Healthcare Assignment: Case Analysis Of Osteoarthritis, Total Hip Replacement & Parkinson’s Disease
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.
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).
As per the case examined in this healthcare assignment, Carol Hiscox, a 68 years old lady has been suffering from Osteoporosis and Parkinson’s disease (PD). She has been under treatment and continuous monitoring of the doctors since the diagnosis of the disease. The purpose of the study is to carry out in-depth analysis of the pathophysiology, the medicines and the treatment process of the patient suffering from Parkinson’s disease and osteoporosis. This research parameters includes investigation and diagnosis of osteoporosis and Parkinson’s risk faced by the patient. The medications that are taken by Carol during the pre-admission stage such as Celecoxib 100 mg, Cabergoline 2mg, and Levodopa 100 mg along with its action, dosage, and the management of OA and PD has been highlighted in the study considering the nursing and the polypharmacy considerations. Moreover, the rationale will also be provided for taking care of Carol during the first 48 hours of hip replacement.
Pathophysiology and diagnosis of osteoporosis as well as the explanation of the risk factors witnessed by Carol.
Osteoporosis can be considered to be a disease involving the compromised bone strength when the bone strength is found to be built of the bone mass and the bone quality. The reports of WHO have stated that osteoporosis is used for the designation of the bone mass value that is higher than the standard deviation of 2.5 in adults (Yoo & Ha, 2018). This bone quality incorporates the geometry of the bone, the properties of the bone material, the bone turnover, and the microstructure. The compromise in the strength of the bone leads to the risk of fracture (Singh & Garg, 2020).
In adults, the removal of small amounts of bone minerals through the process of resorption is generally balanced through the equal deposition of the new minerals to maintain bone strength. The continuous re-deposition and the resorption of the bone mineral are linked with the pathophysiology of osteoporosis (Both et al., 2017). There should be careful attempts made of understanding the remodeling of the bone in the prevention and treatment of osteoporosis.
As the bones are considered to be light but strong, this property can be associated with the geometry and the architectural process. These bones can be considered to be tubular where the outer shell highlights the cortical layer that surrounds the spongier core known as the trabecular bone (Föger-Samwald et al., 2020). This combination of the bone can be considered to be strong and light thereby possessing the capacity to absorb the stress due to the impact of higher exercises. The vertebrae in this case are generally constructed with a thick cortical layer that is linked with the sheets of the bone where it can compress and thus return to the original size (Oxford Medicine Online, 2014). Thus, the remodeling process of the bone microarchitecture lays a higher effect on the pathophysiology of osteoporosis. In this case, the risk factors witnessed by Carol indicate her fall in the garden because of which she has sustained a fracture of the femur bone. Because of the lack of appropriate bone density, minerals, and calcium in Carol’s body, the fall in the ground has led to the replacement of the right total hip despite the diagnosis as osteoporosis. Due to this osteoporosis, Carol found it difficult to maintain balance and thus carry out her daily activities properly.
The diagnosis of osteoporosis can be carried out through a bone density scan. This will help in measuring the mineral density of the bones. Further, it can be said that the bone density scan is generally performed using dual-energy x-ray absorptiometry as well as bone densitometry (Bystrytska et al., 2020). The amounts of x-rays absorbed by the bones and the tissues are generally measured with the help of the DXA machine thereby linking to the bone mineral density. The DXA machine converts the bone density information the T score and the Z score to find out the risk of development of fracture and the need for the drug therapy (Awasthi et al., 2020).
Medications used by Carol in the pre-admission stage to help manage both her OA and PD.
Mechanism of action.
The mechanism of action of Celecoxib 100 mg includes the careful inhibition of Cyclooxygenase-2 assisting in the amalgamation of prostaglandin which is a vital aspect of the inflammation and the pain pathway. Celecoxib 100 mg can be considered to be analgesic, anti-0inflmamtory as well as possess antipyretic effect (Celebrex, 2020).
The mechanism of action of Cabergoline 2 mg includes the secretion of prolactin through the anterior-pituitary gland that is under the control of hypothalamic inhibitor. This also helps in the release of dopamine by the tuberoinfundibular neurons. On the other hand, it can be said that Cabergoline is also a long-acting dopamine receptor with higher attraction for the D2 receptors (Aziz, 2020).
The mechanism of action of Levodopa 100mg includes the conversion of dopamine via the action of a naturally occurring DOPA decarboxylase. This is generally used in controlling the peripheral circulation as well as tackling the central nervous system when the medicine has crossed the blood-brain barrier (Medline Plus, 2021).
The dosage of Celecoxib 100 mg should be administered twice daily to Carol (Celebrex, 2020).
Cabergoline 2 mg must be provided to Carol once daily (Aziz, 2020).
The dosage of Levodopa 100mg must be provided thrice daily to Carol (Medline Plus, 2021).
ADRs, nursing, and polypharmacy considerations.
The adverse drug reaction of Celecoxib 100 mg includes gastric, diarrhea, heartburn, vomiting, nausea, constipation, dizziness, stomach pain as well as swelling in the hands and feet. The nursing considerations that are to be taken in this case include assessment of the range of motion, the pian and swelling in affected joints before and during the therapy (Celebrex, 2020). Moreover, the patients are to accessed for checking the sulfonamides, aspirin, or NSAIDs. The skin rash of the patient is to be judged during the therapy.
The adverse drug reaction of Cabergoline 2 mg includes vomiting, nausea, vomiting, dizziness, lightheadedness, tiredness. The pharmacological considerations include the handover of the medicine only by showing valid prescriptions (Aziz, 2020). This will make it easier for the nurses to control the side effects after consuming the medicine.
The adverse drug reaction of Levodopa 100 mg includes dizziness, vomiting, loss of appetite, unusual dreams, headache, nausea, and trouble sleeping (Fayyaz et al., 2018). The nursing considerations include assessment of the therapeutic response, appropriate care to avoid confusion, monitoring of the side-effects to avoid confusion and tackling the false results in urine for monitoring the ketones and sugar (Medline Plus, 2021).
Provision of the rationale for at least 2 problems of Carol.
As Parkinson’s disease poses anesthetic issues including airway management, the movement of the neck, respiratory impairment, drug interaction as well as post-delirium operative consideration, it is the responsibility of the nurse to keep an eye on Carol and thus assist her on these aspects (Lane, 2019). The right-hip replacement surgery of Carol requires a considerable level of care because Carol has been suffering from osteoporosis as well as PD for a long and thus adjustments are to be made in the pre-and post-operative medicines Carol. On the other, there are higher chances of Carol suffering from an infection in the hip after the operation process. In such a case, it is the responsibility of the nurse to take careful steps and thus assist Carol correctly for a quick recovery.
On the other hand, when Carol has been administered Fentanyl 500 after the operation, the nurse must keep a close eye on her as the medicine is likely to lay adverse reactions on patients suffering from Parkinson’s disease (Andrade et al., 2017). The dosage of Fenatyl 500 in 20 microgram bolus is mixed with 50mL of Na Chloride and thus injected to Carol once daily. Carol has higher chances of being restless after injecting this medicine and thus it might be difficult for the nurse to control her in that stage. Moreover, the patient is likely to suffer from hallucination if there is no such adequate administration of the drugs. It is the responsibility of the nurse to consult the doctor if such a type of adverse reaction is observed in Carol after the administration of the medicine. The medicine is also likely to cause the withdrawal of the patient if she is not taken care of appropriately.
Thus, it can be said that the nurses and the doctors must carry out a proper medical examination of Carol before administering any medicines to her during the pre-operative and the post-operative stage. It is important to monitor Carol continuously because she has been suffering from Parkinson’s disease and Alzheimer’s for a long time. Due to the improper bone density of Carol as well as her body weakness, Carol had fallen on the ground thereby requiring a total hip replacement. Therefore, the nurses must administer the medicines to Carol as advised by the doctors to help her recover timely.
Andrade, K., Fornetti, J., Zhao, L., Miller, S. C., Randall, R. L., Anderson, N., ... & Welm, A. L. (2017). RON kinase: A target for treatment of cancer-induced bone destruction and osteoporosis. Science translational medicine, 9(374). https://www.ncbi.nlm.nih.gov/pmc/articles/pmc5771677/
Awasthi, H., Mani, D., Singh, D., & Gupta, A. (2018). The underlying pathophysiology and therapeutic approaches for osteoporosis. Medicinal research reviews, 38(6), 2024-2057. https://www.researchgate.net/profile/Harshika_Awasthi2/publication/324999033_The_underlying_ pathophysiology_and_therapeutic_approaches_for_osteoporosis/links/5d166916458515c11c008827/ The-underlying-pathophysiology-and-therapeutic-approaches-for-osteoporosis.pdf
Aziz, E. (2020). Successful Treatment of Risperidone-Induced Symptomatic Hyperprolactinemia with Cabergoline: A Case Report. Journal of Clinical Case Studies Reviews & Reports. SRC/JCCSR-195. DOI: https://doi. org/10.47363/JCCSR/2020 (2), 159, 1-3.
Both, T., Dalm, V. A., van Hagen, P. M., & van Daele, P. L. (2017). Reviewing primary Sjögren's syndrome: beyond the dryness-from pathophysiology to diagnosis and treatment. International journal of medical sciences, 14(3), 191. https://www.ncbi.nlm.nih.gov/pmc/articles/pmc5370281/
Bystrytska, M., Povoroznyuk, V., Grygorieva, N., Karaban, I., & Karasevich, N. (2020). Bone Mineral Density and Risk of Osteoporotic Fractures in Women with Parkinson’s Disease. Journal of osteoporosis, 2020. https://www.hindawi.com/journals/jos/2020/5027973/
Celebrex (2020). RxList. Retrieved 05 May 2021, from https://www.rxlist.com/celebrex-drug.htm#description
Fayyaz, M., Jaffery, S. S., Anwer, F., Zil-E-Ali, A., & Anjum, I. (2018). The effect of physical activity in Parkinson’s disease: a mini-review. Cureus, 10(7). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6143369/
Föger-Samwald, U., Dovjak, P., Azizi-Semrad, U., Kerschan-Schindl, K., & Pietschmann, P. (2020). Osteoporosis: pathophysiology and therapeutic options. EXCLI journal, 19, 1017. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7415937/
Lane, N. E. (2019). Glucocorticoid-induced osteoporosis: new insights into the pathophysiology and treatments. Current osteoporosis reports, 17(1), 1-7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6839409/
Medline Plus. (2021). Levodopa. Retrieved 05 May 2021, from https://medlineplus.gov/druginfo/meds/a601068.html
Oxford Medicine Online (2014). Pathophysiology of osteoporosis. Retrieved 05 May 2021, from https://oxfordmedicine.com/view/10.1093/med/9780198713340.001.0001/med-9780198713340-chapter-1
Singh, M., & Garg, K. (2020). Osteoporosis in Parkinson's Disease–Need of Screening in Early Stages. Neurology India, 68(2), 401. https://www.neurologyindia.com/article.asp?issn=0028-3886;year=2020;volume=68;issue=2;spage=401;epage=402;aulast=Singh
Yoo, J. I., & Ha, Y. C. (2018). Review of epidemiology, diagnosis, and treatment of osteosarcopenia in Korea. Journal of bone metabolism, 25(1), 1. https://synapse.koreamed.org/upload/SynapseData/PDFData/2187jbm/jbm-25-1.pdf