Running Head: OSTEOARTHRITIS CASE STUDY 1

Osteoarthritis Case Study

Name of the Student

Name of the Teacher

Date

Name of the Institute

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Background (CRC 1 & 2)

The study has been conducted on Mr. X who was interviewed through phone, He is 40-

year-old and has been diagnosed 4 years ago with hypertension and also with hip osteoarthritis.

Mr. X has a wife and 2 sons. He has been married for 15 years. He is also a first-generation

Australian of Philippines heritage. His wife is a registered nurse and works part-time at the

Charles hospital. Mr. X worked as a carer in cooper house aged care as a full time. He also visits

the gym every weakened. As a social activity, he used to meet his family and friends in every 2

weeks. The pain and also the mobility problem due to hip osteoarthritis have prevented him to

continue his social life. In osteoarthritis, the cartilage present within the hip joint slowly wears

away. This becomes corroded and rough as the cartilage wears away, and the safe joint space

amid the bones reduces. This ultimately leads to the rubbing of bone on the bone. The damaged

bones can keep growing externally, forming bone spurs (osteophytes) to compensate for the lost

cartilage (Poquet, Williams & Bennell, 2016). Osteoarthritis progresses gradually, and over time,

the discomfort that it produces worsens. It may take place due to increasing age, injury to the

joint of hip, obesity, or family history of osteoarthritis. The symptoms may involve pain and

stiffness which worsen over time (Murphy, Eyles & Hunter, 2016).

Pharmacology

OARSI NSAIDs for elbow, knee, and hip: Preferred for those with the lowest effective

dose of the symptomatic hip or knee osteoarthritis (OA) (Yusuf, 2016). AAOS: highly suggested

for symptomatic knee OA ACR: conditionally prescribed for hand hip, and knee OA OARSI:

recommended using refractory pain treatment in patients with knee or hip OA ((Rajamäki et al,

2019). Selective COX-2 inhibitors AAOS: is highly suggested to the patient with hip OA Intra-
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articular corticosteroids: conditionally it has been offered to the patient with hip OA. Tramadol

for pain in the hip and knee (Aresti, N., Kassam, Nicholas & Achan, 2016).

Discussion (CRC 3)

Mr. X is diagnosed with hip Arthritis. "Osteoarthritis is arthritis of wear and tear that

impacts bearing weight and overstressed joints including hip and knee." Mobility and pain issues

have hindered Mr. X’s social life. Mr. X said that he feels a Liability, unable to function and

financially help his family, unable to indulge himself socially. In addition, he feels useless as

well as incapable of hardly any better future for himself. The psychosocial influence on his

quality of life left him feeling depressed and constantly nervous. In accordance with the

researchers Sambamoorthi and colleagues (2017), although osteoarthritis can harm only one

joint, it can affect the independence or the ability to stay independent and, in effect, cause

depressive feelings. Researchers have in fact related to some factors which measure the severity

of depression in patients with osteoarthritis (from the strongest to the weakest predictor): Patient

awareness of their level of pain, with few social contacts, lower body physical limitations, upper

body physical limitations, patient age and body mass index (overweight). In one research study

by Sharma and colleagues (2016). the effect of osteoarthritis-induced physical disability on

social impairment was compared. It may be surprising to learn that physical restrictions have not

been associated with higher depression, but that the social ramifications have been associated

with higher depression.

The RLT Model

The nursing model of Roper, Logan, and Tierney (published in 1980, and later revised in

1985, 1990, 1998 and the latest edition in 2000) is indeed a model for nursing based on living
OSTEOARTHRITIS CASE STUDY 4

activities (ALs) (Stonehouse, 2017). The medical history related to Mr. X’s pre-assessment visit

will be thoroughly reviewed and revised. Furthermore, his social history and also the nursing

examination will also be performed. The respective assessment needed to be concentrated in

particular on the day-to-day living tasks as the care planning of the ward is based on the Roper-

Logan-Tierney Nursing model.

This model is based on a living model and connects nursing to living, as According to the

research study of Martsolf and colleagues (2016), Tierney suggest s "Health and ill health are

inextricably linked with lifestyle" and states that, overall, the nursing requirement is typically

only for a shorter amount of time, the basic objective of nursing should be less disturbance to the

developed and natural lifestyle of patient. Mr. X was found to have a problem with: mobilizing,

removing (trouble getting to the toilet fast enough and getting on and off the bathroom),

working, playing and sleeping. Roper defines the particular function of nursing as "Assisting the

individual to prevent, alleviate, solve or cope positively with problems related to the activities of

living." That statement applies in particular to Mr. X, since it describes the specific areas of

difficulty. The cycle has been completed with a dietary and moving and managing review and his

proper care plan will be designed.

Two nursing care priorities/health education areas

Early mobilization: Early mobilization is highly important as Mr. X was found to have a problem

with: mobilizing, removing (trouble getting to the toilet fast enough and getting on and off the

bathroom), working, playing and sleeping. Lespasio and colleagues (2018), indicates that "long

bed rest may be dangerous rather than beneficial." He will be assisted to stand and show how to

move from bed to chair using a walking frame. Mr. X will be monitored on a daily basis by his

physician and continue to work with the physiotherapy team doing bed exercises in order to
OSTEOARTHRITIS CASE STUDY 5

strengthen his leg muscles and slowly increase the number of steps through which he will be able

of using his walking frame.

patient education: patient education before discharge and after the surgery needs to be done as it

is highly essential to monitor home self-care for the patient. Activities regarding health

promotion will be clarified to Mr. X and a booklet supporting this information will be provided

to him. The researchers’ Lu and colleagues (2019), argues that post-operative positioning is vital

to prevent the new hip’s dislocation. Mr. X will be given directions to avoid this including

bending from the waist, crossing of the ankles and legs, holding the knees beneath hip level

while seated by avoiding low chairs, using a raised toilet seat and sleeping on the back putting a

cushion between both the legs to maintain proper alignment of the joint. Instead of taking a bath

for the next 12 weeks, Mr. X will be recommended to shower, again to avoid hip bending above.

Research by Ćwirlej-Sozańska and colleagues (2019), supports the significance of exercise in

preventing the occurrence of ADL impairment and prolonging autonomy" Mr. X will need

physiotherapist advice to do the regular exercise until his recovery is over. This would not only

improve his overall fitness and agility but also enable him to reach his weight loss goal. The

dietician will provide Mr. X a nutrition sheet to follow at home to help with this.

GOAL of Care and NSQHS Partnering with Consumers Standard

Using NSQHS Partnership with Consumers Standard, the objective of care, Mr. X with

hip osteoarthritis after gaining information about his condition and therapies for it, will be

involved in the development of an individualized self-management plan that discusses both his

physical and psychosocial needs for wellbeing.

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Conclusion

Mr. X, a 40-year-old male diagnosed with hip osteoarthritis suffered from mobility and

pain issues. The psychosocial influence on his quality of life made him feel depressed and

constantly nervous. He is looking forward to the time when he could once again be safe and

responsible for himself. According to the study of Younas (2017), the theorist Orem describes

self-care as "an individual's ability to control all things necessary to live and survive. This is

often something that is taken as a matter of course before illness goes that route. Mr. X's surgery

and hospital stay will be largely incidental and difficult, but after a recovery period such as

mobilization and patient education, he will be able to return to a healthy and active life.

Patient details

After interviewing Mr. X on the phone, it was revealed that Mr. X is a 40-year-old male

who was diagnosed with pulmonary hypertension 4 years ago. He is a first-generation Australian

of Philippines heritage. Mr. X lives with his wife phen and 2 sons. They have been married for

15 years and have 2 children, Robert who is 12 and Sam who is 8. Phen works as a Registers

Nurse at Prince Charles hospital part-time work. They recently moved into a new two-story

house closer to Phens parents. Mr. X and wife have always been close to their parents and often

host large family gatherings in their home. Mr. X worked as a carer in cooper house aged care as

a full-time. Mr. X goes to the gym every weekend for exercise. For social engagement, Mr. X

used to meet his family and friends every 2 weeks. Mr. X is diagnosed with hip Arthritis.

Problems of mobility and restrictions placed by his present condition, along with prolonged

periods of absence, made him leave his profession. Osteoarthritis is considered wear and tear

arthritis that has an effect on weight-bearing and overstressed joints like hip including the knee.

Mobility and pain problems have prevented this for the past 18 months, and consequently, social
OSTEOARTHRITIS CASE STUDY 7

life has declined. Mr. X said that he feels a Liability, unable to function and financially help his

family, unable to support himself socially, he feels useless and inept with a very little better

future for himself. The psychosocial influence on his quality of life left him feeling depressed

and continually nervous. Schmidt et al. (2016), states Age-related risks of osteoarthritis are

growing, resulting in pain and reduced quality of life. Salmon et al., (2016), indicates that

anxiety, depression, and exhaustion are closely linked to pain.

Gradually his symptoms worsened, increasing pain, decreasing mobility and constant sleep

disturbance. He was prescribed Ibuprofen NSAIDS (Non-Steroidal Anti-Inflammatory Drugs)

and Tramadol, a centrally acting analgesic that helped in relieving the pain but only partially,

following X-Ray examination and several consultations Mr. X was advised to consider a total

hip replacement. Selten et al. (2016), states Full hip replacement is an optional procedure for

removing weakening bone as well as the cartilage in a joint and replacing the joint with only an

artificial part which is identified as a prosthesis. Mr. X decided that he needed time to consider

whether or not to undergo surgery and not to jump into something without considering other

options. Mr. X participated in pre-assessment screening after opting to undergo surgery.

OSTEOARTHRITIS CASE STUDY 8

References

Aresti, N., Kassam, J., Nicholas, N., & Achan, P. (2016). Hip osteoarthritis. Bmj, 354, i3405.

doi: https://doi.org/10.1136/bmj.i3405

Ćwirlej-Sozańska, A., Wiśniowska-Szurlej, A., Wilmowska-Pietruszyńska, A., & Sozański, B.

(2019). Determinants of ADL and IADL disability in older adults in southeastern Poland.

BMC Geriatrics, 19(1). doi: 10.1186/s12877-019-1319-4

Lespasio, M. J., Sultan, A. A., Piuzzi, N. S., Khlopas, A., Husni, M. E., Muschler, G. F., &

Mont, M. A. (2018). Hip osteoarthritis: a primer. The Permanente Journal, 22. doi:

10.7812/TPP/17-084

Lu, Y., Wu, Z., Tang, X., Gu, M., & Hou, B. (2019). Effect of articular capsule repair on

postoperative dislocation after primary total hip replacement by the anterolateral

approach. Journal Of International Medical Research, 47(10), 4787-4797. doi:

10.1177/0300060519863526

Martsolf, G. R., Gordon, T., May, L. W., Mason, D., Sullivan, C., & Villarruel, A. (2016).

Innovative nursing care models and culture of health: Early evidence. Nursing Outlook,

64(4), 367-376. DOI: 10.1016/j.outlook.2016.02.009

Murphy, N. J., Eyles, J. P., & Hunter, D. J. (2016). Hip osteoarthritis: etiopathogenesis and

implications for management. Advances in therapy, 33(11), 1921-1946. doi:

10.1007/s12325-016-0409-3

Poquet, N., Williams, M., & Bennell, K. (2016). Exercise for Osteoarthritis of the Hip. Physical

Therapy, 96(11), 1689-1694. doi: 10.2522/ptj.20150597

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Rajamäki, T., Puolakka, P., Hietaharju, A., Moilanen, T., & Jämsen, E. (2019). Use of

prescription analgesic drugs before and after hip or knee replacement in patients with

osteoarthritis. BMC Musculoskeletal Disorders, 20(1). doi: 10.1186/s12891-019-2809-4

Salmon, J., Rat, A., Sellam, J., Michel, M., Eschard, J., & Guillemin, F. et al. (2016). Economic

impact of lower-limb osteoarthritis worldwide: a systematic review of cost-of-illness

studies. Osteoarthritis And Cartilage, 24(9), 1500-1508. doi: 10.1016/j.joca.2016.03.012

Sambamoorthi, U., Shah, D., & Zhao, X. (2017). Healthcare burden of depression in adults with

arthritis. Expert review of pharmacoeconomics & outcomes research, 17(1), 53-65. doi:

10.1080/14737167.2017.1281744

Schmidt, A., Meurer, A., Lenarz, K., Vogt, L., Froemel, D., & Lutz, F. et al. (2016). Unilateral

hip osteoarthritis: The effect of compensation strategies and anatomic measurements on

frontal plane joint loading. Journal Of Orthopaedic Research, 35(8), 1764-1773. doi:

10.1002/jor.23444

Selten, E., Vriezekolk, J., Geenen, R., van der Laan, W., van der Meulen-Dilling, R., & Nijhof,

M. et al. (2016). Reasons for Treatment Choices in Knee and Hip Osteoarthritis: A

Qualitative Study. Arthritis Care & Research, 68(9), 1260-1267. doi: 10.1002/acr.22841

Sharma, A., Kudesia, P., Shi, Q., & Gandhi, R. (2016). Anxiety and depression in patients with

osteoarthritis: impact and management challenges. Open access rheumatology: research

and reviews, 8, 103. doi: 10.2147/OARRR.S93516.

Stonehouse, D. (2017). A support worker's guide to models of living and nursing. British Journal

of Healthcare Assistants, 11(9), 454-457. 10.12968/bjha.2017.11.9.454

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Younas, A. (2017). A Foundational Analysis of Dorothea Orem’s Self-Care Theory and

Evaluation of Its Significance for Nursing Practice and Research. Creative Nursing,

23(1), 13-23. doi: 10.1891/1078-4535.23.1.13

Yusuf, E. (2016). Pharmacologic and Non-Pharmacologic Treatment of Osteoarthritis. Current

Treatment Options In Rheumatology, 2(2), 111-125. doi: 10.1007/s40674-016-0042-y