Case Study #35Case Study #35Scenario
S.P. is admitted to the orthopedic ward. She has fallen at home and she has sustained an intracapsular fracture of the hip at the femoral neck. The following history is obtained from her: She is a 75-year-old widow with three children living nearby. Her father died of cancer at age 62; mother died of heart failure at age 79. Her height is 5’3 and weighs 118 pounds. She has a 50 pack year smoking history and denies alcohol use. She has severe Rheumatoid Arthritis (RA) and had an upper GI bleed in 1993 and had Coronary Artery Disease with CABG 9 months ago. Since that time, she has engaged in “very mild exercise at home.” Vital signs are 128/60, 98, 14, 99 degree farenheight (32.7 degrees C) SAO2 94% on 2 Liter per nasal cannula. Her oral medications are rabeprazole (Aciphex) 20 mg/day, prednisone (Deltasone) 5mg/day, and methotrexate (Amethopterin) 2.5mg/week. 1. List at least four risk factors for hip fractures.
Four risk factors for hip fractures are history of smoking, being a female, and a frail build. Another risk factor is the client’s age, “Women who are postmenopausal had significantly increased risk of hip fracture.”(Tang, Chong, & Xu, 2013, p. 11)Case Study Progress S.P. is taken to surgery for a total hip replacement. Because of the intracapsular location of the fracture, the surgeon chooses to perm an arthroplasty rather than internal fixation. The post-operative orders include: Cefazolin (Kefzol) 1000mg IV q8h x 3 doses
Enoxaparin (Lovenox) 30mg subcut q12h
Warfarin (Coumadin) 2.5mg x 3 days, starting postoperatively day 1, then titrated to INR Docusate and senns (peri-Colace) 1 capsule PO bid
Multivitamin with iron (Trinsicon) 1 capsule/day PO with meals CBC in morning after blood re-infusion
Hydromorphone (Dilaudid) PCA intermittent 0.1mg dosing, lockout 10 minutes PT and OT to evaluate on postop day 1 and start therapy
Ketorolac (Toradol) 15mg IV q6h prn pain x 5 days only
Hip precautions per...
References: Katz, J. N., Wright, E. A., Polaris, J. J., Harris, M. B., & Losina, E. (2014, May 22). Prevalence and risk factors for periprosthetic fracture in older recipients of total hip replacement: a cohort study. BMC Musculoskeletal Disorders, 15(1), 1-9. http://dx.doi.org/10.1186/1471-2474-15-168Lewis, S. L., Dirksen, S. R., Heitkemper, M. M., Bucher, L., & Camera, I. M. (2011). Medical-surgical nursing: Assessment and management of clinical problems (8th ed.). St. Louis, MO: elsevier mosby.Orlicka, K., Barnes, E., & Culver, E. L. (2013). Prevention of infection caused by immunosuppressive drugs in gastroenterology. Therapeutic Advances in Chronis Disease, 4(4), 167-185. http://dx.doi.org/ 10.1177/
2040622313485275Renaud, A., Lavigne, M., & Vendittoli, P. (2012, December). Periprosthetic joint infections at a teaching hospital in 1990-2007. Canadian Journal of Surgery, 55(6), 394-400. http://dx.doi.org/10.1503/cjs.033610Tang, L., Chong, G., & Xu, Z. (2013, December). Association between estrogen receptor gene pvull and xbal polymorphisms and hip fracture risk: evidence from a meta-analysis. PlosONE, 8(12), 1-12. http://dx.doi.org/10.1371/journal.pone.0082806
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