Reference no: EM133250897
Client Scenario - Helen Maroney, an 81-year-old woman presents to the emergency department after slipping on the ice in her driveway. She reports right hip pain and an inability to bear weight. She has no prior history of hip pain and is ambulatory with the use of a cane. She lives with her husband and performs all activities of daily living independently. Her medical history includes mild dementia, hypertension, and osteoarthritis. She is currently on metoprolol, Lisinopril, and acetaminophen.
Physical examination of the right hip demonstrates pain with range of motion, external rotation of the right root, shortening of the right leg and then leg is adducted. The leg is neurovascularly intact with good sensation, capillary refill, and pulses in the foot. Radiographs demonstrate a displaced subcapital femoral neck fracture of the right hip.
The client receives an ultrasound guided regional nerve block in the emergency department for pain control and is admitted to the hospital for treatment of her hip fracture. Preoperative traction is not used but the client is placed on bed rest with use of intermittent pneumatic compression devices. Adequate pain relief is achieved with acetaminophen following the administration of a regional block, which was used to minimize the risk of delirium.
The orthopedic surgeon had a discussion with the client and family regarding the overall long-term prognosis of possible decreased mobility and independence as a result of the hip fracture. The discussion also includes the possibility of mortality. After considering nonsurgical treatment measures, the client makes an informed decision to proceed with surgery based on the quality of life and mobility benefits associated with this method of treatment. The surgeon also discusses with the client the option of a total hip arthroplasty for the benefit of improved function and long-term results.After careful consideration, the client decided to move forward with surgery.
Postoperatively, the client is mobilized. The client is placed on Hip Precautions. Weight-bearing exercises are introduced as tolerated with physical and occupational therapy. She is placed on low-molecular-weight heparin and continues on intermittent pneumatic compression devices because of the high risk of venous thromboembolic events in this client population. Her admission albumin level was low; the nutrition service is consulted. The client is started on nutritional supplements following surgery to improve her protein levels and caloric intake. In addition, she is found to be vitamin D deficient, calcium and vitamin D supplementation are initiated.
Pain is initially well controlled after surgery because of the long-acting regional nerve block. A multi modal pain regimen is also used, including celecoxib, acetaminophen, and Tramadol, thus minimizing narcotic use to avoid delirium.The client's hemoglobin level decreases to 8.1 g/dL postoperatively; however, her blood pressure is stable. Although she experiences some transient lightheartedness and tachycardia, this improves with hydration.
Teaching Plan Directions -
1. Think about the learning/educational needs of this client. Create a concept map that outlines your plan for educating the client. The concept map must include: Assessment of learning readiness, expected learning outcomes, content outline, teaching strategies/resources, expected outcomes.
2. Complete Medication Templates for celecoxib, tramadol, and acetaminophen.
3. Answer the reflection questions below.
Reflective Questions -
1. What physical and/or sensory limitations does the client have?
2. Will sensory or physical functioning create learning barriers? Explain.
3. Describe the teaching method you would utilize and why?
4. At the hospital, where would you obtain your audio-visual aides?
5. When would you complete teaching with this client?
6. Why is it important to document patient education?