Task: Case Study – Osteoarthritis, Total hip replacement and Parkinson’s disease (PD) Presenting complaint Carol Hiscox aged 68 yrs, is admitted to the surgical ward following a fall in the garden where she sustained a fractured right head of femur. As this is a low trauma / impact fracture the admitting doctor suspects Osteoporosis (OP). Carol is booked to have a right total hip replacement (THR) in the morning. Currently her pain is being managed with a Fentanyl patient controlled infusion and her right leg is in an anti-rotation box (ARB). Past medical history and subjective data Carol is lactose intolerant, drink one or two glasses of wine most evenings and an ex-smoker of 15 years. Carol led a fairly active life despite Osteoarthritis (OA) in her knees until developing Parkinson disease (PD) which has affected her balance, so she stopped her daily walks for fear of falling. Objective data BP 136/54 mmhg HR 86 BPM regular T 368 c RR 22 breaths per minute Pain score 7/10 on movement 4/10 at rest Osteoarthritis was diagnosed 11 years ago Parkinson’s disease (PD) - diagnosed 2 1/2 years ago Medications Celecoxib 100mg (Celebrex) twice daily Cabergoline 2 mg (Cabaser) daily Levodopa 100mg / Benserazide hydrochloride 25mg (Madopar) Three times a day Fentanyl 500 microgram in 50 mLs Na Chloride (Patient controlled intravenous administration ,In patient prescription) 20 microgram bolus with 10 minute lockout time Paracetamol 1 gm 6 hourly (in patient prescription) The following is to be addressed in your healthcare assignment. Pathophysiology: Discuss the pathophysiology and diagnosis of osteoporosis, identify and explain any risk factors Carol may have (include a brief explanation of the pathophysiological process of these risk factors in your answer) Pharmacology: Discuss how the medications Carol is currently prescribed pre admission to help manage both her OA and PD. Include in your answer mechanisms of action, normal dosage, ADR’s and any specific nursing and poly pharmacy considerations. Specific Nursing Care: Identify, discuss and provide rationale for at least 2 problems (specific to Carol’s Parkinson’s disease and medications) you will need to address when planning Carols first 48 hour post-operative nursing care following her right Total hip replacement (Right THR).
Subject Name: Health Care
Level: Diploma
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