NR305 – RN HEALTH ASSESSMENT
WEEK 7 DISCUSSION
Assessment of the Musculoskeletal System and Pain (graded)
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?.
Class,
For this exercise, identify and discuss medical disorders that may produce the abnormal musculoskeletal
findings. Take into consideration the developmental, age, psychosocial, cultural, and health history. etc... in
assessment and findings.
Post
Fred seems to present with a fractured hip due to the slight rotation of his right leg. As a precaution,
his extremity should be immobilized since unnecessary movement can caused neurovascular
injuries. I would visually inspect for shortening of the affect extremity and assess for muscle
spasms. An x-ray would be ordered to validate or rule out the initial suspicion hip fracture. High pain
levels at the time of the fall could contribute to subsequent complications, especially in the elderly
(Oberkircher, 2016). I would also help obtain orders for more analgesics since Fred’s pain is not
relieved after receiving morphine in the ER. Reducing pain may help with his collaboration during
the assessment process. Determining the neurovascular status of the injured leg for patency is
important as a disruption in blood supply can lead to necrosis. Any swelling, warmth, or redness
may imply acute inflammation (Jarvis, 2015, p. 586). Therefore I would assess for temperature,
sensation, and pedal pulses. This should be compared bilaterally to detect any differences in quality.
Fred should also receive ongoing monitoring of vital signs, the level of consciousness, and oxygen
saturation for potential development of fat embolism. Anyone who has long bone, pelvic, or multiple
fractures is potentially at significant risk for it (Gore, 2005). Immobilizing and stabilizing the fracture
may help prevent release of fat globules into Fred’s venous circulation which can potentially travel
to his lungs and brain.
Fred is at an increased risk for complications during surgery due to his age and medical history. His diabetes
may impede the healing process. His sleep apnea is a concern because due to potential obstruction while lying
down. Plavix and aspirin should be stopped prior to surgery due to risk of bleeding. Fred will possibly need EKG
monitoring due to his MI history to evaluate the safety of a surgery and receive cardiac clearance. Patient
teaching will include proper positioning such as no leg crossing. Fred may also require an abduction pillow to
help promote alignment of the hip. Encouraging fluid intake for hydration and foot or ankle exercise would be
prudent to help prevent formation of deep vein thrombosis.
This study source was downloaded by 100000832558064 from CourseHero.com on 02-15-2022 23:26:40 GMT -06:00
https://www.coursehero.com/file/24088688/NR305Week-7-Discussiondocx/
WEEK 7 DISCUSSION
Assessment of the Musculoskeletal System and Pain (graded)
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?.
Class,
For this exercise, identify and discuss medical disorders that may produce the abnormal musculoskeletal
findings. Take into consideration the developmental, age, psychosocial, cultural, and health history. etc... in
assessment and findings.
Post
Fred seems to present with a fractured hip due to the slight rotation of his right leg. As a precaution,
his extremity should be immobilized since unnecessary movement can caused neurovascular
injuries. I would visually inspect for shortening of the affect extremity and assess for muscle
spasms. An x-ray would be ordered to validate or rule out the initial suspicion hip fracture. High pain
levels at the time of the fall could contribute to subsequent complications, especially in the elderly
(Oberkircher, 2016). I would also help obtain orders for more analgesics since Fred’s pain is not
relieved after receiving morphine in the ER. Reducing pain may help with his collaboration during
the assessment process. Determining the neurovascular status of the injured leg for patency is
important as a disruption in blood supply can lead to necrosis. Any swelling, warmth, or redness
may imply acute inflammation (Jarvis, 2015, p. 586). Therefore I would assess for temperature,
sensation, and pedal pulses. This should be compared bilaterally to detect any differences in quality.
Fred should also receive ongoing monitoring of vital signs, the level of consciousness, and oxygen
saturation for potential development of fat embolism. Anyone who has long bone, pelvic, or multiple
fractures is potentially at significant risk for it (Gore, 2005). Immobilizing and stabilizing the fracture
may help prevent release of fat globules into Fred’s venous circulation which can potentially travel
to his lungs and brain.
Fred is at an increased risk for complications during surgery due to his age and medical history. His diabetes
may impede the healing process. His sleep apnea is a concern because due to potential obstruction while lying
down. Plavix and aspirin should be stopped prior to surgery due to risk of bleeding. Fred will possibly need EKG
monitoring due to his MI history to evaluate the safety of a surgery and receive cardiac clearance. Patient
teaching will include proper positioning such as no leg crossing. Fred may also require an abduction pillow to
help promote alignment of the hip. Encouraging fluid intake for hydration and foot or ankle exercise would be
prudent to help prevent formation of deep vein thrombosis.
This study source was downloaded by 100000832558064 from CourseHero.com on 02-15-2022 23:26:40 GMT -06:00
https://www.coursehero.com/file/24088688/NR305Week-7-Discussiondocx/
