Question

The client is a 72 year old gentleman who lives with his wife and is a part-time crossing guard at the local elementary school. He is in relatively good health. His only complaint is osteoarthritis in his hands and knees for which he takes NSAIDs prn. He fell walking up the stairs to his bedroom at home. He presented to the ER with a fracture of the right hip and underwent on open reduction and internal fixation repair (ORIF). He has been discharged from the PACU and is now on the orthopedic surgery floor to recover from surgery prior to discharge to a rehab facility. Currently, his vital signs are stable, his dressing is dry and intact, his pain is controlled well with the prescribed narcotic analgesics, and he is continent of bowel and bladder. He is alert but confused and disoriented to place and time. His wife states that he never had this problem before surgery. 1. Identify the complications of immobility that he is at risk for in at least 5 body systems. List at least three nursing interventions for each body system individualized for him in order to prevent these complications. 2. Based on your answers in the question above, list three nursing diagnoses specifically written for this client that will apply during his stay in the hospital. Which do you consider the priority for care and why? Discuss how there might there be competing priorities.

Answer 1

1. Complications of immobility in body systems and interventions

            * Integumentary system

                            * immobility result in increasing pressure over the skin in bony prominances of

                              the body result in pressure ulcers.

                           * Poor circulation to the integumentary system due to immobility result in changes

                             in skin integrity

         Interventions

            * Body massage between 2 to 4 hours to maintain good circulation and skin integrity.

            * Changing position every 2 hours to avoid chances of pressure ulcer.

            * Give ROM(Range of motion) exercises to patient to avoid complications.

* Cardiovasular system

           * Venous thrombosis.

       * Decreased cardicac output due to poor circulation.

           * Increased heart rate to maintain cardiac output.

   Interventions

               * Daily physiotherapy to improve circulation.

               * Increase fluid intake to maintain fluid volume in the blood.

               * DVT stockings to avoid venous thrombosis.

    * Musculoskeletal system

              * Muscular atrophy.

              * Muscle weakness.

              * Contractures.

Interventions

             * ROM exercises to improve muscle strength.

             * Protein rich diet plan for the patient.

             * Regular physiotheraphy.

    * Gastrointestinal system

             * Decreased gastric motility.

             * Constipation.

             * Gastrointestinal obstructions.

   Interventions

              * Postion change every 2 hourly to increase GI motility.

              * soft diet planning for easy digestion .

              * Increase intake of fluids to avoid constipation.

      * Urinary system

              * Urinary retension.

              * Urinary tract infections.

              * Renal caliculi.

          Interventions

            * Increase fluid intake to maintain normal renal function.

            * Maintain hygineic practices to avoid infection.

              * Pelvic exercises during physiotheraphy.

2. Three nursing diagnosis for this patient

              * Risk of Impaired skin integrity related to immobile status of the patient.

              * Risk of infection related to prolonged hospital stay.

              * Imbalanced nutrition related to inadequate intake of nutrients.

* Pressure ulcer is a common problem of patient with immobility because skin is the largest organ

which give first line defence against various type of infections so any injury happening on the skin

   become an opening for pathogens to enter into the body and cause local and systemic damage

result in worsening of present health status of the patient thats why i give first preference to skin

care.

* Maintain adequate nutritinal pattern and infection control sterile practices make the patient recovery

become fast.