Patient Summary: Developed Subtalar Arthritis - Nursing Paper Example

The patient, in this case, is Mrs. P. K. She is a fifty-nine-year-old female weighing fifty-five kilogram. She is 5'8" high. She is a self-employed farmer who manages her farm. She had two children but was separated from her husband. For the past eight and a half years, she has been living alone on her farm at Dunedin. For her diet, she does not eat much food. In the morning, she eats her tea with yogurt and seeds. For lunch she would take mixed vegetables, for her super, she would take cheese and bread. She drinks alcohol occasionally; she would consume between one and two glasses of alcohol every week. She was once a smoker, but she stopped smoking at the age of nineteen. She regularly sleeps for six hours every day. She used to take twenty minutes at the gym she had at her home daily.

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Her primary daily activities include working on her farm, playing tennis, basketball, and hockey occasionally. Mrs. P. K. has no records of childhood illnesses. She has always been healthy and fit until she had an accident 06/01/1995. From the accident, she ended up with a fracture in her ankle. As she was driving, her car collided with buckets of large tractors besides the read in the farm. At first, she was treated with internal fixation, open reduction of a comminuted intra-articular ankle fracture that would later generate into traumatic arthritis that typically occurs after such treatments. She would then need an ankle fusion, between one to two years later. However, her ankle was fused in equines situation that resulted in too much strain on her knees. She has developed subtalar arthritis due to the adverse pains on her knees. After the surgery, she has been undergoing the posterior pains in her knees.

As a result of the pains she feels in her knees after the surgery, she has been taking Fucoidan supplements throughout. Fucoidan is seaweed that is used to maintain body fitness and health; she believes that it would help her keep a healthy and fit body. Also, she takes joint care supplements to help her in reducing the pain she feels in her ankles. She would at the time be forced to use pain to relieve medicines like diclofenac to reduce the ankle pain. She was admitted for treatment on 26/01/2017. She has been diagnosed with subtalar arthritis post ankle fusion on the right ankle. The surgical treatment she has received is the revision of the fusion on her right ankle. Her current blood pressure is 110/80 while in both sitting and standing positions. P: 62, Temperature: 36.8, Respiration Rate: 14, Sp02: 99%.

After surgery, her left foot was pink in color. The capillary refill of the foot was below three seconds. The temperature of the foot was warm with the pulse rate plastered incredible. The discharge plan for the patient after he scheduled surgery is such that the right leg that cannot bear any weights would be supported by shoulder crutches. She would be subjected to back slap plasters for seven days. The moon boot or the back plaster would be used for the following six weeks. She is expected to recover after three months fully.

Nursing Diagnosis

Amid the quick post-agent period it is imperative to keep the intertwined lower leg lifted to limit swelling. In a perfect world, this implies keeping the lower leg over the heart by resting or sitting in a leaned back position. Torment pills and intravenous torment drug are utilized to control torment. The tibia and bone require no less than six to two months before they are melded adequately to start weight bearing. It might take the length of 10 to 12 weeks. Amid this time patients commonly don't put weight on their agent's leg. Most patients find exploring their day by day lives without putting weight on one leg troublesome. Patients commonly utilize supports, walkers, wheelchairs or knee bikes to get about. The readiness with a physical advisor preceding surgery might be prudent. It is useful to have somebody available to help with essential undertakings and exercises at home, particularly amid the initial two weeks. A patient's home ought to be arranged fittingly. Inclines might be expected to explore stairs. Beds may be exchanged to ground level. Helps, for example, shower seats, chests and railings might be required.

Non-absorbable join or staples are ordinarily removed 10 to 14 days after surgery. Delicate active recuperation to keep alternate joints in the foot supply may start as of now. X-beams might be taken to watch that arrangement has not changed. Amid an initial couple of weeks after surgery, swelling and torment will increment when the foot is beneath the heart for expanded timeframes. Gentle measures of swelling and torment when the foot is beneath the heart for drawn out stretches of time may persevere for quite a long time, yet will steadily enhance after some time. After adequate time has passed, patients gradually start putting weight on their lower leg utilizing a mobile boot. X-beams might be gotten to affirm that the lower leg is combining admirably. Active recuperation will help in this move. Following 10-12 weeks, the lower leg combination is regularly sufficiently strong to permit leaving the plastic boot and a progressive come back to the more fiery movement.

Action Plan

All past restorative reports and imaging studies ought to be gathered and precisely broke down. Second, watchful evaluation of patients' history ought to be performed with a particular address of taking after viewpoints: genuine agony, confinements in everyday exercises, sports exercises, and present and past medications. Patients with any previously mentioned total contraindications ought to be barred. If important, a discussion in the division of neurology as well as inward prescription ought to be performed preceding arranging of surgery. The routine physical examination incorporates a watchful assessment of the foot and lower leg while strolling and remaining with exceptional consideration given to clear disfigurements and skin and delicate tissue condition. Rearfoot security ought to be evaluated physically with patient sitting. Lower leg arrangement is evaluated with the patient standing. Lower leg scope of movement is resolved with a goniometer put along the sidelong outskirt of the leg and foot. All goniometer estimations are performed in the weight-bearing position.

Radiographic assessment of influenced lower legs is performed utilizing weight-bearing radiographs including Antero-back perspectives of the foot and lower leg and a parallel perspective of the foot. Just weight-bearing radiographs ought to be utilized for assessment of foot and lower leg arrangement and biomechanics because non-weight-bearing radiographs are regularly deceptive. Besides, standing position may institutionalize the radiographing system permitting more dependable correlation amongst pre-and postoperative radiographs. Saltzman view ought to be utilized to evaluate the intermalleolar arrangement. The supra malleolar lower leg arrangement ought to be surveyed in the coronal and sagittal plane by estimation of average distal tibial edge and front distal tibial edge, individually. In patients with degenerative changes of the nearby joints, single-photon-discharge figured tomography may assess the morphologic changes and their organic exercises. We don't prescribe the routine utilization of attractive reverberation imaging in patients with lower leg OA. Summarily, this demonstrative apparatus might be useful to survey wounds or morphologic changes of tendon structures and ligaments, and to assess the confinement and level of avascular corruption of bone as well as the tibia.