Medical Diagnosis
The diagnosis of the hip fracture is generally done by an X-ray of the hip and femur. Magnetic Resonance Imaging (MRI) may also be suitable if the fracture cannot be spotted by X-ray. Ideally, a hip fracture is a break in the upper quarter of the femur (thigh) bone. Usually, the hip is a ball-and socket joint. It gives allowance to the upper leg to bend and rotate at the pelvis. A patient with a hip fracture will experience pain over the outer upper thigh or in the groin.
Therapeutic Regimen
The patient’s active medical orders are Metoprolol to stabilize blood pressure, Metformin that lowers the patient’s blood sugar because she has Type II Diabetes, and Lipitor to regulate the abnormal lipid levels of the patient.
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Current Health Problems
Mrs. K suffers from numerous medical conditions. Firstly, is Meniere’s, a disorder of the inner ear, which can cause dizzy spells, and ultimately, hearing loss; it is a current diagnosis. It is probably the reason she got dizzy and fell when trying to go to the bathroom. Secondly, Mrs. K has hypertension because of the high B/P of 190/114. Thirdly, she suffers from Type II Diabetes, Dyslipidemia and Urge incontinence. She also has stage 2 pressure ulcers on her coccyx, which could cause a lot of pain. Lastly, she also has 4+ pitting edema in her lower right extremity. The fall caused by dizziness must have also caused health problems, probably a bone fracture or dislocation, causing the severe pain.
The patient in this case is of advanced age and obviously, most of her body systems and functions have begun to slow down. Secondly, she suffers from multiple chronic conditions, which can only be managed. The first care intervention would have been to give the patient Morphine IV to reduce the pain caused by the possible dislocation of her hip bones. Afterwards, a minor surgery is needed to correct the bone dislocation. It is then advisable to use drugs from the diuretics class to manage the patient’s dizziness, as well as attempt to restore her balance. The patient also needs to continue taking the normal dose of medication for the multiple chronic conditions from which she suffers.
Some of the normal observations from the assessment of the patient are that she has a normal pulse rate (100) and Oxygen saturation (92%). However, she has abnormal blood pressure, and respiratory rate (32). The respiratory rate is too high and quite abnormal, considering that the pulse rate is normal as well as Oxygen saturation. This patient needs close monitoring because the high respiratory rate could be an indication that she might be in need of surplus Oxygen. However, one of the priorities includes ensuring that the patient gets enough support because she cannot bear weight and walk unaided. If she tries to get out of the bed on her own, she will automatically fall, and probably worsen her health situation. If she needs to use the washroom, she will automatically have to be taken. It will be necessary to have a wheelchair available for easier mobility, but someone will have to push the wheelchair. Again, it is necessary to reposition her after every few hours, probably after every 2 hours because she cannot turn herself. This patient also needs to feel at peace with herself. Since she has photos of some of her family members by the bedside, it means that she really misses them. The healthcare provider should not just perform some sort of algorithms or only aim at providing medication; rather, it is important to adopt a patient-centered approach, which includes love, care, and compassion. The patient will need someone to talk to so that she feels valued.
Most of the body functions and organs of the patient, due to her advanced age, have begun to slow down, and it is important to consider these aspects while administering medication. It is vital to prescribe the various drugs for the patient in low quantities because their rate of absorption is slow because of the old age. Concurrent use of the multiple drugs could also result to a condition known as polypharmacy (Vallerand, & Sanoski, 2019). This concurrent use of drugs may also cause difficulties in their absorption to the bloodstream. Therefore, it is prudent to have adequate time spacing for the doses to allow time for the absorption. Again, multiple use of drugs can cause reactions, which could have adverse effects on the health of the patient. In this light, it is vital to reduce the quantities of drugs used by the patient to avoid these effects.
Mrs. K suffers from chronic illnesses, and the best intervention is to ensure that there is proper management. Care should be directed towards ensuring that once the patient leaves the healthcare center, she lives as normally as possible. Even within the healthcare environment, it is important for the patient to be taken outside; rather than just being confined within the hospital. Secondly, she needs to maintain high hygiene standards, and since she does not have the ability to move freely, she will need to be assisted. Thirdly, she needs a healthy diet, especially consumption of foods rich in vitamins, particularly, fruits and vegetables. These foods could help greatly to boost her immune system even when multiple drugs are being used. She also needs to take food rich in calcium to boost the strength of her bones. Generally, Mrs. K needs care that is patient-centered; caring healthcare providers, as well as an environment that gives her peace of mind.
Medications
Metoprolol 25 mg po twice daily to regulate the patient’s blood pressure (Vallerand, & Sanoski, 2019)
Class : Beta blockers
Contraindications : Thyroid disease, Diabetes Mellitus, acute heart failure
Reactions : Tiredness and dizziness
Pravastatin 20 mg po at bedtime to treat abnormal lipid production
Class : Statins
Contraindications : Hepatic disease
Adverse reactions : Muscle pain, fever, nausea, lack of energy
Furosemide 20 mg po after every 12 hours for the treatment of fluid retention (edema)
Class : Diuretics
Contraindications : anuria
Adverse reactions : nausea, diarrhea, dizziness
Ondansetron 4 mg po after every 6 hours to treat nausea
Class : serotonin receptor antagonist
Contraindications : Hypersenstivity
Adverse reactions : headache, fatigue, rash
Warfarin 2.5 mg po daily to act as an anticoagulant, and consequently to prevent and remote blood clot in the circulatory system
Class : anticoagulant
Contraindications : bleeding. Intracranial hemorrhage
Adverse reactions : severe bleeding, severe headache
Lab Tests
The first lab test to be performed on the patient is the Complete Blood Count (CBC) test. It is a test that evaluates the cells that circulate in the blood (Lab Tests Online, 2015). For this test, the three most prominent blood cells to be evaluated are the white blood cells, red blood cells and the platelets. Examining the number of white blood cells in the blood of the patient helps to evaluate the immune system of the patient, and if it is established to be weak, then proper medication is provided to enhance it. Red blood cell count is important because they carry out an important role of transporting oxygen around the various organs of the body. A low red blood cell count means that the patient also probably lacks enough hemoglobin and could possibly suffer from anemia. Therefore, it could be very important to prescribe medication, as well as other intervention strategies aimed at increasing the amount of iron in the body. Lastly, a low platelet count could mean coagulation of the patient’s blood, or frequent clotting of blood. Once such a case it established, then medication that serves as anticoagulation agents may be prescribed.
The second lab test that must be performed on the patient is the Comprehensive Metabolic Panel (CMP) test. The test is designed to evaluate the current metabolism status of the patient, and in this case, it includes the health status of the liver and kidneys (Lab Tests Online, 2015). Since most of the body functions of the patient might have slowed down because of her old age, the strength of the liver and the kidneys could have weakened and the performance of the CMP test is supposed to establish the extent of the damage. It is from this point that better intervention strategies are put in place to boost the functions of these organs.
Discharge Planning
The patient needs to be discharged at least after her pain has healed, and can support herself, albeit weakly. She needs to be taken to an older adult facility for care because of her advanced age, as well as because of the critical conditions she suffers from. Most of the conditions are chronic, and therefore, can only be managed. In the adult facility, she will find all the necessary help. Apart from prescribing the required medication, it is also important to provide healthcare tips such as exercising, wearing loose clothes, and maintaining a healthy diet for the patient.
References
Lab Tests Online. (2015). “ Complete Blood Count (CBC)”. https://labtestsonline.org/tests/complete-blood-count-cbc
Lab Tests Online. (2015). “ Comprehensive Metabolic Panel (CMP)”. https://labtestsonline.org/tests/comprehensive-metabolic-panel-cmp
Vallerand, A. H., & Sanoski, C.A. (2019). Davis's drug guide for nurses . FA Davis.
