Ok nursing students/ nurses/ medi students/ residents/ etc. Lets put our brains together! MY nana got hurt recently and I need your help with her care, here is the case study: My nana is a 79 year old female. Past medical hx includes Type II Diabetes mellitus, Atrial Fibrillation, hyperthyroidism (Graves Disease), as well as a type of blood cancer that is still unknown to me. She is on Coumadin, I am unsure of the dosage for her atrial fibrillation. I am still trying to obtain a Med list from my family. Anyways, she fell approximately two to three days ago. She was taken to the urgent care because she coul not ambulate and reported pain of 10/10 in the hip. Diagnostics, x-ray ruled out hip fracture, and a medical diagnosis of internal hematoma of the hip was made. My nana was given Acetaminophen -Codeine because she is on Warfarin. My nana still reports pain of 10/10 upon attempting to ambulate and when changing position from supine to high-fowlers position. My aunt and my two cousins are helping her ambulate to the restroom, but we are all concerned about her immobility. Nursing Friends what are your top three nursing dx/ priorities? This is what I came up with so far based on the little knowledge I have now. I have no current vitals. - impaired mobility r/t soft tissue trauma to the hip. -Ineffective tissue perfusion r/t internal hematoma of the hip and immobility -Hemmorahage r/t trauma to the blood vessels and the use of Warfarin prior to fall and after fall. -Impaired gas exchange r/t atelectasis from prolonged immobility -Risk for impaired tissue integrity r/t immobility and diabetes *I dont know when she got her INR and PT drawn last, but if her medication is sub-therapeutic then possibly I worry about this: -Risk for Thromboembolism r/t venous stasis because of immobility and atrial fibrillation Necessary Labs: -INR, Pt, Ptt -CBC -GLusoce - Electrolytes *I am thinking also about contracture prevention because it is so painful for her to walk-I will implement range of motion exercises, and also tell her to wear her comfortable shoes in bed to prevent contractures. - I will see if i can get her compression stocking if she cannot walk - I will monitor for DVT -Risk for injury- implement preventative measures, remove tripping hazards -Educate about no salicytates, NSAiDS, OTC - Increase fluids and fiber to prevent constipation -Monitor for black tarry stools that indicates internal bleeding * I am concerned about her glucose levels because of the stress and pain-Glucose monitored frequently * I am concerned about pneumonia- SO i will implement TCDB q 2hours Kristen Carter- do you think its possible they missed the hip fracture with the x-ray, what experience do you have in this? Can you guys think of anything else?
Posted on: Thu, 25 Sep 2014 22:03:22 +0000
Trending Topics
Recently Viewed Topics
© 2015