question archive Clinical Scenario: Helen Maroney, an 81-year-old woman presents to the emergency department after slipping on the ice in her driveway
Clinical Scenario: Helen Maroney, an 81-year-old woman presents to the emergency department after slipping on the ice in her driveway
Subject:NursingPrice: Bought3
Clinical Scenario:
Helen Maroney, an 81-year-old woman presents to the emergency department after slipping on the ice in
her driveway. She reports right hip pain and an inability to bear weight. She has no prior history of hip pain
and is ambulatory with the use of a cane. She lives with her husband and performs all activities of daily
living independently. Her medical history includes mild dementia, hypertension, and osteoarthritis. She is
currently on metoprolol, Lisinopril, and acetaminophen.
Physical examination of the right hip demonstrates pain with range of motion, external rotation of the right
root, shortening of the right leg and then leg is adducted. The leg is neurovascularly intact with good
sensation, capillary refill, and pulses in the foot. Radiographs demonstrate a displaced sub-capital femoral
neck fracture of the right hip.
The client receives an ultrasound guided regional nerve block in the emergency department for pain
control and is admitted to the hospital for treatment of her hip fracture. Preoperative traction is not used
but the client is placed on bed rest with use of intermittent pneumatic compression devices. Adequate pain
relief is achieved with acetaminophen following the administration of a regional block, which was used to
minimize the risk of delirium.
The orthopedic surgeon had a discussion with the client and family regarding the overall long-term
prognosis of possible decreased mobility and independence as a result of the hip fracture. The discussion
also includes the possibility of mortality. After considering nonsurgical treatment measures, the client
makes an informed decision to proceed with surgery based on the quality of life and mobility benefits
associated with this method of treatment. The surgeon also discusses with the client the option of a total
hip arthroplasty for the benefit of improved function and long-term results. After careful consideration, the
client decided to move forward with surgery.
Virtual Clinical Assignment Template Spring 2021
2
Postoperative Orders Medications
Hip precautions cefazolin 500mg q 8 hr. X2 doses
Diet: DAT metoprolol ER 25 mg q day
IV: D5 1⁄2 NS KVO Lisinopril 10 mg q day
Activity: out of bed as tolerated with
physical therapy
heparin 5000 units SC bid
Weight-bearing as tolerated per physical
and occupational therapy
calcium carbonate 600 mg TID
Continuous intermittent pneumatic
compression device
Vitamin D 1000 IU bid
Nutrition consultation Metamucil 1 Tbsp. q AM
Ensure with meals, TID acetaminophen 500 mg q 6hr
AM Labs; CBC, WBC, albumin, calcium,
vitamin D
celecoxib 100 mg bid
tramadol 50 mg q 6 hr.
Postoperatively, the client is mobilized. The client is placed on Hip Precautions. Weight-bearing exercises
are introduced as tolerated with physical and occupational therapy. She is placed on low-molecular-weight
heparin and continues on intermittent pneumatic compression devices because of the high risk of venous
thromboembolic events in this client population. Her admission albumin level was low; the nutrition
service is consulted. The client is started on nutritional supplements following surgery to improve her
protein levels and caloric intake. In addition, she is found to be vitamin D deficient, calcium and vitamin D
supplementation are initiated.
Pain is initially well controlled after surgery because of the long-acting regional nerve block. A multimodal
pain regimen is also used, including celecoxib, acetaminophen, and tramadol, thus minimizing narcotic use
to avoid delirium. The client's hemoglobin level decreases to 8.1 g/dL postoperatively; however, her blood
pressure is stable. Although she experiences some transient lightheadedness and tachycardia, this
improves with hydration.
Teaching Plan Directions:
Think about the learning/educational needs of this client. Make sure to include physical/sensory limitations
& learning barriers.
1. Create a teaching outline for educating the client. The outline must include: Assessment of learning
readiness, expected learning outcomes, content outline, teaching strategies/resources, expected
outcomes.
2. Complete Medication Templates for celecoxib, tramadol, and acetaminophen.
3. Answer the reflection questions below.
Virtual Clinical Assignment Template Spring 2021
3
Reflective Questions:
1) What would your PreOp checklist look like?
2) What PostOp systemic complications would you want to look out for?
3) What interventions would you want to implement to prevent post-op complications?
4) Describe the teaching method you would utilize for someone with her limitations and why?
5) When would you complete teaching with this client?
6) Why is it important to document patient education?
