NR 305 Week 7 Discussion Topic, Assessment of the Musculoskeletal System and Pain

NR 305 Week 7 Discussion Topic, Assessment of the Musculoskeletal System and Pain 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. 1. 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. 2. 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? 3. 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? Fred, an 83-year-old male is being admitted to med/surgical unit, status post fall after tripping on a curb. He is alert and oriented. He landed on right side and is bruised from jaw to knee and has a slight rotation of the right leg. Immediately he is moved to from the stretcher to the bed, using a slide board to minimize painful movement. The initial assessment includes watching for grimacing or clenching with the movement and doing a pain assessment. The pain assessment is crucial to assess first so that he may better function and tolerate the rest of the assessments. He had recently had Morphine in the ED. I will ask him to rate his pain using the numerical pain scale. And have him describe where it hurts, what the pain feels like. Deep somatic pain comes from blood vessels, joints, tendons, muscles, and bone. Bone pain is usually described as aching or throbbing and sharp pain with movement (Jarvis,2016). With the rotation of his leg, I’m assuming he has either a femur or hip fracture that will be determined by x-ray. My next step is to provide him pain medication that is ordered for him. The route for administration is preferably IV as he may need to be NPO for possible surgery. If morphine is due and worked to relieve some of his pain in the ED, that will be my first choice. Toradol, is another option depending on lab results and kidney function. When the pain is tolerable and managed, I will do a physical assessment. Checking the five Ps. Pain, pulse, pallor, paresthesia, and paralysis. Checking the pulses above and below the injury will verify adequate circulation. Lack of pulse or cold to touch alerts to a compromise in circulation. Can he wiggle his toes or flex and extend his ankles? Check and compare his joints and assess edema and bruising. Does he have impaired skin integrity? How was his balance and gait prior to the fall? I will ask about assistive devices such as cane or walker use. He will be placed on fall precautions because of age, recent fall, pain medications, possible surgery, and pain with movement. The rationale will be explained to him.