Scenario 1
Mabel Smith is a 64 year old. Her medical history includes: Rheumatoid Arthritis and Diabetes Mellitus type 2 and weight 110kgs.
Rheumatoid arthritis is a chronic inflammatory disorder that typically affects the small joints hands and feet (MayoClinic.com., 2012). The disease affects the lining of joints, causing a painful swelling that can eventually result in bone erosion and joint deformity. During rheumatoid arthritis certain proteins that drive inflammation in the joints of rheumatoid arthritis sufferers seem to have an effect on bone cells, causing increased loss of the cells. Research has proved that rheumatoid arthritis accelerates bone loss (Pearson C., 2011). Therefore, individuals with RA (especially women) are at higher risk of breaking bones, what, actually, happened to Mabel.
The most prevalent form of diabetes mellitus - is type 2 diabetes. The underlying metabolic causes of type 2 diabetes are the combination of impairment in insulin-mediated glucose disposal (insulin resistance) and defective secretion of insulin by pancreatic β-cells. Insulin resistance develops from obesity and physical inactivity, acting on a substrate of genetic susceptibility (American Heart Association, 2012). Considering, that Mablel’s body weight is 110 kilograms, we can tell that she has obesity. When an individual's body mass index, or BMI, is greater than 30, he or she is considered obese. Diabetes type 2 and obesity are disease connected to each other.
All diagnosis listed above are aggravated with Mabel’s smoking experience. Since we know that she has been smoking for 15 years, and it is a fact that smoking detains blood circulation, causes lack of air in lower extremities and lowers immunity (PolitoJ.,2010).
O.R.I.F. – from Open Reduction Internal Fixation. It is an Operative Treatment of for a fractured bone due plates and screws or an intramedullary (IM) rod are used to fix broken bone (Cluett J.,2008).
Factors that could lead to Mabel’s trauma may include: rheumatoid arthritis, lack of exercise and, probably, side effects of one of the medicaments that she has been taking daily – prednisolone.
As it was mentioned previously, rheumatoid arthritis is a disease that leads to bone weakening, so even simple falling could lead to such a serious bone fracture. Lack of exercising caused by extra body weight caused imbalance of the organism. Being retired and obese the patient did not move enough and her body was not ready for extremely situations like, for instance, falling. The medicine that Mabel is taking has a certain side effects. Prednisolone (reduces inflammation during arthritis) may cause dizziness and tiredness which could lead to absentmindedness and caused falling. Also individuals with type 2 diabetes (Mabel’s case) are at higher risk taking prednisolone (Allen H., 2011).
On examination Mabel is nauseated, lethargic and has increasing pain in Right lower leg, P 124, R 26, BP 138/90, T 38.5 degrees. One of possible variants is that she has an inflammatory process caused by infection. It could be a nosocomial infection that she could get in the hospital.
Another variant is implant failure. Pain that Mabel …