Medical Task – Acute and Chronic Disease Assignment
Discuss the differences between acute and chronic wounds in terms of healing and management options; and with reference to Mrs. Anita Bacash’s operative wound.
Wounds have been classified into many types but severe one with extreme nature is chronic and acute wounds. The wounds that heal with certain time period are defined as acute wounds (Thornhill & Lee, 2015). They usually take one to two weeks to heal up for a normal healthy person as it varies from condition of patients. But when these wounds are unable to heal in proper way or they take too long to settle down then these wounds are chronic one. Chronic wounds are inactive and dull. These wounds are one in which healing process becomes stagnant (Thornhill & Lee, 2015).
Many reasons can be there behind non-healing of chronic wounds. Mostly the blood supply required for healing is not efficient enough so this lack of supply becomes major reason for chronic wounds (York, 1995). Another reason is insufficient oxygen. The normal healing process requires sufficient amount of oxygen for complete satisfactory recovery but when it lacks so wounds are unable to heal. Oxygen plays vital role in healing of wounds. The reason behind lack of oxygen and blood supply to the wound is constant pressure over it. This localized pressure is due to tightly packed bandages and dressings as air doesn’t pass through them so both vessels venous and arterial are compressed. These compress vessels cause tissue breakdown as nutrition and oxygen supply to the wound is decreased enough (Thornhill & Lee, 2015).
The chronic wounds are categorized as serious stage of acute wounds and there can be many reasons behind it such as diabetes, severe reaction of chemical agents or acids, infections or peripheral vascular disease (Weinberger, Tierney, Booher, & Katz, 1989). Some chronic wounds are very dangerous and may become life threating if not treated properly. The treatment of chronic wounds must consider all the internal and external hurdles so that successful healing can take place. If the issues are not addressed properly then chronic wounds become threat for the life of the patient. Firstly, chronic wound must be converted back to acute wounds by taking certain measures. The wound nutrition must be improved and bioburden must be decreased as presence of bioburden will prevent white blood cells to heal the injury for which proper bandage and dressing is essential for healing process of the wounds (York, 1995). It can be observed in Anita’s case as the basic measures she has taken for such wounds; those weren’t efficient enough due to which the treatment was must to be taken. Her complete medication history was reviewed and then decision was taken.
It can be seen in Miss Anita Bacash’s case that she had total knee replacement due to arthritic changes in her knees. The delay has made it more painful for Miss Anita. Her life is affected due to this as her operation was delayed since one and half year. In her case, it can be seen that she has taken the preliminary dose for cure of her knee pain. After the surgery certain changes in Anita’s condition could be seen as her blood pressure was lowered and she had mild temperature.
Discuss the operative procedure that Mrs. Anita Bacash has had (total knee arthroplasty) in relation to her osteoarthritis and future mobility.
The most commonly performed orthopedic procedure is total knee replacement. The most usual indicator for this orthopedic procedure is osteoarthritis. As it can be observed in Anita’s case that she had pain while playing tennis and her knee was quite unstable at times. There are many other reasons too for osteoarthritis like enlargement of bony, contracture of flexion or varus deformity (Altman, et al., 1991). The evidence collected for osteoarthritis through radiology proves that there are osteophytes, space between joints has narrowed and subchondral cysts and sclerosis. The decision of total knee replacement is not taken until considering all the medical history of patient in the past. There are different invasive treatments that are being done and some other pharmacological therapies too. If these methods fail to produce the desired result, then the total knee replacement is considered (York, 1995). It can be seen that Anita has taken several medications for osteoarthritis as she has gone through several treatments before knee replacement which includes glucosamine, fish oil, acupuncture and cortisone injections but her pain wasn’t cured. She was taking diclofenac 50 mg too before the surgery.
The total knee replacement is considered as an excellent procedure for osteoarthritis. The outcome of this orthopedic procedure is highly satisfactory and patients have reported that their pain has reduced a lot. The major benefit is improved mobility and it also improves quality of life although there are some risks as well as one can face infection, deep vein thrombosis or nerve damage (York, 1995). There are some potential risks that are linked with the surgery of total knee replacement. The annual mortality of the surgery is 1.5% and it has been observed that older patients have same improvements if compared with young patients (Thornhill & Lee, 2015). But in Anita’s case nothing such happened and she recovered from the pain and she could start doing exercise with physiotherapy shortly.
Osteoarthritis can be classified into two different paradigms one is chronic and second is progressive joint disease (Thornhill & Lee, 2015). The smooth fibrous connective tissue between the knee joints which is also called articular cartilage, it covers the bone when it contracts with other bone which is not normal. The behavior of normal joint is different. The cartilage is shock absorber in normal joints and it allows the movement of joints without any hurdle and the patient does not feel any pain while moving as one face in osteoarthritis. The cartilage is degraded mostly and it becomes quite thinner and with passage of time it disappears and causes joint pain. So after surgery, it is ensured that movement between the joint is without any pain and it helps the patient to improve their life (Weinberger, Tierney, Booher, & Katz, 1989).
Explore the evidence underpinning the non-pharmacological management (non-surgical) of osteoarthritis that Mrs. Anita Bacash has or could have utilized to relieve her pain and improve her quality of life.
The osteoarthritis of knee can be treated along a spectrum from least to most invasive treatment (Thornhill & Lee, 2015). It can be seen in Mrs. Anita Bacash’s case that she initially used fish oil and injections for it but due to not having proper information she then ended up with total knee replacement. It is initially instructed that firstly management for symptomatic knee osteoarthritis must start with intervention in life style and education. Later on pharmacological treatments can be added for defined time period. This should be all done before proceeding to any invasive therapy. Treatment should be done after viewing the complete medical history of patient as different factors might affect the surgery and it is threat to patient’s health. The treatment must be tailored according to patient’s level of pain and degree of structural damage (Thornhill & Lee, 2015).
As per the details mentioned about Anita’s case, it can also be treated through non-pharmacologic treatment. Though non-pharmacologic treatment is quite time taking but the operation takes around one and half year which comparatively is not that much lengthy. The non-pharmacologic treatment includes basic education of that disease and doctors prescribed exercises regarding knee joints which can reduce the pain. These treatments also include weight loss programs as knee is lifting more weight than it should have lifted; bracing, insoles and lifestyle changes. Physical and occupational therapy also helps in heeling the pain. The best plantar insoles can reduce the pain too but it varies from patient to patient (Altman, et al., 1991). But it is recommended that patient must receive combination of both pharmacological and non-pharmacological treatment so that it can heel in both ways. A plan must be given to the patient from physiatrist that includes complete management of non-pharmacological treatment and a nutritionist must guide patient to lose weight so that desired result can be obtained.
In case of Anita’s case, her weight has to be reduced according to her Body Mass Index as Anita’s BMI is 29.1 which is higher than normal weight so considering Anita over-weight, she must had visited to nutritionist to lose weight. After reducing the weight, she must had started exercises instructed by physiotherapist so that she could heel her osteoarthritis by the time. These were all the steps if she would have taken, it might have prevent her from total knee replacement. But the essential component behind any nonpharmacological plan is correct attribution of signs and symptoms as pain and other symptoms of osteoarthritis can be confused with other soft tissues processes. Nonpharmacological management also includes basic interviews in which patient’s family history is being asked and reviewed (Thornhill & Lee, 2015). After some period of time if condition is not controlled and complications still persists then it leads to surgical treatment.
Altman, R., Alarcón, G., Appelrouth, D., Bloch, D., Borenstein, D., Brandt, K., et al. (1991). The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hip. PubMed
Thornhill, T., & Lee, D. (2015). Total Knee Arthroplasty. The Journal of Medical Insight (JoMI).
Weinberger, M., Tierney, W., Booher, P., & Katz, B. (1989). Can the provision of information to patients with osteoarthritis improve functional status? A randomized, controlled trial. PubMed .
York, J. R. (1995, January 01). The non-pharmacological treatment of osteoarthritis. Retrieved September 20, 2016, from Australian Prescriber: https://www.nps.org.au/australian-prescriber/articles/the-non-pharmacological-treatment-of-osteoarthritis