Nursing Case Study Cathery Case

Introduction :

Mrs. Audrey Smith, a 75 year old widow who has been admitted to the Emergency
Department with a history of fall at home in the morning at around 10:45. On examination, she has been diagnosed with a fracture of left neck of femur along with soft tissue injury, bruises on the left shoulder and a small hematoma on the left forehead. She is found to be neurologically stable with the GCS of 14, although she has anxiety about her dog as nobody will be there to look after. At 14:00 she was shifted to the ward after placing IDC and IVT from the Emergency Department. She is going to undergo arthroplasty on the left hip at 17:00. Her past medical history reveals that the diagnoses such as
Smith based on the priority for the best possible outcome with the least issues. In addition to this, the comprehensive evaluation will be certainly an assistance to prepare Audrey to be admitted to fast track rehabilitation centre after getting discharge.

NURSING INTERVENTIONS

1. Safety

Safety is the core area of concern for Mrs. Audrey while planning nursing interventions, as the major issues such as risk for fall and there by further worsening of present injuries, risk for impaired skin integrity, risk for infection and prone to develop Venous Thrombo Embolism come under this area of practice.

• Prevent fall risk

As Audrey is an elderly lady with multiple history of diseases, it is always preferable to keep her in the room which is very close to nurse’s station in order to assess her frequently and meet her needs as soon as possible. It is advised to keep the bed in lower position and the side rails up except while giving nursing care. To make sure that she is secure with clutter- free surroundings and the
Hygiene and Comfort

Severe pain on the fractured site will be the main barrier for the comfort of the patient. Multimodal analgesic regimen is the most effective way of pain control, particularly in patients with hip fracture or arthroplasty (Kang et al., 2013). It includes the drugs such as acetaminophen, opioids, local anaesthetic agents and NSAIDS. But , Audrey is a patient with atrial fibrillation and on warfarin, NSAIDS need to be administered very cautiously as it may cause severe bleeding and thromboembolism (Lamberts et al., 2014) . In addition, Kumar, L., Barker, C., & Emmanuel, A. (2014) state that the over use of opioids will be resulted in the aggrevation of constipation for Audrey. Hence, it is always adviceable to follow non-pharmacological measures such as provide comfortable surroundings, music therapy, relaxation techniques and back massage as the means of pain and anxiety management
(Büyükyılmaz, F., & Aştı, T.2013). Since Audrey is on bed rest after surgery and she is affected with right side weakness due to old CVA, she is not able to carry out her activities of daily living independently. Hence,health care workers should assist her to take dialy sponge bath and routine hygienic