misleading reporting of the pain experienced by them.
Through the use of extensive assessment tools, the chronic pain in elderlies can be evaluated and managed efficiently. For enabling care for the patient in the given case scenario a holistic assessment should be carried out for the patient. There are multiple factors that should be assessed as follow:
Treatment and management of this patient mainly depends on the short-term and long-term goals defined. The short-term goals can be defined as follow:
The long-term goals can be defined in the case as mentioned-below:
Managing a post-operative case can be quite challenging and involves the role of multidisciplinary approach for handling patient care. The challenge multiplies by several folds when the patient is of aged population. However, with a comprehensive and detailed assessment, a well-crafted intervention care plan can be devised, by the means of patient-centred approach model of care. This will be helpful in getting positive healthcare outcomes post-implementation of these strategic interventions’ management for patient care.
Abd Aziz, N. A. S., Teng, N. I. M. F., Hamid, M. R. A., & Ismail, N. H. (2017). Assessing the nutritional status of hospitalized elderly. Clinical Interventions in Aging, 12, 1615. DOI 10.2147%2FCIA.S140859
Blyth, F. M., & Noguchi, N. (2017). Chronic musculoskeletal pain and its impact on older people. Best Practice & Research Clinical Rheumatology, 31(2), 160-168. DOI 10.1016/j.berh.2017.10.004
Bolduc, J. A., Collins, J. A., & Loeser, R. F. (2019). Reactive oxygen species, aging and articular cartilage homeostasis. Free Radical Biology and Medicine, 132, 73-82. DOI 10.1016/j.freeradbiomed.2018.08.038
Briggs, A. M., Slater, H., Hsieh, E., Kopansky-Giles, D., Åkesson, K. E., Dreinhöfer, K. E., ... & Woolf, A. D. (2019). System strengthening to support value-based care and healthy ageing for people with chronic pain. Pain, 160(6), 1240-1244. DOI 10.1097/j.pain.0000000000001526
Fahim, M., Visser, R. A., Dijksman, L. M., Biesma, D. H., Noordzij, P. G., & Smits, A. B. (2020). Routine postoperative intensive care unit admission after colorectal cancer surgery for the elderly patient reduces postoperative morbidity and mortality. Colorectal Disease, 22(4), 408-415.DOI 10.1111/codi.14902
Gaur, A., Jain, M. P., & Joshi, V. (2020). Cemented modular bipolar in unstable femur intertrochanteric fracture in osteoporotic elderly patients-its functional outcomes. International Journal of Orthopaedics, 6(1), 1250-1254. DOI 10.22271/ortho.2020.v6.i1q.1989
Gupta, K., Prasad, A., Nagappa, M., Wong, J., Abrahamyan, L., & Chung, F. F. (2018). Risk factors for opioid-induced respiratory depression and failure to rescue: A review. Current Opinion in Anaesthesiology, 31(1), 110-119. DOI 10.1097/ACO.0000000000000541
Hah, J. M., Bateman, B. T., Ratliff, J., Curtin, C., & Sun, E. (2017). Chronic opioid use after surgery: implications for perioperative management in the face of the opioid epidemic. Anesthesia and Analgesia, 125(5), 1733. DOI 10.1213%2FANE.0000000000002458
Hari Prasad, S., Patil, S. N., Sarath Chandra, P., & Cecil Fernando, A. (2017). Functional outcome of unstable intertrochanteric femur fracture in elderly osteoporotic patients treated by primary cemented bipolar hemiarthroplasty versus internal fixation with proximal femoral nailing. International Journal of Orthopaedics Sciences, 3, 319-23. DOI 10.22271/ortho.2017.v3.i4e.43
Karcioglu, O., Topacoglu, H., Dikme, O., & Dikme, O. (2018). A systematic review of the pain scales in adults: Which to use?. The American Journal of Emergency Medicine, 36(4), 707-714. DOI 10.1016/j.ajem.2018.01.008
Leegwater, N. C., Bloemers, F. W., de Korte, N., Heetveld, M. J., Kalisvaart, K. J., Schönhuth, C. P., ... & van Royen, B. J. (2017). Postoperative continuous-flow cryocompression therapy in the acute recovery phase of hip fracture surgery—A randomized controlled clinical trial. Injury, 48(12), 2754-2761. DOI 10.1016/j.injury.2017.10.024
Liao, C., Han, Q., Ma, Y., & Su, B. (2016). Age-related gene expression change of GABAergic system in visual cortex of rhesus macaque. Gene, 590(2), 227-233. DOI 10.1016/j.gene.2016.05.010
Madhanraj, K., Sharma, U., Kaur, S., Tewari, M. K., & Singh, A. (2019). Impact of self-instruction manual-based training of family caregivers of neurosurgery patients on their knowledge and care practices–A randomized controlled trial. Journal of Family Medicine and Primary Care, 8(1), 209. DOI 10.4103%2Fjfmpc.jfmpc_287_18
Malara, A., De Biase, G. A., Bettarini, F., Ceravolo, F., Di Cello, S., Garo, M., ... & Rispoli, V. (2016). Pain assessment in elderly with behavioral and psychological symptoms of dementia. Journal of Alzheimer's Disease, 50(4), 1217-1225. DOI 10.3233/JAD-150808
Prabhakar, S., & Nanavati, A. J. (2016). Enhanced recovery after surgery: If you are not implementing it, Why not? Practical Gastroenterology, 47. DOI 10.1007/s12262-015-1224-9
Rattray, M., Roberts, S., Desbrow, B., Wullschleger, M., Robertson, T., Hickman, I., & Marshall, A. P. (2019). A qualitative exploration of factors influencing medical staffs’ decision-making around nutrition prescription after colorectal surgery. BMC Health Services Research, 19(1), 178. DOI 10.1186/s12913-019-4011-7
Silva, F. S., Silva, O. R. D., Silveira, M. M., Rosa, A. B. M. Z., Bem, R. R., Kuplich, P. A., ... & Dohnert, M. B. (2017). Transcutaneous Electrical Nerve Stimulation (TENS) reduces pain and drug intake in the immediate postoperative period following proximal femoral fractures. Journal of Advances in Medicine and Medical Research, 1-12. DOI 10.9734/BJMMR/2017/31594
Stout, N. L., Sleight, A., Pfeiffer, D., Galantino, M. L., & deSouza, B. (2019). Promoting assessment and management of function through navigation: opportunities to bridge oncology and rehabilitation systems of care. Supportive Care in Cancer, 27(12), 4497-4505. DOI 10.1007/s00520-019-04741-0
Suh, J., Desai, A., Desai, A., Cruz, J. D., Mariampillai, A., & Hindenburg, A. (2017). Adherence to thromboprophylaxis guidelines in elderly patients with hospital acquired venous thromboembolism: A case control study. Journal of Thrombosis and Thrombolysis, 43(2), 172-178. DOI 10.1007/s11239-016-1432-6
Venkataraman, M., Pradeep, E., & Regis, P. (2019). Role of arthroplasty in unstable trochanteric fractures in elderly patients. International Journal of Orthopaedics, 5(4), 486-489. DOI 10.22271/ortho.2019.v5.i4i.1720
Wang, A. Q. L., Ng, B. H. P., Cheung, L. P. C., & Chin, R. P. H. (2017). Factors affecting mortality and hospital admissions after hip surgery among elderly patients with hip fracture in Hong Kong–Review of a three-year follow-up. Hong Kong Journal of Occupational Therapy, 30, 6-13.DOI 10.1016/j.hkjot.2017.10.004
Yang, Y., Zhao, X., Dong, T., Yang, Z., Zhang, Q., & Zhang, Y. (2017). Risk factors for postoperative delirium following hip fracture repair in elderly patients: A systematic review and meta-analysis. Aging Clinical and Experimental Research, 29(2), 115-126. DOI 10.1007/s40520-016-0541-6
Zhang, N., Liang, M., Zhang, D. D., Xiao, Y. R., Li, Y. Z., Gao, Y. G., ... & Wu, X. D. (2018). Effect of goal-directed fluid therapy on early cognitive function in elderly patients with spinal stenosis: A Case-Control Study. International Journal of Surgery, 54, 201-205. DOI 10.1016/j.ijsu.2018.04.007
Zis, P., Daskalaki, A., Bountouni, I., Sykioti, P., Varrassi, G., & Paladini, A. (2017). Depression and chronic pain in the elderly: Links and management challenges. Clinical Interventions in Aging, 12, 709. DOI 10.2147%2FCIA.S113576
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