Question

Orthopedic Nursing

Patient Scenario

Mary Jane is an 81-year-old woman was admitted to hospital after a simple fall, complaining of hip pain and inability to walk. The affected right leg appeared internally rotated. Passive motion was painful, and active movement was impossible secondary to pain. The patient has several chronic medical problems including as DM, Hypertension and Ischemic Heart Disease. Treatment in the Accident and Emergency Department was centered around her diagnosis of a fractured right femur. She lives in a nursing home, although she was independently ambulant. She has now been admitted to your Orthopedic Unit for further management.

Chief Concern:

• Severe, sharp pain on movement 9/10
• Inability to bear weight, sit-up or ambulate

PHH (Past Health History):

• appendectomy age 15, fractured clavicle age 19.
• laminectomy (L4‐5) 17 years ago due to a work-related injury.

Medications History:

• acetaminophen 500 mg PO q6h
• Insulin 70/30 12units SC, AM and PM
• Enalapril 10mg PO BD
• Atenolol 25mg PO OD
• Aspirin 81mg PO OD
• Calcium 600mg PO OD

Physical Exam:

• BP 160/94 P 103 regular R 24 T 37.2
• Conscious and alert but appears anxious, GCS 13/15
• Height 188 cm, weight 118 kg
• IVF in progress, 0.9% Nacl to left anti-cubital fossa
• Skeletal Traction to right leg with 15 pounds weights in place
• Urinary catheter in situ, on free drainage
• TED stocking in place to left lower limb

Social History:

• Trinidadian born, graduated form 5 high school
• worked on an assembly line in manufacturing company; is physically demanding
• smokes 1pk/day x 18 years, occasional marijuana use; drinks beer ~ 2/week.
• recently lost a long‐time friend at the nursing home to cancer
• spouse died 8 years ago (MI)
• no children, 1 sister alive she lives abroad

Family History

• Mother died of heart disease
• Father died of prostate cancer

Assignment

1. What is the nursing considerations/management for this patient?
2. Develop a plan of care for Mrs. Jane, (utilize 2 actual and 1 potential nursing diagnosis).

Answer 1

Nursing consideration of Mrs Jane involves  

• pain management
• nutritional status and diet management
• social support to cope with current situations
• Prevent the risk of infection related to urinary catheter
• Health education regarding the risk and complication of smoking and marinjuana usage.

Plan of care Mrs Jane

Acute pain related to fracture

• assess the severity of pain and examine the affected area.
• provide comfotable position for her with additional pillows and supportives.
• administer analgesucs as prescribed by the doctor.
• Privide diversional therapies for her to deviate and relieve pai n.
• assist her in daily activities and support her.

Anxiety related to medical condition.

• Provide a calm and quiet atmosphere for her.
• arrange a social worker for her to support
• ensure her about the speedy recovery
• make sure her regarding the health care system and availability . eg: calling bell for any time.

Risk for infection related to urinary catheter.

• asess the catheter site daily for any signs of infection
• Make sure regarding catheter care twice daily .
• Check the urine consistency and inform doctor whenever necessary .
• If require do urine riutine and culture as advised.
• Provide adequate amount of water.
• remind to change cather after 7 days .