Question

care for this patient. Two (2) actual problems and One (1) potential
problem.
DUE: 16 th OCTOBER 2020

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
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.
3. Briefly explain how a femur fracture is diagnosed.

Answer 1

1.As the patient is suffering from fracture, our primary concern is to treat fracture. As the patient is completely bed ridden due to fracture we need to take care of pressure point to prevent pressure ulcers. We also need to take measures to prevent DVT (deep veanous thrombosis) by taking measures like applying stockings on other limb.

Next we also need to make sure that patient takes her regular medications as she is a known diabetic, hypertensive and heart patient, or else this can land her in major issues.

Also we need to provide her psychological support as she is having emotional trauma as she don't have any one to support her and recently she lost her friend and has no immediate family members to take care of her.

2.The multidisciplinary team to take care of Mary should include an orthopedeic doctor as her primary diagnosis is fracture. General physician to take care of her diabetes and hypertension. Cardiologist as she has ischemic heart disease. Nurses, a Psychologist is also needed to be part of her treatment team as she needs psychological support also.

3.Usually femur fractures are diagnosed basing on X-ray of hip.

But if doctor cannot see any thing in X-ray and patient still experiences pain in hip, then in such cases MRI or bone scan are performed to detect any hairline fractures.