Fred is an 83-year-old male who is being admitted to the medical-surgical unit s

Question

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. 1. 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. 2. Considering this patien'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? 3. 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?

Explanation / Answer

1) The following plan care has to be initiated

Assess the level of pain as the score is 6 he has unbearable pain,so pain management to be done by giving proper rest,comfort, pain killer medication as per the order of physician.

Assess for risk of fracture as in old age people the bones are fragile and chances of breaking on fall happens.so check for swelling, redness, tenderness,inward or outward rotation of the limb ,X Ray as per order

Risk for delayed wound healing because of diabetes. So blood glucose has to be maintained in between normal ranges.

Risk for bleeding as he is taking Aspirin ( anti coagulant) the action lasts for 5 days ,so it has to be stopped if surgery planned

Risk for cardiovascular problem when anticoagulant are ceased

Risk for impaired skim integrity due to restricted movement so back care,change of position to be given.

2) The need of surgery is very important if its a fracture at any age depending on the risk factors and recovering period. He should be kept in intensive care unit after surgery for close monitoring and observation.

3)If its a fracture surgery is required, as per the illustration it seems to be a fracture so a correction is needed.

Pre op order:

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