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)
Step by stepSolved in 3 steps
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- Mr Jankovic a 78 years old male, is admitted for a left total hip replacement. He underwent surgery and is now three days post-operative, in the orthopaedic ward. He has gained a lot of weight over the past few years and has severe osteoarthritis in his hips. He also has had resection of a prostatic cancer that has no current treatment and has residual prostatomegaly. He has occasional angina, high blood pressure and obstructive sleep apnoea, using a Continuous Positive Airway Pressure (CPAP) machine infrequently as it dries his mouth and nose and the noise annoys his wife. Past medical history: — Osteoarthritis (diagnosed 10 years ago) — Mild left cardiac failure and occasional angina (diagnosed 2 years ago) — Hypertension (diagnosed 5 years ago) — Frequent gout Surgical history: — Internal fixation left tibia and fibula following motorcycle accident at age 21years — Appendectomy at age 23 years — Resection prostatic carcinoma (7 years ago) Q1. Q2. Explain the difference between…arrow_forwardAt 8am, 52 year old female (patient X) is admitted to the medical ward you are assigned in due to uncontrolled hyperglycemia and a mild edema on her feet. She was previously diagnosed with Diabetes Mellitus type II. She has history of diabetes, hypertension and heart disease. You are assigned to her during the 6am-2pm shift. The attending physician ordered Diabetic Diet, Metformin 500mg tablet TID and a sliding scale of insulin if blood sugar is above 200mg/dl. Blood sugar monitoring is ordered every four hours for the first 24 hrs. It is also ordered 1L of PNSS for 12 hours and insert Foley catheter and monitor urine output. You successfully started the infusion at 9am. Since Patient X has missed the morning dose of metformin, you immediately gave her the morning dose with 100ml of water, the 1 pm; you gave her another dose with again 100ml water after her lunch. At 10am, you drained her urine bag and got 105 ml output and again, you drained 150ml at 2pm prior to leaving your patient.…arrow_forwardA 63-year-old woman reports for her annual physical examination. She has no major previous medical history but does have a recent history of a broken wrist she sustained after a mild fall. Three years ago her height was recorded at 5'3" and is now recorded at 5'1". She complains that she can't be quite as active as she used to be and that her back is beginning to bother her. This leads her to be outside less frequently. Her physician orders some laboratory testing and diagnoses her with osteoporosis. Analyte 2/20/2018 08:00 Reference Range 135-145 mEg/L 3.5-5.0 mEg/L 95-105 mEg/L 22-28 mEg/L 70-100 mg/dL 7-20 mg/dL 0.5-1.1 mg/dL Na 141 K 4.1 CI 101 CO2 25 Glucose 98 BUN 15 Creat 0.9 BUN/Creat Ratio 17 10-20 8.5-10.5 mg/dL 25-80 ng/mL 10-65 g/mL Calcium 10.4 25-Cholecalciferol 15 ΙPTH 89 Highlight the abnormal results in the above table. List three risk factors this patient has for osteoporosis. What is the most likely cause of her case of osteoporosis? Explain. What are two treatments…arrow_forward
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