Question

An 83-year-old man is admitted through the emergency department after being found lying on the floor inside his home. He had fallen three days prior after tripping over rug in his kitchen. The local police department found him after the neighbors requested a welfare check. He was unable to reach food or water, head a large laceration to his forehead with dried blood, was incontinent of urine and stool, and had noted shortening and rotation to his left leg. Upon arrival to the ED, he was disoriented to person, place, and time, was very lethargic, and moaned with any touch to his left leg. X-rays revealed a left hip fracture. His lab work showed a low hemoglobin. An intravenous infusion of normal saline was initiated, and the orthopedic surgeon ordered the patient prepped for surgery. His family has been notified, but they live 5 hours away. What interventions should be completed prior to sending to the patient to OR? What potential complications should the healthcare team expect? Surgery was uneventful and the patient is taken to PACU. Upon arrival to PACU, vital signs are 98/68, 101, 16, 97.2oF. He briefly arouses to stimulation. Oxygen is being administered at 4L/NC, and LR infuses well at 100 mL/hr. His indwelling catheter is patent with approximately 50 mL dark yellow urine. The Hemovac drain to the left hip is compressed with a small amount dark red drainage. His dressing site is dry and intact. At 45 minutes into the PACU stay, the patient’s vital sign are 90/58, 115, 10, 97oF, he moans with tactile stimulation, the urine amount remains about 50 mL, the Hemovac drain has approximately 200 mL dark red drainage, and his dressing is ½ saturated with dark sanguinous exudate. Dark purple bruising is evident to the left thigh. What complications is this patient experiencing? What interventions should the nurse implement?

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Answer 1

Before sending patient to OR :

• Get details about patient
• Get details on how injury occured
• Detailed physical examination
• Blood tests, chest xray ,ECG ,urine analysis
• Anaesthesia test dose
• Permission for surgery from patient or relatives.

Potential complications :

• Consciousness of patient
• Lethargy
• Blood clots
• Infection
• Change in leg length
• Swelling,fever,chills
• Post operative delirium
• Blood loss and anaemia