Question

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 stent.

Home medications include:

Calcium +D 600mg daily

Tenormin 25mg po daily

Plavix 75mg po daily

Ibuprofen 400mg po 2-3 times daily

Multivitamin 1 tablet daily

Aspirin 81mg daily

Colace 100 mg po daily

Metamucil as directed one daily

Physicians Orders

Admit

CBC, CMP, UA,

Repeat CXR in AM

Oxygen protocol

Diet as tolerated

Activity as tolerated

Incentive Spirometer

Tylenol 325 mg 1 or 2 po q 4 hours prn pain

write a care plan with the scenario

Answer 1

1. Fracture Management

Broken ribs heal on their own. Bed rest is advised. Support to the ribs such as orthopedic bed is advised. Patient sister to be with her to take care of her. X rays , CT scan to be taken to assess rib, lungs damage. If pain is associated with breathing, it is dangerous which may lead to pneumonia and death. Elastic bandages can help in the affected area. Check whether the fracture is simple or compound. Sometimes a portion of rib will be broken and injure the lungs causing escape of air leading to pneumothorax. So remove excess air from chest cavity.

2. Pain management:

Acetaminophen can be taken depending on the severity of the pain. Pain may be present for 6 weeks to 6 months.

3. Check for other organs such as lungs, aorta, spleen, liver etc for laceration or damage.

4. Breathing exercise to be advised.

5. Fiber rich diet to be given to the patient to reduce constipation. we can increase from 100 mg to 400 mg a day to see good result.

6. Oxygen protocol to be followed as per the saturation limit of oxygen which should be always greater than 90%.

7. worst complication could be ARDS. So need to take care by ABG monitoring.

8. biphosphonates, Forteo, Denosumab, hormone like medications can be given.