Question

1. You are a nurse preparing to receive a new patient, fresh from surgery, to your unit. The patient is a 71-year-old man who underwent a surgical repair of a fractured femur. As you receive a report from the postanesthesia recovery unit, you learn that his medical history includes hypertension, 40 pack-years of smoking, and COPD. His surgical repair was successful but complicated by excessive bleeding, and he is receiving IV fluids to compensate. He is widowed, and his three children are scattered throughout the United States. He lives alone, receives Meals on Wheels, and pays a cleaning service to keep his home clean. (Learning Objective #6)
   1. What data in this scenario are pertinent?
   2. What potential collaborative problem(s) could be applicable in this situation?
   3. Which nursing diagnoses would you expect to be applicable regarding the medical procedures in this situation?
   4. Which nursing diagnoses would you expect to be applicable regarding the nursing/medical history in this situation?
   5. Which nursing diagnoses would you expect to be applicable regarding the discharge planning in this situation?

Answer 1

a) Data that are pertinent:

• Present surgical history: repair of fractured femur
• Past medical history: Hypertension and COPD
• Habits: smoking
• Age: 71 years old
• Marital status: widowed, lives alone
• Complications post surgery: Hemmorrhage
• Treatment: IV fluids

b) Potential problems include:

• Loss of muscle strength
• Pain
• Pressure sores
• Infection
• Blood clots
• Respiratory complications
• Social isolation
• Risk of fall if unattended

c) Nursing diagnosis after medical procedures that is post surgery of fractured femur :

1. Fluid volume deficit related to loss of blood post surgery
2. Acute pain related to surgical incision
3. Impaired physical mobility related to surgery and fractured femur
4. Risk for impaired gas exchange
5. Risk for infection

d) Nursing diagnosis regarding medical history of patient: HTN, COPD

1. Ineffective breathing pattern
2. Impaired gas exchange
3. Decreased cardiac output

e) Nursing diagnosis for discharge planning:

• Self care deficit related to physical immobility
• Deficient knowledge related to home care management
• Risk of infection
• Risk of trauma:fall
• Risk of impaired skin integrity: pressure sore