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Anterior Cruciate Ligament Based Nursing

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Question:

Discuss about the Anterior Cruciate Ligament Based Nursing.
 
 

Answer:

Introduction

In case of arthroscopic surgeries, the anterior cruciate ligament (ACL) and the repair of the torn meniscus are common. The ACL helps to stabilize and provide support to the joints.

In the case scenario, Mr. James Versace is 17 years old adolescent, who is a soccer player. He faced problem in exercise and pain. Other medical problems of Mr. Versace are asthma, dermatitis, subluxed his left patella, allergic problem and hayfever.

The assignment discusses about the continual risks of postoperative condition. The current therapeutic regime is discussed that helps to reduce the risk factors. In the section, manual therapy, rationale, and intervention are discussed. The benefits of evidenced based Nursing are discussed.

Continual risks of postoperative condition

Westermann et al. (2014) mentioned that every surgery has some risks that is known as the complication. However, the meniscus repair is one of the safest processes, in which the risk rate is 1.3%. The main complication of the meniscus repair is the injuries to the skin nerves. Other complications of the postoperative condition are knee stiffness and infection, which are uncommon but can occur. In such circumstances, Wasserstein et al. (2013) mentioned that the doctors need to minimize the risks of complications that will help the patient to overcome the surgical risks. In the case scenario, Mr. Versace has various health complications. Therefore, before the medication, the doctor and nurse need to check his medical history as he has allergic problem. He has allergies in lactose, cashews, animal fur, peanuts, and pollen. Therefore, the nurse needs to be careful about his diet as well, which may increase the complications of the postoperative condition. The nurse needs to observe him and provide intensive care to avoid the infection. He needs to take complete bed rest and avoid the alcohol consumption. From the case scenario, it is clear that Mr. Versace takes alcohol occasionally.

In postoperative condition, the doctor can suggest about the rehabilitation to the patient that will help them to get over the problem. The rehabilitation technique with the sound rehabilitation plays major role in the treatment of the meniscus repair. With the medication, the physiotherapy is also important that will help in leg movement. As Mr. Versace is an adolescent athlete, he needs to get over the problem as earlier as possible. In such cases, physical therapy helps the patient to get back in his normal life.  To provide the quality to the patient, who has gone through arthroscopic surgeries, need to understand the biomechanics. Achtnich et al. (2016) suggested that with the medication, the physical exercise is necessary that can help the patient to avoid the complication. The clinical evaluation and the treatment techniques ensure the optimal outcomes. In such circumstance, communication plays key role. The nurse needs to have proper communication skill that will help to know about the patient requirement. In such condition, the medical lab reports can help the nurses as well to know about the condition of the patient.  Therefore, the nurse needs to check the lab reports minutely.

Manual therapy

The main purposes of the manual therapy are to modulate the pain, increase the motion range, reduce the soft tissues inflammation, improve the contractile tissue repair with the extensibility, and facilitate the movement. As mentioned by Forkel et al. (2015), manual therapy refers to the application of the manual forces of therapist to improve quality and range of motion of the soft tissues and joints. Michalitsis et al. (2015) mentioned that the mobilization is one of the manual technique, which replicate the normal joint via the repeated passive motion at the low speed. The normal joint moves smoothly at varying amplitudes. On the other, Chahla et al. (2016) defined that manipulation is the fast and small force with the small amplitude, in which the joint is moved in high speed. The manual therapy helps to improve the joint mobility and joint function. In case of Mr. Versace, he needs the manual therapy as well so that he can be able to play soccer again. In case of manual therapy, the joint glides need particular planes so that the movement can be done smoothly. In case of anterior cruciate ligament (ACL) and the repair of the torn meniscus, manual therapy helps the patient in movement (Anderson & Anderson, 2015). This helps to reduce the complications of arthroscopic surgeries and provide benefits to the patient. 

The patient Mr. Versace is 17 years old male, who have been admitted for the arthroscopic surgeries due to anterior cruciate ligament (ACL) and the repair of the torn meniscus. In the current context, the main problems are prioritized to manage his pain and knee movement problem.

For managing the pain, the pain score needs to be managed with the pain measuring scale. This is based on the pain management plan, which needs to be developed. To reduce the pain, the doctor suggested diclofenac and mentioned the dosage of the drug to 25 mg. therefore the patient takes 1 to 2 tablets daily for the pain management. The oral medication helps him to reduce the pain. Duchman et al. . (2015) suggested that when the pain of the pain will be reduced, he will be able to move his knee and the complications will be reduced as well.

 

Managing asthma and allergy:

The patient is suffering from asthma and allergy problem.  To reduce the problems he needs to modify his dietary habit first. He needs to exclude the peanuts and cashews from the diet. The nurse needs to monitor the patient and note down the problems of the patient. Mr. Versace needs to take sufficient amount of water that helps to maintain the fluid balance of the patient body. The doctor prescribed some drugs to reduce the problems of the asthma and allergy. The nurse needs to follow the medication routine of the patient and provide the medication timely. Mr. Versace needs to take the salbutamol 100 mg with the CFC inhaler. The dosages need to be maintained. Another medication includes flticasone, advantan, prednisolone and epipen. The administration of the injection needs proper routes and dosage. The nurse should be careful about the routes and dosage.

Nurse responsibility

Rationale

Check the administration of medication (drugs and injections)

Before administration of drugs, the nurse should check dosage and route. However, the dosage needs to be applied in a safe level (Shybut et al. 2015). Overdose of the medication is fatal for the patient. The overdose of the drugs that are prescribed for the asthma and allergy can be fatal for Mr. Versace. Therefore, the nurse needs to recheck the dosage of the medication.

Check symptoms of the patient

The medication and injection needs to be provided after detecting the signs and symptoms of the patient. As the patient has various problems, therefore the medication should be provided carefully.

Check route with dosage of medication administration

The nurse needs to check the dosage and route of the medication. Proper implication of medication can help the patient to reduce the problems and get well soon.

Observe the patient after medication

 The medication is provided to reduce effects of asthma, allergy, and pain. The nurse should monitor the patient, which help to develop the patient’s health.

Take the consent of the patient and family members

Before applying the medication, the nurse needs to take the consent of the patient and his family members (Mall et al. 2014).

Table 1: Rationale of nursing intervention

The benefits of evidenced based nursing

Evidence based Nursing has various benefits, which include to provide the quality care to the patient. The quality care helps to improve the patient outcomes (Hamer & Collinson, 2014). The evidence based Nursing helps the nurses to increase their skills as well as the critical thinking and decision-making. As result, the clinical performance of the nurse develops with the experience. Evidence based nursing helps to provide knowledge and satisfaction to the nurses as it helps to enhance the patient outcomes. Implementation of the evidence-based practice can manage the available resources, which is used effectively and efficiently (DiCenso, Guyatt & Ciliska, 2014). However, there are various barriers that needs to be reduced to increase the rate of positive patient outcome.

Conclusion

Based on the above discussion, it can be said that the meniscus repair is one of the safest processes, in which the risk rate is less. As the patient has various problems including asthma and allergies, therefore the medication process should be done properly. the patient needs to take the medication timely and should take rest that will help him to get back in the normal lifestyle. In such cases, the physical therapy and manual therapy provide relief to the patient. Hence, it is necessary for the patient. The fluid balance of the patient’s body needs to be maintained, which helps in the treatment. As well as the patient needs to be careful about the diet and avoid the foods that can create allergic problem.

 

References

Achtnich, A., Herbst, E., Forkel, P., Metzlaff, S., Sprenker, F., Imhoff, A. B., & Petersen, W. (2016). Acute proximal anterior cruciate ligament tears: outcomes after arthroscopic suture anchor repair versus anatomic single-bundle reconstruction. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 32(12), 2562-2569.

Anderson, A. F., & Anderson, C. N. (2015). Correlation of meniscal and articular cartilage injuries in children and adolescents with timing of anterior cruciate ligament reconstruction. The American journal of sports medicine, 43(2), 275-281.

Chahla, J., Dean, C. S., Moatshe, G., Mitchell, J. J., Cram, T. R., Yacuzzi, C., & LaPrade, R. F. (2016). Meniscal Ramp Lesions: Anatomy, Incidence, Diagnosis, and Treatment. Orthopaedic Journal of Sports Medicine, 4(7), 2325967116657815.

DiCenso, A., Guyatt, G., & Ciliska, D. (2014). Evidence-based nursing: A guide to clinical practice. Elsevier Health Sciences.

Duchman, K. R., Westermann, R. W., Spindler, K. P., Reinke, E. K., Huston, L. J., Amendola, A., & Wolf, B. R. (2015). The fate of meniscus tears left in situ at the time of anterior cruciate ligament reconstruction: a 6-year follow-up study from the MOON cohort. The American journal of sports medicine, 43(11), 2688-2695.

Forkel, P., Reuter, S., Sprenker, F., Achtnich, A., Herbst, E., Imhoff, A., & Petersen, W. (2015). Different patterns of lateral meniscus root tears in ACL injuries: application of a differentiated classification system. Knee Surgery, Sports Traumatology, Arthroscopy, 23(1), 112-118.

Hamer, S., & Collinson, G. (2014). Achieving evidence-based practice: A handbook for practitioners. Elsevier Health Sciences.

Mall, N. A., Chalmers, P. N., Moric, M., Tanaka, M. J., Cole, B. J., Bach Jr, B. R., & Paletta Jr, G. A. (2014). Incidence and trends of anterior cruciate ligament reconstruction in the United States. The American journal of sports medicine, 42(10), 2363-2370.

Michalitsis, S., Vlychou, M., Malizos, K. N., Thriskos, P., & Hantes, M. E. (2015). Meniscal and articular cartilage lesions in the anterior cruciate ligament-deficient knee: correlation between time from injury and knee scores. Knee Surgery, Sports Traumatology, Arthroscopy, 23(1), 232-239.

Shybut, T. B., Vega, C. E., Haddad, J., Alexander, J. W., Gold, J. E., Noble, P. C., & Lowe, W. R. (2015). Effect of lateral meniscal root tear on the stability of the anterior cruciate ligament–deficient knee. The American journal of sports medicine, 43(4), 905-911.

Wasserstein, D., Dwyer, T., Gandhi, R., Austin, P. C., Mahomed, N., & Ogilvie-Harris, D. (2013). A matched-cohort population study of reoperation after meniscal repair with and without concomitant anterior cruciate ligament reconstruction. The American journal of sports medicine, 41(2), 349-355.

Westermann, R. W., Wright, R. W., Spindler, K. P., Huston, L. J., & Wolf, B. R. (2014). Meniscal repair with concurrent anterior cruciate ligament reconstruction: operative success and patient outcomes at 6-year follow-up. The American journal of sports medicine, 42(9), 2184-2192.

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