Question

Ruby, an 86-year-old, thin, osteoporotic woman, gets up onto a stepstool to reach something on the top shelf of her cabinet. She loses her balance and falls onto her left side. She finds that she cannot sit up without pain. Her daughter later finds her and calls an ambulance to take her to the emergency department. Per radiograph, left femoral fracture is present. Surgery is scheduled for open reduction with internal fixation (ORIF). Blood clot prevention injections and pain medications are prescribed. Next, the patient is monitored for postoperative anemia and infection. After discharge, Ruby has rehabilitation for inpatient and then nursing home temporary care for 30 days. She is discharged to her daughter ’s home with home health and assistive equipment.

Today’s visit:

Chief complaint: “I am still recovering from my fall last month and now am staying at my daughter ’s but want to go home.”

Objective: Blood pressure (BP) 100/60 mm Hg, pulse 87, respiratory rate 20 breaths/min

1. How will you use the information to prepare for today’ s visit?

2. What additional subjective data are you seeking?

3. What additional subjective data will you be assessing for?

4. Are there any national guidelines you want to consult for the postoperative and rehabilitation care

of this patient with an ORIF related to osteopenia of the left femur?

5. What tests will you want to order as part of this follow-up visit?

6. Are there any new differential diagnoses you need to consider?

7. What is your plan of care?

8. What additional patient teaching may be needed?

9. Are there additional community resources to consider?

10. Will you be looking to add any referrals for this patient?

Answer 1

1. The nurse can use this information to make plans and interventions for the patient . The complaint patient has is she wants to go home so the nurse must make her understand it's been only a month ,she needs to take rest to recover fully . So, it's better to stay with her daughter .

2. Additional subjective data information that needs to be seeked is that does she have any issues staying with her daughter as she is complaining of going back to her house or she is missing her home .

3. Additional subjective data I will be assessing for is that I would assess the behaviour of the daughter with the Patient and the care given by her .

4. Postoperative and rehabilitation care :-

- Monitor :-

vitals

I&O

supervise respiratory activities - deep breathing & coughing

pain meds

observe dressing & incision for bleeding/infection

- there is potential for neurovascular impairment - assess

color

temp

capillary refill

distal pulses

edema

sensation

motor function

pain

- hip surgery - postop - to relieve edema

elevate leg when in chair

- hip surgery - postop - pain management

keep pillows (or abductor splint) between knees when turning

keep in proper alignment

sandbags & pillows used to prevent external rotation

- hip surgery complications - when

if an endoprosthesis was placed

risk for hip dislocation

teach patient hip precautions/demonstations

- hip surgery - PT

supervices active-assisted exercises

ambulation