Reference no: EM133695490 , Length: Words Count:600
Assignment:
Case study Maria Russo is a 76 year old woman admitted to the Emergency Department via ambulance. Maria fell when watering her garden and was unable to get up. She was lying in her garden for 3 hours until discovered by her neighbour. Maria's medical history includes osteoporosis, prediabetes and depression. She has recently been experiencing some orthostatic hypotension. She has no significant surgical history. Maria lives alone, her husband died 6 months ago. Her adult children live interstate. Maria's current medications include Aspirin 75mgs daily, Citalopram 20mg and Alendronate Sodium 10mg orally daily. She was administered Intravenous Morphine and inhaled Methoxyflurane by the paramedics.
Assessment data: Airway: patent Respiratory rate: 18 breaths/min Oxygen saturation: 97% on room air Heart rate: 90 beats/min (irregular) Blood pressure: 104/70 mmHg Capillary refill: 2 seconds Right leg shortened and externally rotated Right hip bruised and oedematous Right foot pink, cool, no paraesthesia or abnormal sensation, pedal pulse present Maria informs you that she "can't remember what happened when she fell.
She woke up on the ground and could not get up'' Pain score: 5/10 on rest, 7/10 on movement Temperature: 35 C Small laceration to right shoulder Intravenous cannula inserted Cephalic vein Left arm Weight: 54 kgs Height: 174cm X-rays reveal an Intertrochanteric fracture of the Right femur. Maria is seen by the Orthopaedic surgeon and is scheduled for an Open Reduction and Internal fixation (ORIF) of the fracture. She has been placed on the Emergency Operating List. The Registered Nurse has just administered Intravenous Morphine 2mg and the anaesthetist has been contacted to perform a femoral nerve block. The orthopaedic registrar will visit Maria to gain consent for surgery.
The Emergency Department is extremely busy and Maria is positioned on a trolley in the corridor while she waits for the Registrar to come. Maria's neighbour, Francesco has arrived at the hospital and keeps asking you what is wrong with Maria and demanding to speak to the doctor. Maria is upset that she is going to require surgery and is worried about her pet dog, Bonnie, and who will care for her while she is in hospital.
Questions
1) Discuss the Registered Nurse's role regarding informed surgical consent, confidentiality and privacy in this scenario (120 words)
2) Develop four short term goals to be achieved in the pre-operative period.
3) Discuss who must be involved in the development of these goals (80 words)
4) Discuss the nursing interventions required to meet the identified goals and preoperative patient problems
5) Ensure that rationales are provided for these interventions (400 words)