Case Study – Gianna

Question: Describe about the Case Study for Gianna. Answer: 1: The acetabula femoraljoint present between the acetabulum and femur of the pelvis is known as the hip joint (Buller et al., 2012). The primary function of this joint is to support the weight of the body both in static that is while standing and in the dynamic state that is while running or walking. Osteoporosis is a disease in which the bones becomes weak and are more susceptible to fracture (Chen Kubo, 2014). Osteoporosis sometimes referred to porous bones. This low bone density is more common in women than in men (Wren Gilsanz, 2015). The pathophysiology of osteoporosis may be understood as the thinning of the bones, which results in a painful fracture. No one is aware of osteoporosis until the individual encounters a fracture though there remains symptoms of the disorder like a backache, gradual loss of height accompanied with stooped posture. The occurrence of the back pain due to the change in the vertebrae can be considered as the first sign of osteoporosis. Osteoporosis the cause behind 1.5 million fractures every year (Varacallo Fox, 2014). Compression fractures in the spinal cord are very common; the tiny fractures in the vertebra result in the collapse and alter the shape of the spine. It also results in hip fractures which ultimately results in sustainable mobility problems and even increase the risk of death. Other fractures like the pelvic fracture, wrist fracture, and other fractures are common in the case of the person having osteoporosis (Dehamchia-Rehailia et al., 2014). The bones are being rebuilt throughout the lifetime of an individual. The bones are mainly composed of a protein called collagen which provides the main framework and a mineral that is calcium phosphate which hardens the bones (Sol et al., 2016). As the age of a person increases the individual loses more bone. After five to seven years of menopause there comes the greatest change in the womens bone density. Loss of bone density is natural, but it does not mean that people will lose bone density so much so as to be diagnosed with osteoporosis. As one grows old the chance of developing osteoporosis increases. Different studies show that more than 80% of the women are prone to develop osteoporosis (Nguyen Seeman, 2015). The reason behind this is that the woman normally have thinner bones than men, and also as there is a rapid decline in the bone density of the women after the menopause. From last two decades, the treatment for osteoporosis has totally changed. Nowadays patients with a fracture in the hipbone due to osteoporosis are recommended treatment in the form of Total Hip Arthroplasty (THA) (Byrd, 2013). THA is a procedure of replacement of the diseased bones or cartilage of the hip joint with artificial material by surgery. It consists of the replacing both the femoral head and the acetabulum. 2: According to the case study, Gianna Rossi is a 79 years old woman. The name of her husband is Antonio. He died four months ago, and they have five adult children. Gianna is presently living with her elder son Luca and his family. Gianna is woman of length 158cm having a body weight of 89 kgs and a BMI of 35. Her medical history states that she had osteoporosis and hypertension. She was experiencing pain in the left hip from last few months. A X-Ray revealed a fracture in the left hip due to osteoporosis. Gianna was recommended a total hip arthroplasty (THA). Gianna after completing Total Hip Arthroplasty was transferred to the post-anesthetic recovery room (PARU). In the Post Anaesthetic Recovery room Gianna was drowsy and was sleeping in the supine position. Most of the agents that are used as a general anesthetic to relieve the pain drastically change the control of breathing. They impact on the chemical control of an individuals breathing or ventilation. Anesthesia, opioids, and surgery exert many affects in the clinical condition of the patient. Anesthesia causes chills and shivers, and researchers have suggested that this may happen due to the cooling of the body. Certain studies reveal the fact that in regards to opioid as an anesthetic, it affects the chemical control of respiration. Gianna has a respiration rate of 10. However, a respiration rate less than 12 and more than 16 is considered to be an abnormal medical condition (Al-Ali et al., 2015). This means that Gianna has a low respiration rate. Upon waking up Gianna was complaining about the pain, so she was administered with 5mg of Morphine and later IV analgesia. It is observed th at these medicines had a very positive effect on her health. But Morphine is an opioid which may be responsible for lowering her respiration rate per minute to 10. With such a decrease in respiration rate, it is suggested that oxygen be provided to the patient. She had been administered oxygen at a rate of 6L/min with the help of a Hudson mask. The administration of oxygen is very important in this case because a decline in respiration rate should immediately be increased and stabilized for the betterment and fast recovery of the patient. The case study of Gianna suggests that before her discharge from the "Post anesthetic recovery room (PARU), her signs and symptoms reflected certain abnormalities in the circulation process of the patient. She has been estimated to have a loss of 1500mls of blood along with a Redivac drain of 200mls of blood. The IDC had drained 30ml of concentrated urine for an hour. She was also administered with packed cells for over two hours. A body temperature of 36 degree Celsius, pulse rate of 110, and blood pressure of 95/50 were the features of Gianna when she was examined after the surgery. The observation indicates that Gianna had a low blood pressure, her pulse rate is more, and the body temperature is less than normal and an increased pulse rate. All these may be due to the use of the anesthetic. Anesthesia is a kind of drug that is used to make the patient unconscious either a specific area or the whole body during a surgery. However, some cases are reported that such drugs result in a significant drop in the blood pressure. A large thermal stress may be imposed due to the attenuation of normal homeostatic thermoregulation during the course of anesthesia and surgery (Hoffmann et al., 2016). According to Mahmoud (2015), the consumption of an opioid like Morphine can be responsible for the development of postural hypotension. Hypothermia is referred to a state where the body temperature of an individual gets lower than the normal body temperature (38 degree Celsius). In the case of Gianna, it is observed that her body temperature was 36 degree Celsius which is lower than the normal body temperature. This condition is referred to hypothermia. This occurs because there is no movement of the muscles during the surgery and subsequently there is no heat generation during the process. A foam abduction pillow was provided between the legs of Gianna so that the position of the leg is not disturbed because if the position of the leg is disturbed several times it will increa se the chance of development of pain. After surgery other than ventilation and circulation, consciousness is also affected. When Gianna was carried to the Post anesthetic recovery room (PARU), she was drowsy as well as in a supine position. She was under sound sleep. During her unconsciousness, she was unable to realize the pain in her bones. However, as soon as she regains consciousness it was observed that she is having a tremendous amount of pain and she starts complaining about the pain. General anesthesia suppresses the central nervous system activities. Anesthetics are the drugs which produce functional disconnection in the posterior complex as it interrupts the communication of the cortical which results in the loss of integration. This is the main reason behind the patient losing consciousness. Anesthesia can be of different types such as local anesthesia, regional anesthesia, full body anesthesia, spinal anesthesia, and epidural anesthesia (Allman et al., 2016). The types of drugs used for anesthesia includes ge neral anesthetics, sedatives, hypnotics, narcotics, neuromuscular blocking drugs, and analgesics (Tranquilli et al., 2013). During the emergence from general anesthesia care should be taken because there remains a risk of complication. About 9.8% of the patients are reported to have nausea and vomiting during the period of emergence but it varies depending upon the procedure and type of anesthesia (De Oliveira et al., 2013). 3: Gianna has undergone Total Hip Arthroplasty because there was a fracture in her left hip due to osteoporosis. After surgery, she was transferred to the post-anesthetic recovery room. At that time Gianna was unconscious, and it was unable to awake her. Her medical condition states that there was a lowering of her blood pressure, her pulse rate was abnormal, and she was having hypothermia. Gianna was eating and drinking well, but she needs assistance for the activities of the daily living like dressing, bathing, and toileting. Gianna is concerned about the maintenance of her independence after discharge. Gianna is using a four-wheeled walker for her mobility but requires a supervision of someone, but her son Luca, and his wife work long hours during the day. So considering the safety of Gianna a caregiver must be appointed to provide assistance and supervise the activities of daily living of Gianna. Due to mobility Gianna was encountering a lot of pain in her hip portion. To manage her pain she was administered with one gram paracetamol tablets every 6 hours or four times daily and with 100mg of tramadol tablets every 12 hours or twice daily. A dry dressing of the incision on the hip should be done once or twice a day (Brown et al., 2014). The dressing should be done by a professional medical practitioner very carefully. No ointments or cream should be applied to the incision until six weeks after the surgery. Gianna can take shower after four days of the surgery but she should not soak the incision in bathtub, or a pool for at least six weeks after the surgery. A shower chair can be dramatically helpful for the comfort of Gianna while taking a shower. While moving the support of walker or crutches is very necessary because it will protect her from falling and also allow the growth of the bone into the hip replacement components. At the time of sleeping Gianna must keep a pillow between her legs. It is best for Gianna to sleep on the right because she had an o peration on the left hip. If conditions like increase of pain, more redness or drainage around the incision, arise Gianna must immediately take pain alleviating medication and inform it to her doctor or medical practitioner. Reference: Al-Ali, A., Majmudar, A. B., Kinast, E. K., O'reilly, M. (2015).U.S. Patent No. 9,066,680. Washington, DC: U.S. Patent and Trademark Office. Allman, K., Wilson, I., O'Donnell, A. (Eds.). (2016).Oxford handbook of anaesthesia. Oxford university press. Brown, G., Weber, D., De Bie, K. (2014). Assessing the value of public lands using public participation GIS (PPGIS) and social landscape metrics.Applied Geography,53, 77-89. Buller, L. 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