Case study Maria Russo is a 76 year old woman who sustained an Intertrochanteric fracture of the Right femur after she fell when watering her garden. She sustained a small laceration to her Right Shoulder when she fell. Maria could not remember what happened before she fell. Maria's medical history includes osteoporosis, prediabetes and depression. She has recently been experiencing some orthostatic hypotension. She has no significant surgical history. Maria's current medications on admission are Aspirin 75mgs daily, Citalopram 20mg and Alendronate Sodium 10mg orally daily. Maria lives alone, her husband died 6 months ago. Maria's adult children live interstate. Pre-operatively Maria shared her concerns about her pet dog, Bonnie, and who will care for her while she is in hospital. Maria has undergone an Open Reduction and Internal fixation (ORIF) of the fractured Right Neck of Femur under Spinal and General Anaesthesia. Maria was nauseated in the Post anaesthetic care unit (PACU) and vomited a small amount of green fluid. IV Metoclopramide was administered with good effect. Post-operative surgical antibiotic prophylaxis and pharmaceutical and mechanical thromboprophylaxis are ordered. An intravenous PCA of Morphine is ordered together with regular intravenous Paracetamol. The surgeon has ordered the drain tube to removed on Post-Operative day 2 (after review) Discharge is scheduled for post-operative day 5. Observations on return to the ward Airway: patentRespiratory rate: 16 breaths/min Oxygen saturation: 97% on room air Heart rate: 84 beats/min (irregular) Blood pressure: 100/60 mmHg Capillary refill: 2 secondsIntravenous therapy Cephalic vein Left arm: Hartmanns solution 8 hourly Dressing to Right hip: Intact with small amount of bright red ooze on dressing Redivac drain tube in situ: patent - 200 mL of bright red drainage Bromage score: 2 Dermatome level: L2Right foot pale, cool to touch, pedal pulse present, slight paraesthesia in toes Graduated compression stockings in situ Alert: orientated to time and place Pain score: 1/10 on rest, 3/10 on movement Temperature: 36 CBGL: 9 mmol/L Maria sustains a skin tear to her lower right arm as you release the bed rails after transferring her to her room. Questions 1. Discuss the elements of open disclosure that are required in this situation.  2. Identify four postoperative/anaesthetic actual or potential patient problems or issues from the data presented. Briefly discuss the factors that pre-dispose Maria to these problems*  3. Discuss the nursing interventions that you would employ to prevent/manage the identified problems. Ensure a rationale is provided for each intervention*  4. Discuss how you would evaluate the effectiveness of these nursing interventions  *Answers to questions 2, 3 & 4 must be submitted in a table (suggested format below) Patient problem Nursing Rationale Evaluation intervention 5. Reflect on what you have learnt from completing this case study and how this learning will inform your clinical practice

Case study

Maria Russo is a 76 year old woman who sustained an Intertrochanteric fracture of the Right femur after she fell when watering her garden. She sustained a small laceration to her Right Shoulder when she fell. Maria could not remember what happened before she fell.

Maria's medical history includes osteoporosis, prediabetes and depression. She has recently been experiencing some orthostatic hypotension. She has no significant

surgical history. Maria's current medications on admission are Aspirin 75mgs daily, Citalopram 20mg and Alendronate Sodium 10mg orally daily.

Maria lives alone, her husband died 6 months ago. Maria's adult children live interstate. Pre-operatively Maria shared her concerns about her pet dog, Bonnie, and who will care for her while she is in hospital.

Maria has undergone an Open Reduction and Internal fixation (ORIF) of the fractured Right Neck of Femur under Spinal and General Anaesthesia.

Maria was nauseated in the Post anaesthetic care unit (PACU) and vomited a small

amount of green fluid. IV Metoclopramide was administered with good effect.

Post-operative surgical antibiotic prophylaxis and pharmaceutical and mechanical thromboprophylaxis are ordered. An intravenous PCA of Morphine is ordered

The surgeon has ordered the drain tube to removed on Post-Operative day 2 (after review)

Discharge is scheduled for post-operative day 5.

Observations on return to the ward

Airway: patent
Respiratory rate: 16 breaths/min Oxygen saturation: 97% on room air

Heart rate: 84 beats/min (irregular) Blood pressure: 100/60 mmHg Capillary refill: 2 seconds
Intravenous therapy Cephalic vein Left arm: Hartmanns solution 8 hourly Dressing to Right hip: Intact with small amount of bright red ooze on dressing Redivac drain tube in situ: patent - 200 mL of bright red drainage

Bromage score: 2 Dermatome level: L2
Right foot pale, cool to touch, pedal pulse present, slight paraesthesia in toes

Graduated compression stockings in situ

Alert: orientated to time and place Pain score: 1/10 on rest, 3/10 on movement Temperature: 36 C
BGL: 9 mmol/L

Maria sustains a skin tear to her lower right arm as you release the bed rails after transferring her to her room.

Questions

1. Discuss the elements of open disclosure that are required in this situation. 

2. Identify four postoperative/anaesthetic actual or potential patient problems or issues from the data presented. Briefly discuss the factors that pre-dispose Maria to these problems* 

3. Discuss the nursing interventions that you would employ to prevent/manage the identified problems. Ensure a rationale is provided for each intervention* 

4. Discuss how you would evaluate the effectiveness of these nursing interventions 

*Answers to questions 2, 3 & 4 must be submitted in a table (suggested format below)

Patient problem Nursing Rationale Evaluation intervention

5. Reflect on what you have learnt from completing this case study and how this learning will inform your clinical practice