A 90years old female is brought to emergency room due falls at home sustained left hip fracture. Full code.weight 80lbs,Height 5feet 8inches.Alert and oriented x3. Primary diagnosis: Fall,left hip fracture. ( Nondisplaced, Conservative treatment)Secondary diagnosis: Hypertension, Asthma, High cholesterol. History of previous visits to Emergency room two days ago. Medical insurance still the same.Risk for fall yes.Patient does not have advance Directive. Copy of advance Directive is on patient chart. Low Braden scale. Transportation method is stretcher. Suicidal risk No.Allergy: NKDA. Diet: Regular diet. Glucerna shake 1can tid.Vital Sign:Bp 110/75,Pulse 88,Respiration 20,Sp02 95%F.0.9NS at 50ml/hour IV right forearm 20guage clean, dry, intact. Echocardiogram. Laboratory tests CBC with differential and Chem 7 in am.Medication Reconciliation done.Skin intergrity impaired: No.
Medications: Norco 5/325mg 1tablet po Q4hours prn moderate pain Morphine Sulfate 2mg IV Q6hour prn severe pain. Lovenox 30mg SubQ Q24hours. Kefzol 1gm IV Q8hours scheduled. Aspirin 81mg po Qday 09am scheduled. Colace 100mg po Bid scheduled. Metoprolol 10mg po daily.Hctz 12.5mg po daily scheduled. Refused SCD doctor notified.Patient on Lovenox and Aspirin. Orthopedic surgery consult. Physical therapy/ Occupational therapy for evaluation and treatment. Laboratory tests in am.
Discharge plans: Patient will be transferred to Rehabilitation center for short term rehab. Please follow doctor orders and your hospital policy and procedures.
2.CASE SCENARIO:MVA DISPLACED STERNAL FRACTURE, FRACTURE OF L3,4.FRACTURE OF TWO RIBS ON THE LEFT SIDE OF CHEST.
A 85years old female is brought in by ambulance due to motor vehicle accident. Displaced sternal fx, abrasion and contusion on the left side.Alert and oriented x2.( Placed in sitter room) Full code.weight 110lbs ,Height 5feet 5inches.Standard Precautions. NKDA. Hx of irregular heart beat,Spinal surgery, Hernia repair. Standard Precautions. Fall risk assessment done and Fall prevention protocol in place. Suicidal risk: No.Do patient have advance Directive : No.Copy of advance Directive on the chart. Transportation method is bed.Diet: Cadiac Heart health diet. Laboratory results: WBC 8.5.H/H 12.0,37.2. NA 138,K 3.9. Vital Signs Bp 109/65,Hr 60,Respiration 18,Sp02 98%f on RA.
Discharge plans: Discharge home with family when medically stable.
Questions 1.It is recommended to limit salt intake as an initial nonpharmacological treatment for high blood pressure because?
.A. It will help reduce water retention and decrease vascular volume.
B.It decrease glomerular filtration.
C. How you to lose excessive weight.
D.It will reduce Renal blood flow and increases cardiac output.
2.What is the ability of the heart to generate its own impulse called?.
Correct answer C.
3.When will lovenox be given after surgical intervention?.
A.To be given 24hours after surgery. B.Immediately after surgery.
Correct Answer A.
4. What are the common complications after hip fracture on older adults?.
Correct Answer is Blood clots which can lead to pulmonary embolism and can be deadly.
5.Why is Physical therapy treatment needed after surgery?.
C.Reduce inflammation, maintain circulation, restore joint mobility and strength.
D.All of the above.