Question

A 74-year-old man was admitted to a nursing home for the first time following hospitalization for an exacerbation from heart failure, which is being controlled with Lasix 120 mg a day at this time. While the patient was in the hospital, he fell on the way to the bathroom and sustained a fractured hip, which required an ORIF. He had spinal anesthesia for the fractured hip.

He lives alone at home and has three grown children who live in the same town. He would like to return home. He has been widowed for 9 months. He had been married for 50 years and worked outside the home as a banker. His wife prepared all his meals for him.

During hospitalization, his dietary intake was 10 to 20% of the food provided. He did not receive any food from family or friends to offset his hospital meals. Since admission to the nursing home two days ago, he has eaten only 10% of his diet, which was a low-NA diet, mechanical soft (due to improperly fitting dentures). He was a 20-year smoker, one pack a day. He reports minimum alcohol intake.

He states that since his wife died, he has been leading a sedentary lifestyle, not going out very often. He reports no “real exercise” activities.

The Medications Discharge from Hospital:

• Digoxin 0.125 mg oral every morning
• Lasix 40 mg tid
• Nu-Iron 150 mg oral daily
• Hydrocodone and acetaminophen tablets, 5 mg/500 mg for pain

Answer these questions:

1. What additional subjective information will you be asking for?
2. What objective findings will you be looking for?
3. What laboratory tests do you think you want to order and why?
4. What factors are affecting this patient’s current nutritional and hydration status?
5. What recommendations would you make to alter his nutritional status?

Answer 1

1. The additional information that I shall be asking to the patient are listed below =

i) How you are feeling now?

ii) Tell me how many days you are admitted here in this hospital?

iii) When you fall on floor? At which time of the day?

iv) Do you have any previous fracture on bone?

v) How many days you are suffering from heart failure symptoms?

vi) Do you have any other injury at any other parts of your body?

2. The objective finding I am looking for are =

i. To monitor the vital signs of the patient.

ii. To assess the movement of the other joints.

iii. Cardio-pulmonary assessment findings.

iv. The nutritional assessment of the patient.

v. To provide treatment of other injuries.

3. The laboratory tests that has to be done are =

I) Blood electrolytes count has to be done as a orthopedic surgary will be performed.

ii) Complete blood count test has to be performed to find out the amount of the blood components.

iii) Blood urea creatinin leve has to determine to determine the kidney function.

iv) A X-ray study is required to assess the type and severity of the fracture.

4. The factors that affecting the patients nutritional and hydration status are may be as below =

a) His present illness may be affect vary much on his nutritional status. He is a patient of heart failure. His metabolism is slower than normal.

b) He is admitted in hospital for sevel days. It is not as like his home environment. May be the food is not like his home food.

c) At present he has a hip fracture and require a surgary. So, he has to stay in NPM (nothing per mouth)