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.

Identify

1. Based on Mr. Lewis’ physical assessment, identify the possible medical diagnosis (or diagnoses) for the symptoms he is exhibiting. Specifically identify two possible triggering agents for his condition. This means what part of his medical history or background could lead him to being in the condition he is in.

Collect

2. Collect at least 4 signs and symptoms that indicate that Mr. Lewis is in need of emergent care and that he needs admittance for further evaluation.

Analyze

3. Based on the collected data, in order of priority, provide three nursing diagnoses that are appropriate for Mr. Lewis. Each diagnosis must be written in three-part format (R/T, AEB).

Develop

4. 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

5. State your rationale for each of the 4 patient education strategies.

   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.

   Identify

6. Based on Mr. Lewis’ physical assessment, identify the possible medical diagnosis (or diagnoses) for the symptoms he is exhibiting. Specifically identify two possible triggering agents for his condition. This means what part of his medical history or background could lead him to being in the condition he is in.

7. Collect

8. Collect at least 4 signs and symptoms that indicate that Mr. Lewis is in need of emergent care and that he needs admittance for further evaluation.

9. Analyze

10. Based on the collected data, in order of priority, provide three nursing diagnoses that are appropriate for Mr. Lewis. Each diagnosis must be written in three-part format (R/T, AEB).

11. Develop

12. 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.

13. Evaluate

14. State your rationale for each of the 4 patient education strategies.

Answer 1

I. Femur fracture and its associated pulmonary function complications are the causative factor of the symptoms that the patient is facing. Triggering agents are the past history of vertigo which led the patient to have a fall once after getting out if bed followed by femur fracture which was caused by weak bones due to ageing factors such as arthritis.

II. Signs that warns medical emergency are femur fracture characeterised by Rt leg shortening, acute pain, tightening and releasing nature, dyspnoea indicated by increased respiratory rate, high BP etc. also to rule out pulmonary and fat embolism that is caused by femur fracture.

III R/T AEB

Nursing Diagnosis 1: Fracture of femur

R/T fall & after blacked out

AEB: Acute & severe pain of Rt leg, Swelling of Rt hip area, Rt leg shortening.

Nursing diagnosis 2: Pulmonary complications:

R/T : Severe Dyspnoea

AEB: Labored breathing, Increased RR.

Nursing Diagnosis 3: Vertigo

R/T past history

AEB : Fall after awakening and blacking out

IV: Patient education strategy:

To take medicines for vertigo

To sit for sometime on bed after waking up

To take medicines for arthritis

To take calcium supplements