Case Study: Osteoarthritis with a Total Knee Arthroplasty

1. What medication would you choose next to manage the pain? Why would you choose this medication?

HISTORY OF PRESENT ILLNESS: David Lockman is a 44-year-old male who injured his right knee on July 21, 2015 when a circular saw came into contact with his medial right knee. He was taken to the operative suite by Dr. Lin for an emergent irrigation and debridement. He tolerated this very well. He was admitted overnight for antibiotic coverage, and discharged with instructions to weight bear as tolerated with the use of a hinged knee brace and walker. He was doing well but presents today with ongoing pain of 6-7/10. His biggest concern was that the swelling, redness, and edema was now extensive down the leg and into the ankle and foot causing him some ankle pain, as well. He has been using Norco for control of his pain. He is not taking any antibiotics currently. He is set up for

Administer Dilaudid 1.5 tab for pain as per physician order. Apply voltaren gel 1% 2 gram transdermal (Diclofenac Sodium) for pain as per physician order……………………………………………………………..….L.Gotora PNS2/WATC

In Kindred Rehabilitation, the patient had a total knee replacement due to osteoarthritis. Osteoarthritis causes degenerative changes, within the joints causing bone stiffening and reactive inflammation. My patient was admitted on 10/21/11 with osteoarthritis and a left total knee replacement. Her PT and INR were a concern because she had developed mild thrombocytopenia which resulted in the elevation and potential bleeding. The physician had to take her off of Lovenox and switch her to an oral anti-coagulant Xarelto at 10mg once daily. During her care I was educated by the interdisciplinary teams managing mobility, safety, and the more

HPI: S.J. is a 67 y/o Caucasian male with a history of left hip pain for two years. He has difficulty walking due to left hip pain and utilizes a cane, can walk five blocks, climbs stairs leading with the right leg. He denies any surgeries on the left lower extremity. He sought physical therapy, but he does not feel that it is improving his pain but does believe it is improving his strength. He is scheduled for a left total hip arthroplasty due to the progression of severe osteoarthritis of the left hip as confirmed by a pelvic x-ray and MRI of the lower extremity without contrast. S.J. has taken various medications that are listed on the current medication section of this note.

Dillon is an 18-year-old male patient who is seen at the medical clinic today in regard of requesting for a newer and better knee sleeve for his left knee. The patient stated that there is no pain, no swelling. He already has knee sleeve but he stated that knee sleeve can pinch his skin sometime, so he requests for having a better knee sleeve. He stated that when he plays sports with the knee sleeve he feels his knee is more stable, not causes a popping sensation. Otherwise, he is doing fine. He has no medical concern at this visit.

Outcome: Consistent pain monitoring and reevaluating. Pain management through opioid medication and non-medication methods. We attempted to use ice packs as pain relief. Patient was unreceptive to the use of pain medication because it did not help his pain. Opioid medication relieved pain for this patient, however pain was consistently rated as 8.

Patient will describe nonpharmacological methods that can be used to supplement, or enhance, pharmacological interventions and help achieve the comfort-function level by anticipated discharge date on 4/26/18.

J.J. stated that she uses Bisacodyl to treat her constipation. Bisacodyl is a stimulant laxative used to relieve constipation (AHFS Drug Information Essentials American Society of Health-System Pharmacists, 2017). This medication works by evacuating the bowels and colon allowing for stool to pass through (AHFS Drug Information Essentials American Society of Health-System Pharmacists, 2017). Side effects of this medication include abdominal cramps, nausea, diarrhea, rectal burning, hypokalemia, muscle weakness, tetany (Vallerand, Sanoski, & Deglin,

OT-82, 40 mg/kg, p.o., 3 days on, 4 days off for 3 weeks. This drug has been

procaine or amphetamines. It was originally made to be a painkiller. It is now known as one of

Administrate the doctor prescribed analgesic such as to reduce the pain level of the patient.

Sulphur: It is another very effective homeopathic medicine. It is very helpful for scrofulous subjects (those having a leucorrhoea which makes the parts

If you are elderly and have been constipated or two weeks more, especially if it is associated with eight losses or bleeding, you should try these natural treatment to get rid of

Americaine Hemorrhoidal/ Anbesol Gel/ Hurricaine/ Benzodent/ Cepacol Extra Strength/ Dent-O-Kain/Oral Pain Relief/Retre-Gel/ Solarcaine Aerosol/ Stik/ Sting-Kill/ Topex/Feminine Cream