NR 305 Week 7 Discussion – Assessment Techniques

NR 305 Week 7 Discussion – Assessment Techniques

First, I would stabilize Fred and provide immediate treatment if necessary. Check his vital signs, postural blood pressure, apical HR, and finger stick glucose. By looking at his medical history and his current condition, lab tests like CBC, urinalysis, pulse oximetry, electrolytes, and EKG should be performed. Risk factors related to medical conditions or medication use may be reflected in abnormal values, so keeping a close check on labs is key. Also, check to see if he took his current medications today and what time. I would suspect that Fred had a fracture after his fall. While in the ER, since his pain was not relieved with Morphine, I would talk with the doctor if he could possibly order another pain medication to control his discomfort or just up the dosage. Find out exactly where his pain is located and give him an ice pack if desired. When assessing Fred, it will be a thorough head-to-toe exam and will focus on the musculoskeletal system. We would focus on his right side since he landed on that side when he fell and examine his face, knee, and right leg. If a fracture is suspected in his right leg, we will immobilize it in the position found. “Fractures cause sharp pain that increases with movement” (Jarvis, 2016). Performing an x-ray to figure out what type of fracture he has is important. This will help determine if he has a fracture in his face or leg.

The concerns that I have with Fred and his potential need for surgery would be the risks of blood clots or bleeding out. He has a risk for bleeding due to the use of Aspirin and Plavix daily, which are blood thinners. And you must be cautious with people who use these types of medication and the planning of surgery.

NR 305 Week 7 Discussion – Assessment Techniques

Making sure to stabilize coexisting medical problems and minimize respiratory and cardiovascular functions is important before surgery. Mortality after hip or leg fracture ranges from 14- 36%, with cardiovascular disease being the most common cause, followed by infection and pulmonary embolism (Sandhu, Sanders, & Geraci, 2013). Since Fred has a potential risk factor of bleeding, most likely, the doctor will order clotting factor labs PT, aPTT, and TT. We would make sure he is NPO in case of surgery. Preoperative elements that require correction before any type of surgery would be dehydration, hypovolemia, anemia, hypoxia, electrolyte imbalance, and arrhythmias.

References

Jarvis, C. (2016). Physical examination & health assessment. (7^th ed.) Philadelphia, PA: Saunders. p. 586

Sandhu, A., Sanders, S., & Geraci, S. A. (2013). Prognostic value of cardiac troponins in elderly patients with hip fracture–a systematic review. Osteoporosis International: A Journal Established As Result Of Cooperation Between The European Foundation For Osteoporosis And The National Osteoporosis Foundation Of The USA, 24(4), 1145-1149. doi:10.1007/s00198-012-2116-5

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NR 305 Week 7 Discussion – Assessment Techniques

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 a rationale for your

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?