Hip Fracture and Pneumonia Case Study

Mrs. Waters is a 74 year old Caucasian widow who lives alone independently. She has been a widow for almost 12 years. She dotes on her Persian cat. er only e!ercise is to wal" around the bloc" every day. #esterday mornin$ Mrs. Waters tripped over a throw ru$ in her home and immediately felt a %pop& in her ri$ht hip as she hit the $round. She was unable to $et up and $et to the phone so laid on her livin$ room floor for most of the day. 'ater in the day( her nei$hbor reali)ed she had not seen Mrs. Waters out for her daily wal" so went over to investi$ate. She loo"ed throu$h the window and saw Mrs. Waters on the floor*tried t $et into her house but it was loc"ed so she ended up callin$ +11. ,a"en to the hospital by ambulance( the emer$ency department physician ordered -. rays( contacted an orthopedic sur$eon and she was sent directly to /0. She returns to an inpatient hospital room. 1t 2722( the ni$ht nurse $ives report to the student nurse( 3ill. She has no si$nificant past medical history e!cept hysterectomy at a$e 45 and arthritis her "nees. She has a smo"in$ history of 42 pac" years but 6uit last year( after $ettin$ her cat. er home medications include occasional Motrin( a multivitamin( and ,7MS Pre /perative 89: showed sinus rhythm with occasional P;Cs. C-0 showed clear fields with normal si$ns of a$in$. She had 1 unit of P03C yesterday at 1+22( and her second unit completed infusin$ at 24<2. Mrs. Waters complained of pain even thou$h she has a PC1 with a basal rate of Morphine at 2.4 m$=hr. ,he ni$ht nurse told 3ill*>? didn&t want to bother the physician last ni$ht for more pain med( and anyway it would only decrease her respiratory rate.@ er ?; is 'actated 0in$ers at 142 ml=hr. er foley drains clear yellow urine. er labs and vitals are as followsA
Labs W3C emo$lobin ematocrit Sodium Potassium 37C Creatinine Vitals ,ympanic ,emp Pulse 0espirations 3P Sa/2 ?D/ Wei$ht Yesterday at 1800 7.5 +.2 <2.1 1<B <.5 17 1.2 <7.1 B< 22 1<2=B4 +< <742=1+24 E24 hour totalF 14B lbs Today at 0600 11.+ 12.+ <4.5 1<+ <.4 14 1.2 <7.4 +2 2B. shallow 142=+2 BB +22=742 142 lbs

,he ni$ht nurse continues that >Mrs. Waters didn&t wal" more than 12 feet from her room post op this evenin$ because she complained of shortness of breath and hip pain. Crac"les auscultated lower lobes bilaterally posteriorly. She had a hard time sleepin$ throu$hout ni$ht( appeared to be an!ious and Gittery. Sur$ical dressin$ is CH?. ypoactive bowel tones all four 6uadrants.@ ,he ni$ht nurse $oes on to report that her Mrs. Waters& 47 year old dau$hter Ma$$ie who lives near her mother called last ni$ht. She is divorced with three children who "eep her very busy. She stated >?&ve always worried about all those ru$s in my mom&s house but she won&t ta"e them up even when ?&ve as"ed her several times to do so. Why won&t she listen to me moreI 9eepin$ an eye on Mom is as e!haustin$ as "eepin$ an eye on my "ids.@ 3ill enters the room at 2714 and notices ,8Hs and SCHs over the end of the bed. Mrs. Waters& incentive spirometer is across the room on the rollin$ table. Hurin$ assessment and reta"in$ of the vitals( 3ill finds that he can clearly auscultate inspiratory crac"les in the lower lobes posteriorly. Pulse is 125 and re$ular( dyspneic respirations are <2( temperature is <7.5( Sa/2 BBJ( 3P 144=+2. Mrs. Waters states that the pain Gust seems to $et worse and that it is difficult for her to ta"e a deep breath. She refuses to cou$h as it only increases the pain. She as"s if she is $oin$ to $et any better and 3ill responds that she will if she $ets up and moves around( wears her ,8H hose and uses her incentive spirometer. Mrs. Waters states she is so afraid she is not $oin$ to $et any better and that she is $oin$ to have to $o to a %home& because her dau$hter thin"s she is too much of a burden. She then busts into tears. HO !LL "!LL #$SPO%&'

,eachin$ Points to ConsiderA Krom this assessment can the student understand that pneumonia is developin$I What other information does the student need to anticipate reportin$ to the Primary Care nurseI What nursin$ actions does this student need to perform to prevent worsenin$ of pneumonia in this patientI ow will pain mana$ement improve this clinical pictureI ow did the actions of the ni$ht nurse contribute to the development of this clinical pictureI ow did the communication of the student contribute to the development of this clinical pictureI What dischar$e concerns do you have about Mrs. WatersI ow will this respiratory complication affect the healin$ of the sur$ical siteI Which of her medications are the most important for her to $etI EKor e!ample are antibiotics compatible for both sur$ical site and for pneumoniaIF ow will student implement teachin$ in this situationI ow mi$ht this scenario chan$e if Mrs. Waters was from a different ethnic $roupI Hid the student notice and interpret correctlyA o Wt $ain=? D / o Wron$ ?; fluid

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Crac"les in lun$s 'ab L&s r=t blood transfusions ;S L&s as r=t pneumonia Predisposin$ factors to pneumonia Patient&s psychosocial situation Edau$hter.mother relationshipF 3ill&s poor communication