Bachelor of Paramedicine science

This case study is based on Mr Ivan Jankovic who is 78 years old. He is admitted for a left total hip replacement. He undergoes surgery and is now three days post-operative, in the orthopaedic ward.

NSB335 Assessment 3 Page 2 of 8

Caring for a patient post-operatively with arthritis and multiple co- morbidities.

Setting the scene

Background- social: Mr Jankovic is 78 years old and has enjoyed good health over his lifetime.

He moved to Australia in his late teens following the communist uprising in his home country in Eastern Europe in the late 1950s. His education

was disrupted, and he has worked in a variety of skilled and semi-skilled jobs that have required manual labour at times, retiring 12 years ago. He

says his English is good.

Ivan lives independently with his wife in a retirement living unit. His wife Marla is 74 years old and is in good health but recently had a fall and suffered a # wrist that required surgery. She is unable to drive for 8 weeks. They have 2 children – one daughter lives a fair distance away and works full time in a high-pressure job. Their son lives interstate and visits infrequently. They report having a lot of friends and social contact in the retirement village, but their friends are all elderly and are unable to assist at all.

Epidemiology / pathophysiology of disease processes The National Health Priority Areas (NHP) of Arthritis and Musculoskeletal conditions, Mental Health Disorders, Cardiovascular Disease, and Injury Prevention and Control were established with the aim of improving health outcomes in these areas. They were established in response to the World Health Organization’s global strategy of Health for all by the year 2000. They are also the areas with the highest economic and health burden for Australians; this assessment considers the following NHP areas in relation to a case (Ivan Jankovic):

• Musculoskeletal conditions are conditions of the bones, muscles and their attachments (e.g. joints and ligaments). Osteoarthritis, rheumatoid arthritis and osteoporosis are the most commonly occurring musculoskeletal conditions. They have substantial influence on a person’s quality of life and impose a heavy economic burden on the community (AIHW, 2018).

• Injuries are adverse effects on the human body. They are a significant source of preventable illness, disability and premature death in Australia (AIHW, 2018).

• Mental Health Disorders relate to behaviours and conditions which interfere with social functioning and capacity to negotiate daily life. They can occur acutely at times of illness (AIHW, 2018).

• Obesity is when the energy consumed from food and drink is greater than the energy used, fat is deposited on the body, which over time can lead to obesity. Obesity increases the risk of many other chronic and potentially lethal diseases (AIHW, 2018).

NSB335 Assessment 3 Page 3 of 8

Your Task: Use the Clinical Reasoning Cycle (CRC) on the following pages to review the nursing priorities in relation to the care of Ivan. Consider the CRC on the following pages and following your work on the modules that encompass the NHP and National Health and Quality Safety (NHQHS) Standards, you should be able to answer the workbook questions. This task will assist you to critically think about typical clinical situations that will arise when you are a Registered Nurse and you will be required to assess and make clinical decisions for your patients. When you have done this, answer the questions at the end of this workbook and submit into Turnitin in the provided template.

NSB335 Assessment 3 Page 4 of 8

Now we shall step through the CRC in relation to Ivan’s’ case to prepare you for the workbook assessment questions.

Watch the video –At home

Gain an initial impression of your patient

Consider Ivan’s situation, both socially and health wise. What is your initial view of this patient?

Consider Ivan’s osteoarthritis and obesity and how these may be linked.

Ivan is at risk of injury – both at home and when he comes to hospital. Consider why and what can be done in these settings to prevent injury.

Further background information

Mr Jankovic is 78 years old and has enjoyed good health over his lifetime. He has gained a lot of weight over the past few years and has severe osteoarthritis in his hips. He also has had resection of a prostatic cancer that has no current treatment and has residual prostatamegaly. He has occasional angina, high blood pressure and obstructive sleep apnoea, using a CPAP machine infrequently as it dries his mouth and nose and the noise annoys his wife.

Past medical history

• Osteoarthritis (diagnosed 10 years ago) • Mild left cardiac failure and occasional angina (diagnosed 2 years ago) • Hypertension (diagnosed 5 years ago) • Frequent gout

Surgical history: • Internal fixation left tibia and fibula following motor cycle accident at age 21years • Appendectomy at age 23 years • Resection prostatic carcinoma (7 years ago)

Medications: • Omeprazole 20mg nocte • Frusemide 20mg mane • Isosorbide Nitrate 60mg mane • Atorvastatin 40mg mane • Prazosin 5mg mane • Panadol osteo tds • Brufen 400mg mane • Glycerol Trinitrate 5mg S/L prn • Colchicine 0.5mg prn • Allopurinol 300 mg mane

Now watch the videos of Mr Jankovic-