Question

Mr. Lewis is a 88-year old man brought to the emergency room by his daughter after finding him in his bedroom, lying on the floor beside his bed. Mr. Lewis is in obvious pain. He is wheeled into the ER by his daughter. He is moaning and rubbing his right leg. Pausing after every few words to catch his breath, he tells the nurse, “My leg is killing me. It keeps tightening and releasing. I cannot stand on it. It hurts terribly.” Mr. Lewis is assisted by the staff to a stretcher. When asked what transpired at home Mr. Lewis remarks, “ I had just gotten out of bed to go to the bathroom. The next thing I know, I was lying on the floor next to the bed in terrible pain. I think I blacked out. The last time I blacked out, it was because of my vertigo. I haven’t had problems with that in years. I don’t even take medicine for that anymore. I had all of my medicines last night before bed. I am usually healthy as a horse.” The daughter has brought in Mr. Lewis’ bottles of lisinopril, lasix, and lipitor. She tells the staff that her dad has been living alone since the passing of her mother 10 years ago, and that she goes by every morning to check on him.

Client Assessment

While assessing Mr. Lewis, the nurse notes that his right leg is markedly shorter than his left one. He also has edema to the right hip/thigh area. His breathing is labored, only when he experiences spasms in his right thigh. He is afebrile. His vital signs are: B/P 162/98, HR 108, RR 24, and his O2 Sats are 96% on room air. He rates his pain 8/10 at rest, but 10/10 with movement of the right leg or spasms. Xrays are obtained. Mr. Lewis is given Morphine through a heplock placed in his left forearm. Mr. Lewis’ past medical history includes severe seasonal allergies, hypertension, hyperlipidemia, vertigo and arthritis. He has no known drug allergies. His leg is placed in #10 buck’s traction and he is transferred to the orthopedic unit.

  1. Assuming that Mr. Lewis’ vertigo is not a factor in this present situation, develop a teaching plan with at least 4 patient education strategies to help decrease Mr. Lewis’ risk of this happening again.

Evaluate

  1. State your rationale for each of the 4 patient education strategies.
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Answer #1
SL NO EDUCATIONAL STRATEGIES RATIONALE
1

Provide safety by using walking aid , calling bell and keep the light at night

reduce the chance of additional injury and to reduce independent activity
2 Assess the patient for auditory and visual deficit, if necessary assist the patient with the use of sensory aid Diminished vision and auditory aquity frequently occurs with aging, glass and hearing aid may increase patient ability to interact with environment
3 Take medicine as per prescribed and do regular follow up reduce the chance of further compliations
4 Offer encouragement and support exercise once get stable Recoorinating exercise can be uncomfortable and fatiguing, encouragement help the patient to comply with it
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