Case Management Review Essay Example | Topics and Well Written Essays - 2000 words

Case Management Review - Essay Example Either way, the result is the same for both instances with single or multiple cortical infarction. Large vessel atherosclerosis starts as fatty layers in the arteries which harden into plaque as a person gets older. The development from fatty streak or layer to an unstable plaque may start off as a response to an endothelial injury which may cause an inflammatory response (Gilman, 2007). This response starts off with inflammatory cell migration, lipid deposition, and smooth muscle cell proliferation. After which, different events occur which then cause instability of the plaque, plaque rupture, platelet aggregation, and cause the formation of thrombus – eventually leading to infarction. Infarcts in particular areas of the brain may then contribute to the cognitive impairment of the patient (Gilman, 2007). In the patient’s case, the part of her brain which is attributed to her memory has been affected, thereby causing her memory impairment, decreasing her capacity for ne w learning and causing her disorientation. Her other functions are intact as she is able to manage writing tasks, difficult and complex activities, as well as basic problem solving. Based on some patient’s aging processes, they also suffer from cognitive sequences which are not dependent on structural lesions in the brain (Gilman, 2007). â€Å"Such people, by virtue of their age, may be more prone to hypoperfusion injury of critical areas of the brain such as the hippocampus of the basal ganglia† (Gilman, 2007, p. 229). In this patient, her cognitive impairment may be attributed to such hypoperfusion injury. Area of concern: Total hip fracture The patient underwent hip replacement when her hips were injured by a fall. This surgical procedure is conducted in order to replace the femoral neck with a metal alloy or any other material. These are common injuries among the elderly, especially those with osteoarthritis, compromised sight, and those using drowse-inducing medic ations (Jackson, et.al., 2009). This type of surgery can only be carried out as an inpatient surgery with its related preoperative and postoperative processes. The patient must therefore be oriented about the surgery and the preparations he must undergo in order to ensure a successful surgery and postoperative process. Following the surgical procedure is the immediate rehabilitation in order to ensure that the patient would regain strength in his injured hips (Paul and Peterson, 2002). A major part of the surgery is walking, sitting, and standing independently. During the physical therapy sessions, the nurse is obliged to assist the therapist in ensuring that the patient is safe during the exercises and that she can later carry out these exercises with the patient even without the assistance of the therapist (Meiner, 2005). The first part of the therapy would involve the safe and proper use of the walker. It also involves the process of learning how to safely sit from a lying positi on, how to stand from a sitting position, and how to walk safely with the crutches or cane (Landefeld, 2004). It is also the nurse’s duty to clear the area where the patient usually walks and to ensure that there are no barriers which would trip the patient or which would block the conduct of his therapeutic activities. The nurse must also learn the different exercises which the patient can safely carry out in order to ensur