Mrs. Schaffer is an 82-year-old obese female admitted to the rehabilitation center after undergoing surgery for repair of the right hip fracture from a fall at home. At 72 hours postsurgery, she is receiving morphine patient controlled anesthesia (PCA) for moderate post-operative pain, with results of reduction in reported pain. She has no significant past medical history and no known drug allergies (NKDA). Her DNR documentation specifies a full code. Mrs. Schaffer’s vital signs are: T 98.9°, P 70 and regular, RR 12 and unlabored, and BP 110/76, with a pulse oximetry reading of 97% on room air (RA). She rates her pain as 5 out of 10 and refuses additional medication. Mrs. Schaffer is reluctant to move around, stating that the pain is worse when she moves. She needs the assistance of one person to move from bed to chair. She has been ordering her own meals from the cafeteria but has not eaten more than ½ of the meal that is sent. Her morning tray included eggs with sausage and a slice of toast. Her fluid intake over the past shift was 200 mL in 8 hours and her output was 180 mL. On auscultation, she has hypoactive bowel sounds and her abdomen is slightly firm and tender to deep palpation. During the evening assessment, the patient informs the nurse that she “feels constipated” and that she has not moved her bowels in days.
Treatment Orders:
Physical Therapy for ambulation
Vital Signs q shift
Regular diet as tolerated
Intake and Output q shift
Incentive spirometer q 1 hr while awake
Complete Blood Count (CBC) and Basic Metabolic Panel daily
Medications:
Morphine (MS Contin) PCA 1 mg/hour basal with 0.4 mg q 10 minutes, with 4 mg/hr lockout
Enoxaparin (Lovenox) 60 mg SQ daily
Docusate (Colace) 1 capsule daily
Constipation is a term used to describe an abnormal infrequency or irregularity of defecation , abnormal hardening of stools that makes their passage difficult and sometimes painful , a decrease in stool volume , or retention of stool in the rectum for a prolonged period. Constipation is caused by certain medications example: Tranquilizers, anticholinergics, antidepressants, anti-hypertensives, opioids, antacids with aluminium & iron.
Some other causes include immobilization, weakness , fatigue, in activeness,chronic laxative usage , refrain defecation, low consumption of fiber and inadequate fluid intake , stress, lack of privacy also lead to constipation.
Here in Mrs. Schaffer case
Mrs. Schaffer is an 82-year-old obese female admitted to the rehabilitation center after undergoing surgery for...
You are assigned to Mrs. Z. a 72-year-old woman who fell at home and was admitted to your unit for a fracture of the right hip. She was alert and oriented on admission. After the initial workup, she was taken to surgery for an open reduction with internal fixation (ORIF) of her right hip. This is her first postop day. Her right hip dressing has a small amount of dried dark red drainage. Handoff Report for Mrs. Z: Patient has...
Carol Petros (C. P.) is a 77-year-old female admitted to the hospital 4 hours earlier after a fall at home caused by dizziness and weakness. She was initially brought to the emergency department by her daughter, who checked on her after not reaching her by phone. Her medical history includes hypertension, osteoarthritis, and a hysterectomy at age 50. She states that she has an allergy to penicillin, and she is full-code status. The patient has lived alone since the death...
Marilyn Hughes is a 45-year-old female who suffered a left mid shaft tibia-fibula fracture while slipping on icy stairs this morning. She was taken to surgery for an open reduction with internal fixation (ORIF). She returned from surgery 1345 hours. She has a below the knee splint dressing Vital signs have been stable and neurovascular checks have been within normal range. She has an intravenous of Normal Saline infusing at 75 mL/hour. She is tolerating liquids well without nausea. Her...
Marcella Schmidt (M.S.) is a 73-year-old, widowed female admitted to the hospital after a right hip fracture sustained when she tripped and fell in a parking lot. She had open reduction and internal fixation of her right hip 24 hours earlier. Her medical history indicates that she is in good health, with no other medical diagnoses. She is employed part time at the community library. She is allergic to penicillin and states she got hives all over her body when...
You obtain the following information from EPIC regarding your patient Mrs. Rodriguez. Mrs. Rodriguez was admitted to the hospital 2 days ago with a diagnosis of Hepatitis C. She is 43 years old, 5’3”, and weighs 140 lbs. She has a history of intravenous drug use but has not engaged in this behavior for over 10 years. Mrs. Rodriguez also has a history of angina. She came to the hospital complaining of severe right upper quadrant pain, nausea, and vomiting....
Susan Lee is a 60 year old female admitted to the medical surgical floor complaining of abdominal pain on and off for 4 months. Her complaints were constipation, bloating, abdominal pain and indigestion. Her CT scan diagnosed an abdominal mass. Susan’s past medical history includes COPD, Diabetes type 1, and vascular issues. Her medications include the following: Location: Medical Surgical Floor Susan is stable to leave the PACU. SBAR to the medical surgical floor is as follows, and you are...
Mrs. Brady is a 58 year old woman who is admitted to your unit post op from an ORIF (open reduction internal fixation) of the left hip. She is now three days post-op and has started physiotherapy. Her pain has been manageable since her surgery and she is keen to go home. Her Foley catheter was removed yesterday evening. You arrive for your day shift and find Mrs. Brady in the bathroom. She tells you that she feels as though...
Patient name: Sarah Grace 78 year old female admitted from emergency room at 1000 this morning with rib fractures from fall sustained while getting up to bathroom during night. Patient lives at home with her sister who is her primary caregiver. Admitted for PT and OT. Patient reports having generalized arthritis that she is taking ibuprofen on a regular basis. She has severe constipation and is taking multiple medications with minimal relief. Patient also reports history of hypertension and cardiac...
Mrs. Lydia Martin, an 88-year-old widow, lives alone in her single-story home. She prides herself in being fully independent. During the middle of the night, Mrs. Martin fell in her home while walking to the bathroom. She was unable to get up, so she crawled to the telephone and dialed 911. She was transported to the emergency department and underwent diagnostic tests including hip and femur x-ray and computerized tomography, which confirmed a left femoral neck fracture. Her past medical...
Mrs. Lydia Martin, an 88-year-old widow, lives alone in her single-story home. She prides herself in being fully independent. During the middle of the night, Mrs. Martin fell in her home while walking to the bathroom. She was unable to get up, so she crawled to the telephone and dialed 911. She was transported to the emergency department and underwent diagnostic tests including hip and femur x-ray and computerized tomography, which confirmed a left femoral neck fracture. Her past medical...