Question

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

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

1. What are the patient priorities?
2. Identify and involve an inter-professional team that will be required to provide holistic care for Mrs. Jane.

Answer 1

Based on this Priorities for the nursing care involves

1. pain management
2. Improve nutritional status and dietry management
3. Manage the risk for infection related to urinary catheter
4. Social support to cope up with current situation
5. Health education regarding the risk and complication of smoking and marinjuana use

Inter professional team required to treat Mrs Jane.

• Physiotherapist have to involve for her passive and active exercise and support for her body alignment
• dietician for diet management regarding hypertension and diabetics. Also need to involve her nutritional management for the healing process . for eg: calcium rich foods .
• Social worker or counsellor for her mental support to cope up with the situations. She need a strong support from a professional worker . She needs to engage diversional therapies .Also she requires an education regarding the complication of her habits .
• Other than the orthopedician and general practioner the above mentioned team would be a great support for her holistic care and speedy recovery.