Treatment and Interventions for Osteoarthritis

Treatment and Interventions for Osteoarthritis INTRODUCTION Osteoarthritis is very common among the old age people. It is also termed as wear and tear arthritis as it occurs when the protective cartilage, surrounding the bones, wears and tears down. In the present case study, an old woman, 87 years of age, is admitted into the hospital as she was found near her bed. Although she was lucid and conscious, she was incapable to walk on her own. This report studies intensively the case of Mrs. Mabel and outlines the problems faced by patients like her, who have had past history of osteoarthritis. The report also identifies the potential treatment options and the interventions necessary in such cases. ASSESSMENT The two basic nursing assessment tools for assessing the health condition of Mrs. Mabel are the Brief Pain Inventory (BPI) and the Geriatric Depression Scale (GDS). In the former, an intensive analysis of pain including its location, history and interference with activities (Seyed K. Malakouti et al. 2006). The pain is recorded on a scale of 10, with 0 representing no pain and 10 representing pain as bad as you can imagine. The latter tool was designed to assess the depression score in the older patients. Score 11 or greater than 11indicates severe depression. This tool has screening efficiency as it relies on affective rather than the physical symptoms (Tito Mendoza 2006). CLIENT’s HEALTH PROBLEMS Studying the case of Mrs. Mabel, it is evident that the three health problems related to her are the inflammation, severe joint pain and cold and cough. Inflammation occurs when the chemicals from the body are released to the site of infection or injury. Mrs. Mabel was found to have inflammation in her lower leg i.e. swelling and persistent pain, possibly due to leakage of fluid into the tissues. Since cold and cough is generally a symptom in every old patient, in case of Mrs. Mabel it is important to treat the joint inflammation first, followed by the pain and eventually the medications for addressing cough and cold. The pain in osteoarthritis is generally caused when the wear and tear of the cartilage, that surrounds the joint, is to a great extent, such that the ligaments and the tendons are completely stretched out, causing pain. The cartilage acts as a shock absorber and also reduces friction in the joints. Lastly, since we know that Mrs. Mabel had been a smoker in the past, the chances of suffering from cold and cough are pretty high. It is therefore necessary to address the inflammation first, so that the pain in that area is comparatively reduced and then give pharmacological or non pharmacological assistance in reducing the pain in other joints as well. To ensure safe and quality care of Mrs. Mabel, these problems should be addressed in accordance with their priorities. The age factor of Mrs. Mabel should also be taken into consideration as many treatment options, even most of the medications, will prove to be harmful for her age. She should be given the support to move along and also be encouraged to participate in daily activities. GOALS The major goals of osteoarthritis treatment include alleviation of pain and restoring the normal functioning of the person. Since Mrs.Mabel has a serious pain issue such that she complains about it frequently and it is hampering her normal being, it is important to address and treat her pain and reduce her discomfort. Another goal should be to restore her normal functioning. As we know that the right leg of Mrs. Mabel is comparatively shorter than the left leg, she faces problem in moving around and needs a constant support to assist her mobility. Therefore, it is important to address the inflammation in her lower leg and prevent its reoccurrence. To address these goals, the patient generally receives both pharmacological and non pharmacological treatment, the former comprising of drugs and NSAIDs, while the latter comprising of therapies and the physical exercises. Surgical interventions have also suggested that if the joints are severely damaged, then the only option available for treatment is the partial or complete replacement of the joint. INTERVENTIONS The first and the foremost goal is to relieve pain and that can be mediated by psychological intervention techniques like providing education through various programs, coping skills training (CST) and cognitive behavioral therapy (CBT). These techniques help in enhancing self efficacy, help in managing stress, reduce helplessness and catastrophizing. Most patients have easy access to the basic medical care but the psychological aspects are generally neglected. The most commonly used educational intervention is the community based Arthritis Self Management Program, which targets the self efficacy skills and helps in management of arthritis symptoms (Catherine Backman 2006). On the other hand, CBT and CST approaches include cognitive and behavioral exercises like guided imagery or relaxation, changing activity patterns, etc. These exercises help in active coping and alleviation of pain in the osteoarthritis’ patients. The second goal is t restore the normal functioning of the joints and this can be achieved by rehabilitation program that helps in motion of the knee and thereby reduces pain also. The patient is advised to do regular exercises including heel prop exercises, prone hang exercises and also the towel extension stretches. These exercises help in knee extension which is opposite and equal to the normal knee. If the patients do not receive any help from this exercise regime then a hyperextension device (Elite Seat, manufactured by the kneebourne Therapeutic) can be used along with other devices that are used for extension purposes (K. Donald Shelbourne 2007). The rehabilitation program also aims in educating the patients about their daily habits and they should change them in order to relieve tension on the knee and relax. Certain aerobic exercises like bike, stair stepping machine or elliptical machines are also the part of the program. The patients are also encouraged to maintain complet e motion so that the non pharmacological approach provides relief that is permanent as compared to the relief obtained via pharmacological drugs and other analgesics (K. Donald Shelbourn 2007). DISCHARGE There are various problems faced by the elderly patients post discharge after getting the treatment for osteoarthritis done. Like in case of Mrs. Mabel, even after getting the surgery for arthritis done, she still complains of persistent pain in her legs. Post discharge issues generally include comorbid physical health problems, depression, and limitation in the functional capacity and improper dietary regulation (T. James 2005). Among all the patients of osteoarthritis, majority of them report persistent pain, even after the surgery. Another issue is the tight check on the weight because osteoarthritis can be severely influenced by obesity and can prove fatal. Next problem or issue faced by the patients post discharge is the intake of medications on a regular basis. Post discharge medications like Acetaminophen and NSAIDs are generally given to the patients. The former is used to reduce pain if taken in prescribed dose and the latter helps in providing relief from swelling and the p ain due to it. Apart from the medications, the doctors generally advise regular physiotherapy exercises that will help in keeping the join in motion and gradually provide the necessary extension to the joints such that the normal functioning is restored. Therefore there are many issues governing the discharge from the hospital. In order to address these issues it important to discuss the problems with the health care specialist first. Older people find it very difficult to cope with the pain and the reduced mobility. They have to keep themselves dependent on various analgesics and the anti inflammatory medicines that help in relieving pain and providing the necessary comfort. In case of Mrs. Mabel she was detected with an inflammation on her lower leg. Likewise, post discharge, there is high risk of inflammation, blood clots and swelling. Even after being treated, the patient may encounter situations of helplessness and depression, which may arise as a result of incapability to part icipate in the routine or daily activities and thereby developing high levels of anxiety. In order to avoid or prevent these issues, the family must take the responsibility of their older loved ones, once they are discharged. Their support, care and continuous monitoring will enable the patients to cope with the prevailing situation and help in quick recovery. CONCLUSION This report gives a detailed description about the symptoms, causes and the crises faced by Mrs. Mabel. It outlines the major interventions and strategies that will her cope with her situation. Techniques like education through various programs, coping skills training (CST) and cognitive behavioral therapy (CBT), work on the psychological aspect of the patient. Along with these the rehabilitation regime also aids in helping the patient by reducing pain and swelling. The major goals of the patient care have also been outlined in this report like the goals of alleviating the pain and restoring the normal functioning of the joints. To summarize, this report is important as it throws light on the condition of the patient and the necessary plan of action that is adopted for the care. It also draws attention towards the post discharge problems, that the patient will face and lists out the strategies that can help and address those issues.

Christian Gospel Essay

This is an inspiring story of how a man of God grew into a man of great influence. Examining his life and ministry from the wise and humble perspective that has made him one of the world’s most beloved and respected leaders, in this memoir, Graham looks back at age 78 on his lifetime of personal relationships, ministry, leadership, and experiences. He chronicles such events and stories as his boyhood in North Carolina, his first steps in ministry, details of evangelistic trips and revivals, and meetings with world and local leaders. Billy Graham’s gift has been to appreciate that in matters of faith there is no approach too simple, no argument too crude, no question too basic. The most striking thing to notice about Graham’s career concerns the most important matter, his view of God. Here the question is whether Graham’s strategies of access and ecumenicity undermine his message. The charge that perhaps they do arises from two ways in which Graham has seemed to reduce the Christian Gospel to a utilitarian device existing for other, more ultimate purposes. In the first instance, it is possible to glimpse pressure on his message from the moral calculus, singularly American, of republican citizenship. This calculus suggests that in a republic the good health of the polity depends upon the morality of the citizenry; that the best thing for personal morality is religion; and that, since Christianity is the best religion, it is positioned to do the most for America. Especially in the first part of his career, Graham was prone to statements that seemed to make the destiny of the United States loom larger than the fate of the Christian Gospel. â€Å"I seriously doubt if the old America is going to exist another generation unless we have a turning to Christ. † Some who share Graham’s beliefs would agree with him, but also wonder if he was making the penultimate into the ultimate. In the second instance, Graham throughout his career has spoken of Christianity, again in his words, as â€Å"alone† pointing â€Å"the way to individual peace, social harmony, life adjustment, and spiritual satisfaction. † For a Christian, true enough again. But priorities seem disarranged when sermons conclude as, for example, one did in New York in 1957: â€Å"All your life you’ve been searching for peace and joy, happiness, forgiveness. I want to tell you, before you leave Madison Square Garden this night of May 15, you can find everything that you have been searching for, in Christ. He can bring that inward, deepest peace to your soul. He can forgive every sin you’ve ever committed. † The charge that may be laid against the utilitarian drift of Graham’s Christian message is the charge that so troubled Martin Luther as he struggled to find a merciful God nearly five centuries ago. The heart of Luther’s spiritual dilemma was the fear that his supposed search for God was really a search for his own ease of soul, the fear that he was seeking God primarily for what God could do for him. Luther may have been overly scrupulous, but he could tell idolatry when he saw it, and tell it most clearly when he saw it up close. Billy Graham claims for himself neither Luther’s theological acumen nor his penetrating powers of self-analysis. Yet what rescued Luther from himself was also what has preserved the authenticity of Billy Graham’s message. The reason that Graham’s message, though admittedly soft at the edges, remains solid as a rock is that at its center is the Cross. In the early 1950s Graham solidified early practice by dedicating himself to the saving work of Christ as the heart of his message: â€Å"I made a commitment never to preach again without being sure that the Gospel was as complete and clear as possible, centering on Christ’s sacrificial death for our sins on the Cross and His resurrection from the dead for our salvation. â€Å" At the close of his memoirs, as at the close of so many sermons, Graham restates the appeal for conversion that is the trademark of his career. As he makes that appeal in this book there is his customary attention to what the Gospel does for us. But under girding all, from first to last, is an equally full sense of what the Gospel does to us: We are not here by chance. God has put us here for a purpose, and our lives are never fulfilled and complete until His purpose becomes the foundation and center of our lives. . . . When you [open your heart to Jesus Christ], you become a child of God, adopted into His family forever. He also comes to live within you and will begin to change you from within. No one who truly gives his or her life to Christ will ever be the same, for the promise of His Word is true: â€Å"Therefore, if anyone is in Christ, he is a new creation; the old has gone, the new has come! All this is from God, who reconciled us to himself through Christ and gave us the ministry of reconciliation† (2 Corinthians 5:17-18). We have seen this happen countless times all over the world, and it can happen in your life as well. Open your life to Christ today. If in the hands of Billy Graham, the Gospel bends, nonetheless, it does not break. To conclude that Graham has remained faithful to the message that God saves sinners for His own purposes, as well as for theirs, is the highest accolade a fellow-believer can bestow on this remarkable man. But Graham, of course, has become more than just a rallying point for Christian believers. Graham’s apparently bottomless kindness, combined with the lightning pace of his narrative—so many visits, so many good friends, so many celebrities—means that Just As I Am is not a particularly challenging book. It is, nonetheless, worth reading carefully, both because Graham is the genuine article and because many of its details and much of its tone are in fact quite useful for attempting a more complex assessment of his career.

Global disaster management Essay

Disaster management became global; financial resources together with the establishment of several associate and group organizations sprang up. Mass media took up the root with each major and minor disaster reported universally. Disaster tradition were formed and disseminated by the mass media. Until this global agenda was affirmed, environmental issues were still in their infancy and the number of research or consulting organizations focused on disasters was exceptionally small. The concern of disaster research units (mainly university-affiliated) and disaster management units in public administrations only became noticeable in the second half of the century in the late fifties. By the start of new millennium, the number of disaster-related organizations had grown exponentially. The U. S. government alone has no fewer than twenty-six major agencies as well as dozens of regional offices dealing with disasters. There are a further ninety-five specialized units established for contradictory disaster situations. To this can be added eighty U. S. domestic non-govermental organizations (NGOs). This number can be used as a rough suggestion of the same process occurring all through the Western world. The sharing of disaster-related global-based agencies likewise grew, comprising over ninety major public agencies with offices all through the world. This guide of the globalization of disaster management also supported the hold of public administration on the area of disasters. It has also led to interagency divergences and problems of management, as well as protective imperatives, turf wars, and competition (International Decade for Natural Disaster Reduction, 1996). What was evident at the national or state level-at which public administrations subjugated the definition of disaster, who was capable to be a disaster victim, what help would be afforded, and so on-was now extensive at the global level by other forms of public administration in diverse guises. As some critical reports have noted, the results have been at the similar mediocre levels of disaster management (on a larger scale), where in several cases such â€Å"assistance† was more unfavourable than supportive. The most observable of these have been linked with the droughts in Africa, where NGOs and international aid have in fact harmed more people than they have helped.

Weakness and Greatness in Literature The Enormous Radio...

â€Å"Weakness and Greatness† Tragedy has a negative meaning. When we hear â€Å"tragedy,† we always link it to car accidents, people dying from crashes, or unfortunate aspect of disasters. A tragedy maybe reflects on both a person’s weakness and greatness, but it tends to emphasize on their problems within one’s self and with other people. It can also review the character’s personal qualities and moral standards through different circumstances. According to the Greek Tragedy, a tragedy never creates only downfall but brought by one’s own hand. In a tragedy, there is always a lesson to be learned despite the disastrous event has an unpleasant but meaningful ending. In a tragic literature, the protagonist tends to create their own tragic flaws resulting in different consequences. In â€Å"The Enormous Radio†, John Cheever uses moral and personality degeneration to foreshadow Irene’s changes. On the other hand, in â€Å"A Rose fo r Emily†, William Faulkner uses the changing of values and social experience to explain Emily’s tragic circumstances. Irene and Emily are lived in different social class. Irene Westcott and her husband, Jim Westcott are a middle class family who earn average income. They live â€Å"on the twelfth floor of an apartment house near Sutton Place† and â€Å"hope someday to live in Westchester†; they have pride. In contrast, Emily Geierson has a â€Å"big, squarish frame house that had once been white, decorated with cupolas and spires and scrolled balconies.† Emily is a wealth woman