Topic
The Musculoskeletal System and Pain
Instructions
Fred is an 83-year-old male who is being admitted to the medical-surgical unit status post fall. He is alert and oriented and reports that while visiting a local casino with his wife Margaret earlier this evening, he tripped over a curb and fell landing on his right side. After receiving morphine in the emergency room prior to transfer to your unit, Fred is rating his pain at 6/10. He has multiple bruises from his jawbone to his knee as well as a slight rotation of his right leg.
Past medical history includes: myocardial infarction (MI) x 2, peripheral vascular disease (PVD) with bilateral iliac stents, non-insulin-dependent diabetes mellitus (NIDDM), sleep apnea, and degenerative joint disease.
Medications include: aspirin, Plavix, Lopressor, Lisinopril, and Metformin.
After reviewing the above scenario please answer the following questions.
- Based on the information provided, how will you prioritize your care, what assessments will you include and in what order? Please provide rationale for your response.
- Considering this patient’s age, injury, past medical history, and list of current medications, what, if any, concerns do you have related to his potential need for surgery?
- Should surgery to repair his right femur be required; what type of clearance and pre-op orders would you anticipate receiving related to his diet, meds, lab work, and so on?
Answer Preview
Based on the information provided about Fred, I would do a series of assessments on Fred in order to determine the best treatment for him. First, I would treat any superficial injuries such as skin gashes and multiple bruises, and then examine him for sprained ligaments, strained muscles, and head injuries. I would also closely examine Fred’s medical history. According to Perdue (2003), a fall in an elderly individual could be the consequence of an already existing condition, or a symptom of an undiagnosed sickness. In addition, old patients who are on medications such as anti-hypertensives, diuretics, and sedatives also tend to experience falls more often than those who are not (Perdue, 2003). If it becomes evident that Fred’s fall was caused by his body’s reaction to his medication, I would reduce the dosage of the drug in question, or suggest that it be substituted with another which performs the same function. If Fred suffered a fracture, I would schedule him for surgery and then recommend that he be attended by occupational therapists to improve his balance and walking after surgery.
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