FRACTURED HIP WITH POSTOPERATIVE COMPLICATIONS M.M., a 76-year-old retired schoolteacher, underwent ORIP of his right femur, He has been on bed rest for 36 hours postoperatively. At 0600 VS were 132/84, 80, 18, 37 C . He is AA&Ox3 (awake, alert, and oriented). Normal heart sounds. Breath sounds are clear but diminished in the bases bilaterally. Bowel sounds are active in all 4 quadrants, and he is taking sips of clear liquids. An IV of DSNS is infusing TKO in his left hand and is to be saline locked in the AM if he is able to maintain adequate PO fluid intake. His lab work shows Hct 34%, Hgb 11.3 mg/dl, K 4.1mEq/L, PTT 44 seconds. Pain is controlled with meperidine (Demerol) 25mg and promethazine (Phenergan) 25 mg IM q3h. He is also using a Nitro patch, heparin 5000 units SQ bid, and docusate sodium. At 2330 on the second postoperative day, you answer M.M.'s call light and find him lying in bed breathing rapidly and rubbing his R chest. He complains of R-sided chest pain and appears to be restless. 1. What nursing interventions should you take? He is slightly hypotensive, tachycardic, tachypneic, restless, and slightly confused. The pulse oximeter reads 86%, so you start him on 2 liters of O' via nasal cannula. You hear faint crackles in the posterior bases bilaterally: they were clear this AM. 2. What information will you share with the HCP via SBAR? 3. The HCP orders ABGS on room air, continuous pulse oximetry, STAT CXR and STAT 12- lead ECG. What information will the physician gain from each of the above?

A 26-year-old male was returning from a neighborhood store with a six-pack of beer. He attempted to run across a busy street but was struck by a car. He was fully conscious at the scene, complaining of pain in his abdomen and left leg. Examination by paramedics revealed an open fracture of the left tibia with moderate bleeding, left upper quadrant pain with rebound tenderness, and a fast, weak pulse. The leg was immobilized, oxygen was administered, an IV started, and he was transported to the Trauma Center, approximately 10 minutes away. About 3 minutes before arriving at the Trauma Center, he suffered cardiopulmonary arrest from which he could not be resuscitated, despite vigorous advanced life support. At autopsy, his stomach was found to be full of beer, along with 4 whole wieners (without any teeth marks!). His spleen, which is normally about the size of the patient’s fist, was grossly enlarged: it measured from just under the diaphragm to the level of the umbilicus, and from the…

Match all the causes with the sign and symptoms.

3. Mr. Garcia and his wife are concerned about the future of his heart health. What role does cardiac rehabilitation play in his return to normal activities and in determining his future heart health? 4. Define these terms/phrases from the chart: a. From History on page 52: "precordial" - 66 b. From History on page 52: " syncope” – c. From MD Progress Note on page 52, for Pulmonary/Chest: "Lungs are clear to auscultation bilaterally" d. From MD Progress Note on page 52, for Abdominal - explain all of the results of the M.D.'s exam- e. From MD Progress Note on page 52, for Extremities: "cyanosis" and "clubbing” – f. From MD Progress Note on page 52, for Skin: "mild diaphoresis" - g. From Orders on page 53 from the ED (emergency dept): "oxygen 2 liters per NC to maintain 02 SAT >95% - h. From Nursing Assessment on page 54, for Other Components: "Braden score" -