Question

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 a left total hip replacement.

Throughout the next 24 hours Mrs. Jarrot has increasing pain and begins to exhibit some confusion. She reorients easily to person and place, however the time and situational confusion resumes. She is wanting to get out of bed. Mrs. Jarrot frequently states, “Why can’t I get up? I’m tired of lying in this bed, it has been days.” She is reminded that she just had surgery and will be getting up tomorrow. After repositioning her and sitting her up to the side of the bed she still she continues to want to get up. Safety precautions have been initiated at this time.

Question 1

What is the best explanation for Mrs. Jarrot’s confusion?

Question 2

Thinking about National Patient Safety Goal for Catheter Associated Urinary Tract Infections (CAUTI) – When should the nurse discontinue the Foley? Why?

Question 3

What nursing interventions would you as the nurse implement for her comfort and confusion? Please list them with your nursing diagnosis.

Question 4

What education would be appropriate for her at this time and what teaching would be appropriate for her husband and family?

Answer 1

Answer 1

Some of the reasons for Mrs.Jarot's confusion are

• Old age can always has a chance to increase confusion in difficult situations
• Pain when not effectively controlled can lead to loss of mental thinking ability and lead to confusion

Answer 2

The Foleys can be discontinued when the patient is capable to remember things without any confusion.Here if the father is discontinued there is a high risk for pressure sore due to moisture if patient voids and unable to tell.Moreover the Foley's can be discontinued after clamp and release method to assess the bladder function post surgery. This is possible only when the patient is able to sense to feel the bladder fullness and request to release clamp. Otherwise this can also increase risk of infection.

Answer 3

Nursing Diagnosis

Acute pain (in hip ) related to surgical incision, fracture as evidenced by increasing pain and confusion secondary to surgery

Goal:

• The patient will have reduced pain
• Will regain memory function

Nursing intervention and rationale

• Assess the level of pain,baseline to plan for care
• Administer analgesics as oer order to relieve pain
• Reorient the patient continuously ,to ensure gaining memory
• Establish therapeutic communication to improve trust and relieve the fear ,tension,anxiety in the patient

Evaluation

The patient will have reduced pain

Nursing Diagnosis

Acute confusion related to age,trauma,cognitive alteration as evidenced by confusion of time

Goal:

The patient will regain cognition

Nursing intervention and rationale

• Assess the cognitive status to plan for care
• Ensure therapeutic communication to ensure trust
• Family can be involved in reorientation
• Underlying cause of confusion has to be treated

Outcome

Able to recognize the time and situation appropriately

Answer 4

The following education can be appropriate

• Cognitive training
• Family support and involvement by improving communication
• Instilling a s sense of hope in patient, that she is not alone