Preview

Case Study #35

Better Essays
Open Document
Open Document
1346 Words
Grammar
Grammar
Plagiarism
Plagiarism
Writing
Writing
Score
Score
Case Study #35
Case Study #35Case Study #35Scenario
S.P. is admitted to the orthopedic ward. She has fallen at home and she has sustained an intracapsular fracture of the hip at the femoral neck. The following history is obtained from her: She is a 75-year-old widow with three children living nearby. Her father died of cancer at age 62; mother died of heart failure at age 79. Her height is 5’3 and weighs 118 pounds. She has a 50 pack year smoking history and denies alcohol use. She has severe Rheumatoid Arthritis (RA) and had an upper GI bleed in 1993 and had Coronary Artery Disease with CABG 9 months ago. Since that time, she has engaged in “very mild exercise at home.” Vital signs are 128/60, 98, 14, 99 degree farenheight (32.7 degrees C) SAO2 94% on 2 Liter per nasal cannula. Her oral medications are rabeprazole (Aciphex) 20 mg/day, prednisone (Deltasone) 5mg/day, and methotrexate (Amethopterin) 2.5mg/week.
1. List at least four risk factors for hip fractures.
Four risk factors for hip fractures are history of smoking, being a female, and a frail build. Another risk factor is the client’s age, “Women who are postmenopausal had significantly increased risk of hip fracture.”(Tang, Chong, & Xu, 2013, p. 11)Case Study Progress
S.P. is taken to surgery for a total hip replacement. Because of the intracapsular location of the fracture, the surgeon chooses to perm an arthroplasty rather than internal fixation. The post-operative orders include:
Cefazolin (Kefzol) 1000mg IV q8h x 3 doses
Enoxaparin (Lovenox) 30mg subcut q12h
Warfarin (Coumadin) 2.5mg x 3 days, starting postoperatively day 1, then titrated to INR
Docusate and senns (peri-Colace) 1 capsule PO bid
Multivitamin with iron (Trinsicon) 1 capsule/day PO with meals
CBC in morning after blood re-infusion
Hydromorphone (Dilaudid) PCA intermittent 0.1mg dosing, lockout 10 minutes
PT and OT to evaluate on postop day 1 and start therapy
Ketorolac (Toradol) 15mg IV q6h prn pain x 5 days only
Hip precautions



References: Katz, J. N., Wright, E. A., Polaris, J. J., Harris, M. B., & Losina, E. (2014, May 22). Prevalence and risk factors for periprosthetic fracture in older recipients of total hip replacement: a cohort study. BMC Musculoskeletal Disorders, 15(1), 1-9. http://dx.doi.org/10.1186/1471-2474-15-168Lewis, S. L., Dirksen, S. R., Heitkemper, M. M., Bucher, L., & Camera, I. M. (2011). Medical-surgical nursing: Assessment and management of clinical problems (8th ed.). St. Louis, MO: elsevier mosby.Orlicka, K., Barnes, E., & Culver, E. L. (2013). Prevention of infection caused by immunosuppressive drugs in gastroenterology. Therapeutic Advances in Chronis Disease, 4(4), 167-185. http://dx.doi.org/ 10.1177/ 2040622313485275Renaud, A., Lavigne, M., & Vendittoli, P. (2012, December). Periprosthetic joint infections at a teaching hospital in 1990-2007. Canadian Journal of Surgery, 55(6), 394-400. http://dx.doi.org/10.1503/cjs.033610Tang, L., Chong, G., & Xu, Z. (2013, December). Association between estrogen receptor gene pvull and xbal polymorphisms and hip fracture risk: evidence from a meta-analysis. PlosONE, 8(12), 1-12. http://dx.doi.org/10.1371/journal.pone.0082806

You May Also Find These Documents Helpful

  • Powerful Essays

    Doc.Ca

    • 1170 Words
    • 5 Pages

    INDICATIONS: The patient is a 69 year old black female who fell, landing on her right hip. She was seen in the emergency room where physical exam and x-ray revealed an intertrochanteric right femoral fracture. She was admitted to Dr. Loyd’s service after an orthopedic consultation and preoperative clearance for surgery. She was taken for ORIF.…

    • 1170 Words
    • 5 Pages
    Powerful Essays
  • Good Essays

    Your 80 year-old great aunt, Persis, was placing a canning jar on the top shelf of her pantry when she stepped awkwardly off the stool and twisted her leg at the hip. She felt a sharp pain in her hip and, after collapsing to the floor, found she could no longer stand. She was taken to the emergency room where an X ray showed that the neck of her femur was fractured. More detailed X ray images revealed reduced bone mass in the head and neck regions of the injured femur, in the ends of other long bones of the body and in the vertebrae. Surgery was necessary to repair the fractured femur and a biopsy of the bone tissue indicated that the composition of the osteoid was normal. Healing of the fractured femur is proceeding slowly.…

    • 453 Words
    • 2 Pages
    Good Essays
  • Good Essays

    Emma Parker

    • 739 Words
    • 3 Pages

    Operation in Detail: After adequeate preoperative evaluation, preoperative medication and signing the informed consent the patient was taken to the operating room and administered a general endotracheal anesthetic with promininces well padded. She underwent an uneventful reduction and was placed on traction through a well padded boot. Her left lower extremity was flexed and abducted at the hip. All bony prominences and the paraneal nerve were well padded. Fluroscopic AP and Lateral images revealed a good reduction of her intertrochanteric femoral fracture.…

    • 739 Words
    • 3 Pages
    Good Essays
  • Satisfactory Essays

    Nursing Case Summary

    • 317 Words
    • 2 Pages

    Per PT note dated 12/23/15, the IW reported no change in symptoms. She still complains of left knee pain. On examination of the left knee, tenderness is noted. Swelling is also seen. Gait is antalgic. Plan is to continue management.…

    • 317 Words
    • 2 Pages
    Satisfactory Essays
  • Satisfactory Essays

    Your 80 year-old great aunt, Persis, was placing a canning jar on the top shelf of her pantry when she stepped awkwardly off the stool and twisted her leg at the hip. She felt a sharp pain in her hip and, after collapsing to the floor, found she could no longer stand. She was taken to the emergency room where an X ray showed that the neck of her femur was fractured. More detailed X ray images revealed reduced bone mass in the head and neck regions of the injured femur, in the ends of other long bones of the body and in the vertebrae. Surgery was necessary to repair the fractured femur and a biopsy of the bone tissue indicated that the composition of the osteoid was normal. Healing of the fractured femur is proceeding slowly.…

    • 252 Words
    • 2 Pages
    Satisfactory Essays
  • Satisfactory Essays

    Case Study Page 168

    • 417 Words
    • 2 Pages

    1-Antonio is definitely feeling stressed. He has too many tasks to perform in a short amount of time. Also he has become the team lead just recently. Anytime one begins a new position there is some amount of stress because of the unknown. New nurses usually have the skills required to perform their job, but can lack management skills, like time management, to get the job done. Management skills are acquired through experience and time.…

    • 417 Words
    • 2 Pages
    Satisfactory Essays
  • Powerful Essays

    Prednisolone

    • 1975 Words
    • 8 Pages

    Bullock, S & Manias, E. (2011). Fundamentals of pharmacology. [6th ed.]. Sydney, Australia: Pearson Publishing.…

    • 1975 Words
    • 8 Pages
    Powerful Essays
  • Satisfactory Essays

    Mary’s sleeping issue before her surgery is an area that OT can help address during her OT rehab stay. This is because the sleep issue is caused by her anxiety over the surgery and the outcome of the total hip replacement surgery. Furthermore, Mary still seems to be very anxious towards her THR. She did not like to talk about the surgery, and do not look at the incision. Also, Mary is very hesitant to put any weight on the surgically replaced leg, transfer only through squad-pivot transfer instead of stand pivot transfer. Her sleep issue can improve if Mary’s confidence in her hip replacement can improve. Some solutions for this problem could be OT can educate and help Mary understand the precautions of THR. OT can improve Mary’s confidence…

    • 157 Words
    • 1 Page
    Satisfactory Essays
  • Better Essays

    Adult Health History

    • 3339 Words
    • 14 Pages

    Kanis, J. (2012). Welcome to FRAX. Retrieved Sept 27, 2012, from FRAX WHO Fracture Risk Assessment Score: http://www.shef.ac.uk/FRAX/index.jsp…

    • 3339 Words
    • 14 Pages
    Better Essays
  • Good Essays

    Hip Persuasive Speech

    • 445 Words
    • 2 Pages

    Be patient with your new hip, and listen to the advice of your physiotherapist after surgery as their goal is to get you standing on your own two feet as quickly and as safely as…

    • 445 Words
    • 2 Pages
    Good Essays
  • Good Essays

    HIPAA Investigation Risks Are Increasing...Reprinted with permission from The Journal of Medical Practice Man­agement, Sep/Oct 2014, pgs 119-123. (2015). Podiatry Management, 34(7), 85-90 5p.…

    • 327 Words
    • 2 Pages
    Good Essays
  • Good Essays

    Three of the studies reported fracture events. (2412). In the control group, there were 178 events among 4058 subjects and in the ICS group there was 195 events in 4037 subjects. (2412). Looking at these numbers there was no statistical difference among the two groups, so increased fractures were not the result of ICS use.…

    • 768 Words
    • 4 Pages
    Good Essays
  • Better Essays

    Lucas, B. (2008). Total hip and total knee replacement: Postoperative nursing management. British Journal of Nursing, 17(22)…

    • 1203 Words
    • 5 Pages
    Better Essays
  • Better Essays

    As a routine practice, post-operative radiographs will be requested within 24 hours of the surgery to validate the success of the Open Reduction Internal Fixation surgery and the placement and alignment of the screws and plates (Jibri et al., 2007). These images have significant diagnostic value as it assists in the assessment of the implantation and hence, the likelihood of long-term success of Mrs. Churchland’s surgery (William & Neep, 2012). Furthermore, the radiographs will help the doctors and nursing team to determine if physical therapy can be commenced as patients who get up and weight bear on their operated hip tend to recover their physical function and quality of life faster (Carneriro…

    • 266 Words
    • 2 Pages
    Better Essays
  • Best Essays

    Gibbs Reflection

    • 3124 Words
    • 13 Pages

    A 89 year old woman was admitted to the recovery ward for monitoring after a dynamic hip screw procedure of the right hip. The patient was received by myself and I immediately began the ABCDE approach to caring for the patient while the anaesthetist began his verbal handover of the patients medical history, intra operative care and instructions for post operative care including iv fluids and analgesia. The anaesthetist explained the patient had advanced…

    • 3124 Words
    • 13 Pages
    Best Essays