Maria Russo is a 76 year old woman admitted to the Emergency Department via
ambulance. Maria fell when watering her garden and was unable to get up. She was
lying in her garden for 3 hours until discovered by her neighbour.
Maria's medical history includes osteoporosis, prediabetes and depression. She has
recently been experiencing some orthostatic hypotension. She has no significant
surgical history. Maria lives alone, her husband died 6 months ago. Her adult
children live interstate.
Maria's current medications include Aspirin 75mgs daily, Citalopram 20mg and
Alendronate Sodium 10mg orally daily.
She was administered Intravenous Morphine and inhaled Methoxyflurane by the
paramedics.
Assessment data:
Airway: patent
Respiratory rate: 18 breaths/min Oxygen saturation: 97% on room air
Heart rate: 90 beats/min (irregular) Blood pressure: 104/70 mmHg
Capillary refill: 2 seconds
Right leg shortened and externally rotated Right hip bruised and oedematous
Right foot pink, cool, no paraesthesia or abnormal sensation, pedal pulse present
Maria informs you that she "can't remember what happened when she fell. She woke
up on the ground and could not get up''
Pain score: 5/10 on rest, 7/10 on movement
Temperature: 35 C
Small laceration to right shoulder
Intravenous cannula inserted Cephalic vein Left arm
Weight: 54 kgs Height: 174cm
X-rays reveal an Intertrochanteric fracture of the Right femur. Maria is seen by the
Orthopaedic surgeon and is scheduled for an Open Reduction and Internal fixation
(ORIF) of the fracture. She has been placed on the Emergency Operating List. The
Registered Nurse has just administered Intravenous Morphine 2mg and the
anaesthetist has been contacted to perform a femoral nerve block. The orthopaedic
registrar will visit Maria to gain consent for surgery.
The Emergency Department is extremely busy and Maria is positioned on a trolley in
the corridor while she waits for the Registrar to come. Maria's neighbour, Francesco
has arrived at the hospital and keeps asking you what is wrong with Maria and
demanding to speak to the doctor. Maria is upset that she is going to require surgery
and is worried about her pet dog, Bonnie, and who will care for her while she is in
hospital.
From your analysis of the data provided, identify four patient problems in the preoperative period (50 words)
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