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
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).

Answer 1

Inthis case

(1) Acetaminophen is Anti-inflammatory

(2) Aspirin is Pain killer

(3) No antibiotic given.

Nursing considerations will be

(1). Support to leg

(2). Psychological support

(3) intake ,output chart maintenance

(4). Maintenance of personal hygiene

(5) care of catheter

Nursing care plan will be

(1) potential diagnosis are

1. Inability of movement due to fracture

2.psychological trauma due to past demice history of relatives.

(3). Need for personal hygiene

(II) interventions:

(1). To provide support to the fractured leg as per doctor orders.

(2) Provide medication as ordered ..

(3) monitoring of vitals

(4) monitoring of intake and ouptput of the body.

(5) care of the catheter

Evaluation::

(1) pain of the patient reduced

(2) personal hygiene of the patient maintained

(3) intake and output of the patient maintained

(4) catheter care given to avoid unnecessary infections.

Short term goals :

(1) To provide releif from pain

(2) protection against infection in the hospital

(3) maintaice of hygiene

Long term goals

(1) Provide accurate information regarding the treatment

(2). To give psychological support to the patient .

(3) Follow up as per the orderes