S----82-year-old Gertrude Miller was brought into the Emergency Department (ED) after slipping and falling at the nursing home last night.
B-----Evaluation in the ED revealed she had sustained a fracture of her right femur. She is scheduled for a total right hip replacement tonight at 6PM. She has a history of DM, HTN, CHF, GERD, cataracts, and is hard of hearing. She is widowed and her next of kin is a niece who lives in town.
A---Intermittent confusion to place and time. Breath sounds diminished. Buck’s traction is in place. Vital signs are: BP 128/74 Temp 98.4, HR 74, RR 16, and Pulse Ox 94%. Dilaudid was last given at 0430. Pain was reduced to a level 2. All other assessments are normal.
R—Monitor pain level, cognitive status, and neurovascular status.
What are three priority nursing interventions that are most beneficial for this patient.
What three topics could be addressed during preoperative education for this patient.
What is the purpose of Buck’s traction? What is one safety consideration? What are two advantages of this type of traction? What is a disadvantage to this type of traction?
What would be three fall prevention techniques that could be included in discharge education for this patient.
What is one fact about hip fractures in the older adult.
1. Pain management,skin integrity and traction care and fall prevention
2. Informed consent for the surgery, post operatives outcomes and rest, post operative exercises
3. Buck's skin traction is widely used in the lower limb for femoral fractures, lower backache, acetabular and hip fractures. Skin traction rarely reduces a fracture, but reduces pain and maintains length in fractures. Advantages: reduces pain, maintain the position of the bone.
Disadvantages: thromboembolism, general weaknes ,skin abrasions/ulcers, skin allergy, constriction of circulation, peroneal nerve palsy due to pressure from adhesive straps
4. fall prevention techniques: prevent slippery falls, side rails in the bed, assistance should be taken if needed.
5.Hip fracture is more common in older people. This is because bones become thinner and weaker from calcium loss as a person ages. This is generally due to osteoporosis. Bones affected by osteoporosis are more likely to break if you fall.
S----82-year-old Gertrude Miller was brought into the Emergency Department (ED) after slipping and falling at the nursin...
An 80 year-old male was transported by ambulance to the emergency department (ED) for evaluation after experiencing an unwitnessed fall in a local nursing home.The patient resided at the nursing home and had a medical history of severe dementia and osteoporosis.The patient arrived to the ED alone without family or staff from the local nursing home. Upon arrival to the ED, the patient was triaged by nursing staff. The triage documentation noted the patient’s vital signs were stable, that he...
An 80 year-old male was transported by ambulance to the emergency department (ED) for evaluation after experiencing an unwitnessed fall in a local nursing home. The patient resided at the nursing home and had a medical history of severe dementia and osteoporosis. Upon arrival to the ED, the patient was triaged by nursing staff. The triage documentation noted the patient’s vital signs were stable, that he was a poor historian and complained of “hurting all over”. After triage was completed,...
Mrs. Jarrot is a 78-year-old Caucasian female who was brought in to the Emergency Department after falling down three steps in her house. She says she is a bit clumsy and lost her balance. She lives at home with her husband and has 5 grown children that live nearby. She complains of severe left hip and her left leg is slightly shortened. An x-ray in the Emergency Department shows a left intracapsular femoral neck fracture. She is scheduled to undergo...
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...
THIS IS NURSING 454 UMSON: PATHOPHYSIOLOGY A 45-year-old person was brought to the emergency department (ED) by ambulance after collapsing at work. Coworkers report she had been "fine" all morning but then had problems speaking and "suddenly collapsed." When EMS arrived, she was breathing on her own, speech was garbled, and she did not move her right side. BP was 176/90 when she arrived in the ED. Total elapsed time from first symptom is 23 minutes. This patient continued to...
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...
A 66 Year old woman is brought to the Emergency Department (ED) complaining of rapid onset of Shortness of breath, stating “ I cannot catch my breath”She also admits to coughing and some blood tinges in her sputum’sand frequent cough almost every 30 minutes to an hour.Patient appear sweaty and warm.Appearing of distress and very uneasy.Pulse Oximetry reading from her index finger 89%,Temperature 98.4,Blood pressure 200/100, Pulse 100 beats/min, Respiratory rate 32, She states that she is 5 ft, 6...
A 19-year-old female arrives at the Emergency Department (ED) after participating in a contest to drink the most water. She drank 5 liters of water in about 2 hours. 911 was called when the student reported a headache and was confused. Upon arrival to the ED, a nursing assessment was performed and laboratory tests ordered by the healthcare provider were obtained. The patient reports a headache, abdominal cramping, and has orthostatic hypotension. The following laboratory results are reported: Sodium: 122...
Mr. McClaren is a 48-year-old man who is admitted to the emergency department (ED) with abdominal pain and general weakness. He reports that he drinks “one bottle of scotch whisky every week for the past one year, and one to two cans of beer during the weekends.” For the past three months, his condition has started to deteriorate. His wife claims that “he has not been eating well for the past three months”. Mr. McClaren reports he has passed dark...
John Mathis, a 73-year-old male, is treated in the emergency department (ED) for an infected wound on his right foot. John states he was walking barefoot and stepped on something sharp that cut his foot. He treated it with topical antibiotics, but it appears red and inflamed, with purulent drainage. John is admitted to the medical-surgical unit for inpatient wound care treatment. As part of the admission interview, the nurse asks Mr. Mathis and his wife how they would like...