Mrs. LV, 74 years old, is 4 days postoperative from a left hip fracture. She had a ConstaVac, which was removed yesterday. The surgical dressing is clean and dry. The pedal pulse on the left foot is present, and circulation, movement, and sensation are within normal limits. Lung sounds reveal fine crackles at the lower bases in both lungs. Encourage her to deep breathe, cough, and use the incentive spirometer.

6 AM signs:
- Temperature: 99.8°F
- Pulse: 80
- Respirations: 18
- Blood Pressure: 130/82
- Pulse Oximetry: 96%

She does not want to move and seems scared. Acetaminophen #3 was given twice during the night for leg pain, with the last dose at 6 AM. She is currently sleeping.

Patient Care Kardex:
- Vital Signs: Every shift
- Diet: Soft
- Hard of hearing
- Intake & Output
- Ambulate with Physical Therapy
- Last bowel movement: 2 days ago
- IV: Saline lock in the left forearm, #22 gauge angiocath inserted day of surgery

Routine Medications:
- Digoxin 0.125 mg orally every morning at 0900
- Furosemide 10 mg orally every morning at 0900
- Ferrous sulfate 300 mg orally three times daily with meals (0800, 1200, 1700)
- Lovenox 30 mg subcutaneously daily at 0900

PRN Medications:
- Acetaminophen with codeine #3, 1 tablet orally every 4 hours as needed for pain

Medical History:
- Elderly female brought to the Emergency Department after falling at home. Diagnosed with a fracture of the left hip, she underwent an open reduction internal fixation (ORIF).
- Hemoglobin: 9.4 g/dL, Hematocrit: 28% on admission.
- Lives alone, with one son. Her husband passed away 2 years ago from a cardiac condition.
- History of atrial fibrillation.

Questions:
1. After you complete your assessment at 0730, what information was missing in the 0700 report?
2. Should the physician have been called? If so, when?
3. What nursing actions can you delegate/assign to the personal support worker?

Question

29-01-2024
Health

College

Mrs. LV, 74 years old, is 4 days postoperative from a left hip fracture. She had a ConstaVac, which was removed yesterday. The surgical dressing is clean and dry. The pedal pulse on the left foot is present, and circulation, movement, and sensation are within normal limits. Lung sounds reveal fine crackles at the lower bases in both lungs. Encourage her to deep breathe, cough, and use the incentive spirometer.

6 AM signs:
- Temperature: 99.8°F
- Pulse: 80
- Respirations: 18
- Blood Pressure: 130/82
- Pulse Oximetry: 96%

She does not want to move and seems scared. Acetaminophen #3 was given twice during the night for leg pain, with the last dose at 6 AM. She is currently sleeping.

Patient Care Kardex:
- Vital Signs: Every shift
- Diet: Soft
- Hard of hearing
- Intake & Output
- Ambulate with Physical Therapy
- Last bowel movement: 2 days ago
- IV: Saline lock in the left forearm, #22 gauge angiocath inserted day of surgery

Routine Medications:
- Digoxin 0.125 mg orally every morning at 0900
- Furosemide 10 mg orally every morning at 0900
- Ferrous sulfate 300 mg orally three times daily with meals (0800, 1200, 1700)
- Lovenox 30 mg subcutaneously daily at 0900

PRN Medications:
- Acetaminophen with codeine #3, 1 tablet orally every 4 hours as needed for pain

Medical History:
- Elderly female brought to the Emergency Department after falling at home. Diagnosed with a fracture of the left hip, she underwent an open reduction internal fixation (ORIF).
- Hemoglobin: 9.4 g/dL, Hematocrit: 28% on admission.
- Lives alone, with one son. Her husband passed away 2 years ago from a cardiac condition.
- History of atrial fibrillation.

Questions:
1. After you complete your assessment at 0730, what information was missing in the 0700 report?
2. Should the physician have been called? If so, when?
3. What nursing actions can you delegate/assign to the personal support worker?

Answer :

Final answer:

When assessing a postoperative patient with a hip fracture, it is important to gather comprehensive information about the patient's condition and report any missing information to the healthcare team. The 0700 report may have missed important details such as the patient's pain level, mental status, and vital signs. Whether or not to call the physician depends on the specific situation and the patient's condition. Nursing actions that can be delegated to a personal support worker include assisting with activities of daily living and providing emotional support to the patient.

Explanation:

Assessment and Nursing Actions for a Postoperative Patient with a Hip Fracture

When assessing a postoperative patient with a hip fracture, it is important to gather comprehensive information about the patient's condition and report any missing information to the healthcare team. In this case, the 0700 report may have missed important details that should be included in the assessment.

Missing Information in the 0700 Report

Pain level: The report does not mention the patient's current pain level, which is crucial in assessing postoperative pain management.
Mental status: There is no information about the patient's mental status, including their level of consciousness and orientation.
Vital signs: The report does not provide the patient's current vital signs, such as heart rate, blood pressure, respiratory rate, and temperature.

It is important to communicate these missing details to the healthcare team to ensure appropriate care for the patient.

Calling the Physician

Whether or not to call the physician depends on the specific situation and the patient's condition. If there are concerning changes in the patient's condition, such as worsening pain, abnormal vital signs, or signs of complications, it may be necessary to notify the physician immediately. The nurse should use their clinical judgment to determine when to involve the physician.

Nursing Actions Delegated to Personal Support Worker

Personal support workers can assist with various nursing actions for postoperative patients with a hip fracture. These actions may include:

Assisting with activities of daily living, such as bathing, grooming, and feeding.
Providing emotional support to the patient.

Learn more about assessment and nursing actions for a postoperative patient with a hip fracture here:

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