NR305 Week 7 Topic 7 Discussion, 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?.
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.
Reference
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.
Reference
