Question

Case study. Just respond the questions at the end of the case study.

SBAR Report:

S: Mrs. Davis is an 85-year-old white female who was admitted last evening after falling and fracturing her hip. X-rays have been taken and show left intertrochanteric hip fracture. Mrs. Davis is scheduled for surgery in 2 days.

B: Mrs. Davis has a 10-year history of osteoporosis and was newly diagnosed with congestive heart failure last year. Her daughter reports that recently Mrs. Davis has been having dizzy spells, fatigue, and weakness. Mrs. Davis lives alone and is usually able to perform all her ADLs independently. She does have a cane at home but often times refuses to use it because she “doesn’t think she needs it”. Mrs. Davis is usually pretty active, but has been much more sedentary lately due to increasing weakness and fatigue due to medication non-compliance with her heart failure medications.

A: Mrs. Davis is AOx4 and her vital signs are stable. Her pain level is currently a 7 out of 10, and she describes is as “throbbing and aching” in her left hip. Often times Mrs. Davis will moan or cry out in pain, especially whenever she needs to be moved in bed. She is very resistant to let anyone touch or move her left leg. The skin is intact; color and sensation around the hip area are within normal limits. A Morse Fall Scale assessment was completed on admission, and her score was 45. Fall precautions were implemented. Mrs. Davis has limited ROM in her left hip and her muscle strength in her left lower extremity is weak at a 2/5. Mrs. Davis has been having some episodes of urinary and bowel incontinence since being admitted to the hospital. She frequently needs to be reminded that she cannot get out of bed due to her activity restriction.

R: You will need to reposition Mrs. Davis as she needs to be turned every 2 hours. You should perform a focused musculoskeletal assessment, reinforce safety, and provide patient education on fall risk. Assess her pain level and medicate for pain if needed.

Medication:

Enoxaparin sodium

Docusate sodium

Morphine sulfate

Metoprolol

Furosemide

Overal Summary:

Mrs. Davis is an 85-year-old white female with a history of osteoporosis. She lives at home by herself where she fell and broke her left hip yesterday evening, after having complaints of dizziness, weakness, and fatigue. She is scheduled to have surgery in 2 days

Diagnosis: Left hip fracture

1. Come up with tree nursing diagnosis

2. identify, signs, symptoms, subjective and objective for each diagnosis

3. identify two outcomes for each diagnosis

4. identify two or three interventions for each diagnosis

Answer 1

Question 1

Solution

Question 2.

Solution

Signs and symptoms of congestive heart failure

1. Dyspnea during activity or lie down.

2. Sudden Fatigue and weakness.

3. Edema in the lower part of the body specifically ankle or feets.

4. Irregular heartbeat.

5. Consistent coughing

6. Reduced ability to work

Objective Diagnosis

Patients with congestive heart failure present these clinical profiles

1. Volume overload that is evident as pulmonary or systemic congestion.

2. Evidence of hypotension and abnormal end-organ perfusion which is a consequence of low cardiac output.

3. Both Volume overload and systemic hypoperfusion.

Subjective diagnosis

1. History: Symptoms and the etiology including Coronary artery disease (CAD), Diabetes, Hypertension, Dyslipidemia, other heart disease or Obesity.

2. prevalence of occurance: Shortness of breath or breathlessness, Fatigue, edema and weight loss

3. Physical examinations including different tests

Outcome

Signs and symptoms of hip fracture

1. Severe pain in the groin area or hip region

2. Stiffness or swelling in and around the hip

3. Inability to lift resulting in immobility after the fall.

4. Size of leg reduced on the side of injury.

5. External rotation occurs in the injured leg

Objective diagnosis

1. Plain radiograph signifies the hip displacement

Subjective diagnosis:

1. Physical examination and MRI for actual position of the hip bone and surrounding injury extention.

Question 3.

Solution

Outcome of Congestive heart failure

1. Dyspnea, chronic cough or wheezing, edema in lower part, nausea and vomiting, a high heart rate, and impaired thinking

2. Increase morbidity and mortality

Outcome of hip fracture

1. Increased dependency for mobility and a decreased physical activity and subsequent quality of life.

2. Bed sore, lung infection or urinary tract infection which results in increased mortality rate

Question 4.

Solution

Intervention for heart failure

1. Monitoring the vital signs of the patient

2. Diet modification.

3. Physical examinations, medical interventions and oxygen support

Intervention for hip fracture

1. Maintain bed rest or limb rest as indicated.

2. Provide support of joints in the fracture site, especially when turning by side.

3. A bed board under the mattress or orthopedic bed must be provided.