B740 Adult Nursing : Comparative Assessment Answers

Answer:

Introduction: 

Pain can be considered as one of the most vital and consistent element of life, each and every individual has to endure pain some or the other time in the entire duration of their lives. However, the concept of chronic pain is completely different; a chronic pain can be defined as a long term and consistent pain that can occur due to a particular health condition or injury. In this case the patient had been suffering with chronic pain in both of the knees, due to long term osteoarthritis. Now it has to be understood that the aspects of care in case of chronic pain management can be diverse. As there can be a diverse health adversity trajectory that can lead to knee pain in the patient, the care aspects for the chronic knee pain management also needs to be patient centered and dependent on the specific needs and requirements associated with the condition that the patient is in (McCracken and Zhao?O'Brien 2010).

In the case study selected for this assignment, the health adversity represented is chronic pain experienced by the patient in both knees due to chronic osteoarthritis. The patient is a 78 year old male who had been suffering with chronic osteoarthritis on both of his knees. The chronic pain in both of the knees have rendered the patient completely incapable of mobility and the patient requires 24/7 support from the care providers for basic chores. Other medical complication of the patient includes peripheral oedema in the lower limbs of the patient and along with that the patient had also been suffering with congestive heart failure and fall tendencies. This assignment will attempt to formulate a pain management biography, taking into consideration the pain assessment, management and care experience attained by the patient.

Bio-psychosocial assessment of pain history:

Both chronic pain and chronic recurrent pain can be considered as a pervasive medical concern and the topic of chronic pain management has been discovered as the main public health priority in the current age. There is various pain assessment and management techniques that have been discovered in the past, however among all the different techniques that have been discovered the bio-psychosocial method of chronic pain management has been discovered to be one of the most beneficial and effective methodology (Nicholas et al. 2012). The late 1900s have called for the extreme reform in the sector of traditional pain assessment and management design, the bio-psychosocial model on the other hand, takes into consideration both the impact of disease and illness. Now it has to be understood that illness or the experience associated with it is explained by the biological, psychological and social manifestation of the chronic pain. It has to be understood that the need for holistic analysis of the experience or grievances of a patient who is suffering through a chronic pain is required. According to the article by Hadjistavropoulos et al. (2011), the bio-psychosocial model is considered to be one of the most heuristic methods of Pain assessment, treatment and management technique which attempt to provide the most tailored and comprehensive pain management program for the patients.

In the case represented in this assignment the patient have been suffering from long term osteoarthritis which had resulted into a chronic pain in both the knees of the patient, which had rendered the patient completely incapable of carrying out normal daily activities, and hence there are a number of different social and psychological impact the patient. Hence, opting for the bio-psychosocial mode of pain assessment and management will be the most plausible method opted to help restore the optimal health and wellbeing of the patient. According to the bio-psychosocial model of health, the assessment must take into consideration the biological, psychological and social impact of the chronic pain and associated health adversity. Hence, for the patient under consideration in this task, the biological, psychological and social aspects of pain would be considered (Yarnitsky et al. 2015).

Considering the biological assessment of pain of the patient, all the interrelated biological and bio-genetic vulnerabilities of the patient needs to be evaluated in detail. There are three sectors of evaluation needed for the correct evaluation of the biological vulnerabilities of a patient; the first assessment included judging the extent of the pain or physical impairment for the patient (Hawker et al. 2011). As the patient under consideration in this assignment is an elderly patient with chronic osteoarthritis and various other age related health concerns, each and every grievance of the patient had to be assessed and co-aligned with the pain experienced by the patient at large. Another crucial sector is be the evaluation of the magnitude of the illness. For instance, the past medical history of the patient included congestive heart conditions, peripheral oedema and other health condition, here the aspects of his pain and its relation to his health conditions will be explored and evaluated effectively.

The psychological assessment is associated with the impact of chronic pain in detail, the psychological impact of pain differs on the basis of how the patient interprets the pain. According to the bio-psychosocial model, the interpretation of pain has two aspects, the physical and the mental deconditioning of the pain. Here the pain felt by the patient will be assessed in terms of the psychological or emotional interpretation of the pain, this assessment can be done in three different stages; the initial stage solely focused on measuring the primary psychological distress of the patient like fear, anxiety, and worry. In the next phase the psychological exacerbation of the chronic pain was assessed in terms of helplessness, depression, agitation, distrust, and substance abuse. The last phase of psychological assessment of the patient is concerned with judging the acceptance and consolidation of the chronic pain in the patient.

The final element of the bio-psychosocial model of pain assessment is the social evaluation where the socio-economic prejudice with respect to pain endurance and management. Here the health care professional assesses whether there are any socio-economic restriction in the life of the patient that might have the potential to further exacerbate the chronic pain that the patent has. This element of assessment also takes into consideration the subtle changes in the social behavior of the patient so that the impact of the pain on his social life can also be determined. Now, considering the assessment tools that can be utilized while conducting the bio-psychosocial assessment of the chronic pain in a patient (Herr 2011). For instance, there are countless pain assessment scales in the market for the correct assessment of the extent of pain felt by the patient and its considerable impact on the health and wellbeing. Assessment tools like McGill pain questionnaire and BPS-SF questionnaire, although for the patient abbey pain scale had been utilized to assess and explore the pain effectively and optimally (Takai et al. 2010).

Pathophysiology of pain:

Considering the origin and characteristics of the chronic pain felt by the patient under consideration, there is a direct link between the specific health adversities of the patient with the patho-physiology of the pain. There is a significant dilemma among the recent authors regarding the exact pathophysiology of the joint pains in case of arthritis as there are intricately interlinked and multifaceted interactive pathways. Although the consensus is that this particular disease is considered to be a degenerative disorder that is the direct result of the biochemical breakdown of hyaline cartilage of the patient (Blagojevic et al. 2010). It has to be mentioned in this context that the osteoarthritis and the chronic knee pain associated with it is critically linked with the synovial joint and its optimal functioning. And the hyaline or articular cartilage damage in the synovial damage facilitates the recurrent chronic knee pain in this disease. There is a significant difference in the clinical manifestation of primary and secondary arthritis (Bruyère et al. 2014). Although it can be stated that based on the fact that the patients had only knee related concern in the pain history and his hands were not reported to be involved, the patient can be considered to be suffering with secondary arthritis. The inflammation that the patient has been experiencing in the site of pain can be considered the direct result of release of cytokines and metalloproteinases into the synovial joint. It has to be mentioned that the degenerative degradation of the articular cartilage of the synovial joint which is the prime reason behind the knee pain in the patient is the excessive matrix degradation (Nguyen et al. 2011).

Management strategies:

As the pain statistics is considerably chronic for the patient with considerably higher pain score in assessment tools, the management strategies opted for the patient also needs to be curated for the particular needs of a geriatric patient with chronic arthritis, along with other health adversities like congestive heart failure and oedema (Makris et al. 2014). First and foremost, considering the chronic pain that the patient had been feeling and the multiple health care concerns that the patient has been having, the care plan for the patient needs to incorporate multidisciplinary approach. In most cases, the multidisciplinary approach for the patient includes pharmacological interventions, psychological intervention, and physical support (Nüesch et al. 2011).

The most commonly opted pharmacological intervention technique that is recommended for the geriatric patients is the use of non-steroidal anti inflammatory(NSAID) drugs, opioids, and muscle relaxants. The pain management medication that has been prescribed to the patients include buprenorphine which is an opioid analgesic drug that is utilized to relieve the patient of severe ongoing pain due to arthritis (Noble et al. 2010). This is a narcotic pain medication that targets the brain function and alters the bodily response to pain; hence this medication is extremely beneficial for relieving the patients from chronic pain. Another pain medication that has been prescribed for the patient is the NSAID drug ibuprofen, this is the analgesic rug that functions by reducing the hormonal level in the body to reduce inflammation and pain response in body (Sethares, Chin and Costa 2013). Evidence from literature suggests that ibuprofen is the kind of NSAID drug that is abundantly used for its properties that can reduce the possibility of fever and treat the chronic pain or any inflammation caused by the health adversities like arthritis. As the patient had been suffering from long term chronic pain and had been mobility restricted due to the intensity of the pain, ibuprofen had been prescribed to control the pain and minimize the extent of inflammation (Abou-Setta et al. 2011). Other pain medications that had been prescribed in alternation to the patient include pregbalin, which is a commonly used pain medication in case of chronic pain and seizures. Although it must be mentioned in this context that the patient had already been suffering with a congestive heart condition. Along with that drugs like ibuprofen can increase the risk of fatal heart conditions as well, hence, a few medications has been used to minimize the risk of ischemic attack, medication like furosemide and lisinopril had been taken to reduce the risk for heart failure or any congestive complications. Furosemide is generally prescribed to reduce the extra amount of fluid in the body caused by oedema in case of congestive heart conditions (Vowles and McCracken 2010). It has to be mentioned that in case of the patient+ that he had peripheral oedema in the lower limbs, hence using this medication was targeted at reducing the oedema that the patient had. Lisinopril was prescribed to the patient to minimize high blood pressure and avoid the risk for congestive heart failure (Elvir-Lazo and White 2010). Now, it has to be mentioned in this context that the patient had also been suffering with anxiety and hence he had also been suffering with insomnia and agitation. And hence lorazepam had been prescribed to him along with donepezil to minimize and control his behavioral changes. Lastly, as the patient had also been suffering with constipation, laxido had been used as a choice of laxative. Along with that, non-pharmacological interventions and counseling sessions had been arranged for the patent to ensure that he is given optimal care opportunity to maximal health and wellbeing (Joshi, Schu and Kehlet 2014). Support from inter-professional domains had been taken involving psychologist and physiotherapist, distracting activities like listening to soft music, conversations and story-telling had also been attempted with the patient however as the patient had not been very co-operative, there were many challenges faced while planning and implementing the pain management strategies.

Reflection and recommendation: 

On a concluding note, I would like to mention that handling the patient discussed above had been a great professional experience for me. It has to be mentioned in this context that there is a vast gap between the theoretical knowledge and practical applicative understanding when health care is concerned. The patent under my care had many complications along with the main health care priority for him, chronic pain in both knees due to extreme osteoarthritis. However the additional medical conditions that he had required us to opt for an interdisciplinary care strategy for the patient. This had been an excellent opportunity for me which enabled me to understand the concept of multi-disciplinary care approach for the patient. However, I would also like to mention that the patient had been suffering with this chronic healthy condition for a long time along with serious additional health issues like congestive heart failure and history of being a chain smoking, which further escalates the possibility of him succumbing to many other health complication. Hence the care strategy taken for him needed to be very careful and precautionary so as not to aggravate any of the additional health issues that he already had. However, the patient had been admitted in the nursing home with 24*7 supportive care and attention to him which increased the dependability of the patient on the care staff tremendously. The extreme dependability and absolute lack of empowerment had made the patient very frustrated and easily irritable. Although a few pharmacological interventions had been administered to the patient in an attempt to minimize the anxiety and behavioral fluctuation he had been feeling, although it had not been overtly successful, and he continued to be non-cooperative which gave rise to many challenges and hurdles in the path of his optimal care delivery (Andrew et al. 2014).

I would like to mention in this context that, adequate pain management for geriatric patient needs to consider a number of highly interconnected multidisciplinary factors which can only be achieved if the health care facility has adequate staffing arrangements, adequate training on managing pain ridden geriatric patients and high inter-professional conduct between staff with high professional satisfaction and morale. However the alarmingly low staffing ratio and staff retention rate in UK is a great challenge for achieving the said goal. Hence, it is very difficult for the nursing staff to provide adequate attention to such patients with extreme work load. Along with that, another very influential challenge in this situation had been the fact that without adequate knowledge and training on multidisciplinary pain management, it had been extremely difficult to assess the particular needs of the patient and device the care plan accordingly. A key observation that I would like to add in here is the fact that temporary staffing is a common occurrence in the UK based health care system in the current age, however the lack of experience and training in the temporary staff is a major concern for effective implementation of the care planning which eventually affects the optimal care delivery for the patient (Lluch et al. 2014). Although, this has been an exceptional professional experience for me which gave me ample opportunity to understand the particular preferences and grievances that are experienced by geriatric patients in 24*7 support and the knowledge gained by the experience will help me effectively to work towards my professional growth as nursing professional.

Reference: 

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