Question

 

Fred is an 83-year-old male who is being admitted to the medical-surgical unit status post fall. He is alert and oriented and reports that while visiting a local casino with his wife Margaret earlier this evening, he tripped over a curb and fell landing on his right side. After receiving morphine in the emergency room prior to transfer to your unit, Fred is rating his pain at 6/10. He has multiple bruises from his jawbone to his knee as well as a slight rotation of his right leg.

Past medical history includes: myocardial infarction (MI) x 2, peripheral vascular disease (PVD) with bilateral iliac stents, non-insulin-dependent diabetes mellitus (NIDDM), sleep apnea, and degenerative joint disease.

Medications include: aspirin, Plavix, Lopressor, Lisinopril, and Metformin.

After reviewing the above scenario please answer the following questions.

1. Based on the information provided, how will you prioritize your care, what assessments will you include and in what order? Please provide rationale for your response.

2. Considering this patient's age, injury, past medical history, and list of current medications, what, if any, concerns do you have related to his potential need for surgery?

3. Should surgery to repair his right femur be required; what type of clearance and pre-op orders would you anticipate receiving related to his diet, meds, lab work, and so on?

Answer 1

NEEDS	RATIONALE	CARE	ASSESSMENT
Pain management	The patient’s pain is rate as 6/10. He needs pain management because elderly have decreased pain perception.	Provide him pain control medications.	Pain scale rating
Immobilisation of limb	The patient has history of degenerative joint disease and now the patient has injured his knee.	Immobilise the limb by using splints or supportive devices.	Past history
Bleeding control	The patient now has multiple bruises from jawbone to knee and the patient is on aspirin and plavix which are blood thinners.	Control bleeding, do dressing for the wounds.	Physical examination of the bruises.
Blood sugar levels	Since the patient is having non- insulin- dependent diabetes mellitus.	Provide metformin as per orders, check for signs of hypoglycaemia and hyperglycemia, provide diabetic diet, increase intake of fluids.	Check for blood glucose levels.

2. The patient has a past history of degenerative joint disease and in on blood thinners. This is a concern in the area of surgery. The patient has to go for surgery to fix his joint.

3. Yes, surgery of the right femur is required. As the patient is on blood thinners, the patient has to undergo many laboratory investigations like INR, Bleeding time, clotting time, Complete blood count, blood sugar monitoring and blood pressure monitoring. Pre-op orders are the patient has to be put on NPO from 8pm before the surgery date, aspirin should be titred and stopped one week before the surgery, the laboratory investigations should be performed and the values should be within normal. If only it is normal the patient can be taken up for surgery.