Case Study:
Incident: 72 yr old female Mrs Geraldine Berry sustained left fractured neck of femur (#NOF) and laceration to her head 5cm while walking her dog. Tripped on an uneven pathway.
PMH: Hypertension and depression
Current Medications: Coversyl 5mg
Doxepin 25mg daily
Atorvastatin 40mg daily
SHx: Lives with elderly husband. Is the primary carer for elderly husband who has had a stroke previously and is mildly impaired. Attends church every Sunday and is responsible for arranging flowers for every Sunday service. She has started volunteering at the St Vincent De Paul’s Meals on Wheels distribution centre two days a week. She lost two children 5 years ago in a car accident. Geraldine is concerned who will look after her husband and their dog Nala. Geraldine and her husband have no children or relatives nearby.
Current presentation
Day 3 post op left total hip replacement, increasing pain in hip unable to weight bear, pain score currently 7/10. Geraldine has been prescribed oral tramadol tds, Ibroprofen prn, paracetamol prn, IV Amoxicillin 1000mg tds and Clexane 40mg SC BD. Suture line on hip appears red and swollen.
Observations – 10am Day 3
Pulse Rate - 120
Respiratory rate - 22
Blood pressure - 120/80
Pain score - 7/10
Sa02 - 96%
Temperature – 39.1
BGL – 6.8 mmol/l
Glasgow Coma Score 15
Heat, pain and redness at suture site
Refusing to mobilise due to pain
Tasks:
- Using the CRC and the information presented about Geraldine, identify the abnormal cues, and discuss why these are considered abnormal.
- Using relevant literature, discuss the pathophysiology related to the two post-operative issues of concern from the abnormal cues you have identified in question one.
- Using the template provided below, complete all the sections which include
- Identify the nursing goalfor each identified issue/problem
- List at least two nursing interventionsfor each issue/problem.
4. Using relevant literature, provide a rationale for the listed interventions and discuss how the interventions will be evaluated.
5. Identify 2 medications that were prescribed for the patient’s pre-operative condition. (Coversyl 5mg, Doxepin 25mg daily, Atorvastatin 40mg daily) used in this case study. Provide the mechanism of action, side effects correct dosage and contraindications for each medication. Explain how this might affect Geraldine in the post-operative period.
6. Using the Roper-Logan Tierney Model, identify one potential cultural/biopsychosocial issue/problem and discuss how this will affect the patient post-operatively or on discharge
