This week’s graded discussion topic relates to the following Course Outcomes (COs).

CO1 Utilize prior knowledge of theories and principles of nursing and related disciplines to explain expected client behaviors, while differentiating between normal findings, variations, and abnormalities. (PO 1)
CO2 Recognize the influence that developmental stages have on physical, psychosocial, cultural, and spiritual functioning. (PO 1)
CO3 Utilize effective communication when performing a health assessment. (PO 3)

Fred is an 83-year-old male who is being admitted to the medical-surgical unit status post fall. He is alert and oriented and reports that while visiting a local casino with his wife Margaret earlier this evening, he tripped over a curb and fell landing on his right side. After receiving morphine in the emergency room prior to transfer to your unit, Fred is rating his pain at 6/10. He has multiple bruises from his jawbone to his knee as well as a slight rotation of his right leg.

Past medical history includes: myocardial infarction (MI) x 2, peripheral vascular disease (PVD) with bilateral iliac stents, non-insulin-dependent diabetes mellitus (NIDDM), sleep apnea, and degenerative joint disease.

Medications include: aspirin, Plavix, Lopressor, Lisinopril, and Metformin.

After reviewing the above scenario please answer the following questions.

Based on the information provided, how will you prioritize your care, what assessments will you include and in what order? Please provide rationale for your response.
Considering this patient’s age, injury, past medical history, and list of current medications, what, if any, concerns do you have related to his potential need for surgery?
Should surgery to repair his right femur be required; what type of clearance and pre-op orders would you anticipate receiving related to his diet, meds, lab work, and so on?

Solution:

Based on the information provided, how will you prioritize your care, what assessments will you include and in what order? Please provide rationale for your response.

As soon as I receive Fred under my care I would obtain a set of vital signs and compare it to the last reading and note any changes especially since he was given morphine prior to transfer and a side effect is it can lower blood pressure. I’ll ask him to rate his pain from 2-10. Also ask, where is the pain? What it feels like? What makes it worse? If it radiates?

Assess range of motion of the affected extremities, “Limitation in ROM is the most sensitive sign of joint disease” (Jarvis pg.590). check radial and pedal pulses and compare each side, note color of the skin, temperature, edema,” Presence of swelling is significant and signals joint irritation” (Jarvis pg.589). Offer ice packs, heat packs, or repostiioning to make him comfortable.

I would assess his level of consciousness, PERRLA, and examine his head for injuries. Even though he was alert and oriented in the ER, there could have been a change from the time he was transferred. In my facility, if a patient is status post fall neurological assessments are implemented every two hours.

Considering this patient’s age, injury, past medical history, and list of current medications, what, if any, concerns do you have related to his potential need for surgery?

One of my concerns is that Fred is on Plavix and he has an increased risk for bleeding and it must be stopped 7 days before if surgery is considered. Also, since he has a history of stents…Please click the Paypal icon below to purchase full solution for only $5