Right Hip fracture

CASE STUDY Tara Ryan (T. R.) is a 75-year-old female who was admitted to the hospital 72 hours earlier because of a right hip fracture sustained while walking her dog. She is currently 36 hours status post (S/P) total right hip replacement.

She has a medical history of hypertension, no known drug allergies (NKDA), and a full code status. T. R.’s vital signs are T 36.6 C (97.90 F), P 84 and regular, R 20 and unlabored, BP 164/90, with a pulse oximetry reading of 99% on room air.

The right hip incision is well approximated, with slight redness at the edges, no swelling, and minimal serosanguineous drainage on the dressing. She rates her pain as 8 of 10, located primarily at the surgical site when she moves in bed or tries to get up to go to the chair or bathroom.

She states, "The pain is sharp and shooting from my hip to midcalf when I move too fast." She grimaces when changing position and is reluctant to move. T. R. complains of weakness and fatigue while bathing or ambulating.

Her Braden score is 20, and her Morse Falls Risk score is 80. Her hemoglobin and hematocrit are 10.5 g/dL and 36.9%, respectively. Treatment orders are as follows: . Vital signs every 4 hours, including neurovascular checks . Adult regular diet . Intravenous (IV) access saline lock .

Bathroom privileges (BRPs) and ambulation with assistance . Dry, sterile dressing to incision site, change every 8 hours . Intake and output (1&0) .

Encourage coughing and deep breathing . Incentive spirometry every hour while awake . Knee-high antiembolism stockings . Sequential compression devices (SCDs) while in bed . Complete blood count (CBC) every morning Medication orders are as follows: . Morphine sulfate: 4 mg intravenous piggyback (IVPB) every 4 hours as needed (PRN) for severe pain .

Enoxaparin: 60 mg subcutaneously every 12 hours . Metoprolol: 50 mg PO (by mouth) bid Refer back to this case study to answer the critical-thinking exercises throughout the chapter.

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