Orthopedic Nursing
Patient Scenario
Mary Jane is an 81-year-old woman was admitted to hospital after a simple fall, complaining
of hip pain and inability to walk. The affected right leg appeared internally rotated. Passive
motion was painful, and active movement was impossible secondary to pain. The patient has
several chronic medical problems including as DM, Hypertension and Ischemic Heart
Disease. Treatment in the Accident and Emergency Department was centered around her
diagnosis of a fractured right femur. She lives in a nursing home, although she was
independently ambulant. She has now been admitted to your Orthopedic Unit for further
management.
Chief Concern:
 Severe, sharp pain on movement 9/10
 Inability to bear weight, sit-up or ambulate
PHH (Past Health History):

 appendectomy age 15, fractured clavicle age 19.
 laminectomy (L4‐5) 17 years ago due to a work related injury.
Medications History:
 acetaminophen 500 mg PO q6h
 Insulin 70/30 12units SC, AM and PM
 Enalapril 10mg PO BD
 Atenolol 25mg PO OD
 Aspirin 81mg PO OD
 Calcium 600mg PO OD
Physical Exam:
 BP 160/94 P 103 regular R 24 T 37.2
 Conscious and alert but appears anxious, GCS 13/15
 Height 188 cm, weight 118 kg
 IVF in progress, 0.9% Nacl to left anti-cubital fossa
 Skeletal Traction to right leg with 15 pounds weights in place
 Urinary catheter in situ, on free drainage
 TED stocking in place to left lower limb
Labs:

XRay:

X-ray shows a transverse fracture
of the femur. The break is a
straight horizontal line across the
shaft.

Social History:
 Trinidadian born, graduated form 5 high school
 worked on an assembly line in manufacturing company; is physically demanding
 smokes 1pk/day x 18 years, occasional marijuana use; drinks beer ~ 2/week.
 recently lost a long‐time friend at the nursing home to cancer
 spouse died 8 years ago (MI)
 no children, 1 sister alive she lives abroad
Family History
 Mother died of heart disease
 Father died of prostate cancer
Assignment instruction;
1. Briefly describe three (3) classes of medications used in the treatment of patients with femur fracture:  Pain relief  Antibiotic  Anti-inflammatory

2. What is the nursing considerations/management for this patient?

3. Develop a plan of care for Mrs. Jane, (utilize 2 actual and 1 potential nursing diagnosis, short and long term goals, nursing intervention, evaluation).

Choose one of the following categories of violence described in your text and describe it; include key risk factors and prevention strategies in your answer: ● assault and homicide ● gang-related violence ● hate crimes ● school violence ● workplace violence

23. Close contact with families leads to family identification with the program and appreciation of teacher efforts (T/F)

24. Young children who enter school with high self-esteem are unlikely to lose it when overly challenges with academic tasks or racial bias (T/F)

25. Children in the primary grades automatically are more difficult because of their increasing wish for independence (T/F)

27. Since academic learning is so important in the primary grades, teachers should strictly limit time spent in primary physical activity (T/F)

30. Collaborative teaching means one teacher plans the lesson and gathers the materials and the other teacher teaches the lesson (T/F)

31.Themes should be addressed once per year (T/F)

35.Themes should last about one week each (T/F)

39. Teachers should give reasons for why some behaviors are acceptable and others are not every time they talk to children about behaviors (T/F)

Select the type of prevention the following activity/action best represents. Washing your hands often:

Select the type of prevention the following activity/action best represents. Thyroid screening test in a 50 year old woman at her annual exam.

Select the type of prevention the following activity/action best represents. Insulin injections used daily in a person diagnosed with diabetes:

Question 1: Describe 3 different strategies for data collection and give examples for each type of assessment or data collection. 

Question 2: Describe the difference between independent, dependent and collaborative nursing interventions. Give an example of one of each type. 

Hospital President Jose Vasquez, in a virtual online call with journalists, a recording of which was reviewed by Forbes, said the hospital has been given extra personnel from the state and federal governments but still has insufficient resources, and is “establishing an ethics committee as well as a triage committee that is going to be in charge of reviewing each one of these cases that need hospitalization.” He said if a patient, particularly someone with a significant underlying medical condition, needs “mechanical ventilation to survive we have to start making a triage evaluation and [determine] who has a better chance to use, in a beneficial way, all of the resources versus who is a patient that because of chronic medical illness does not have the chance to survive.” Vasquez said some badly ill Covid-19 patients have been transferred to hospitals outside of the county, and in some cases outside of the state, a pattern he said is not sustainable and could lead to “those patients who most certainly do not have any hope of improving going ...thousands of miles away dying alone in a hospital.” Answer the following: Based on this situation if you were Jose Vasquez – what would you do? What options are available that may alleviate the situation? In Chapter 8 we learned about life and death issues, would any of those help in this situation? If so, which ones and how would they help?

The Affordable Care Act shifted payment from paying for quantity to paying for quality. All of the terms listed below are part of this shift. Explain each of the following terms, their key components, and the relationship between the terms:

• Value-Based Purchasing
• Total Performance Score (what are the domains)
• HCAHPS

If specific requirements are met, Medicare covers care in all of the following settings except:

1. What types of foods are fortified? Give an example.

2. In order for fortified foods to have their intended impact, what conditions are required?

3. Do consumers need to be aware that a food is fortified in order to receive benefits?

4. Are fortified foods necessarily good for us? Give an example of a fortified food that could also be high in added sugars, saturated fat, and sodium

5. Do you think food fortification is still necessary in the United States today? Why or why not?

• Even if you see ALL OF THE SUBJECTS in our theoretical blood glucose study have LOWER blood glucose after they take the medication, does that mean that the blood glucose worked?
• What other factors could be influencing a lower blood glucose among all the participants? Would those factors be confounders? Effect mediators?
• If you had to take into consideration all of those other factors, would you still do a t test?

Please discuss and evaluate the impacts and relationships between meaningful use objectives, HL7, the Joint Commission, and EMR systems.

Be sure to include strengths and weaknesses of each system as it impacts healthcare costs, quality, and access from two perspectives:

• Patient;
• Healthcare organization of your choice (hospital, skilled nursing facility, etc.).

The strengths and weaknesses of each system (regarding cost, quality, and access) should be based on your knowledge of business practices, ethical considerations, and research/evidence-based practices.

If you could explain in a few paragraphs that would be great, just enough for me to add more information into a paper. Thanks.