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

1. Patient has a history of high blood pressure and heart attack. At present monitoring his pulse rate, ECG,EKG, X-ray ,diabetes status, CBC, Basic metabolic panel, PT, partial thromboplastin time, and planning on further treatment is neccessary to evaluate all these parameters. Multiple bruises and slight rotation of his right leg is a sign of fracture in his right hip associated with his fall and he may have slightest chance of head injury. Assessment of his pain is also required.

2. Due to his age and high blood pressure medication as well as diabetes history, surgery decision requires a discussion of case with orthopedic surgeon, cardiac and pulmonary consultation is required. Montoring his bleeding time is a significant factor before his surgery.

3. Before surgery his diets would be simple through IV as nothing from mouth should be administered and for medication we can increase the doses for pain reduction after assessment of other parameters if it is within normal limits. A joint decison of the all the associated physician with case is essential for surgery and further planning of treatment.