Assessment of the Musculoskeletal System and Pain (graded)
Fred is an 83-year-old male who is being admitted to the medical-surgical unit status post fall. He is alert and oriented and reports that while visiting a local casino with his wife Margaret earlier this evening, he tripped over a curb and fell landing on his right side. After receiving morphine in the emergency room prior to transfer to your unit, Fred is rating his pain at 6/10. He has multiple bruises from his jawbone to his knee as well as a slight rotation of his right leg.
Past medical history includes: myocardial infarction (MI) x 2, peripheral vascular disease (PVD) with bilateral iliac stents, non-insulin-dependent diabetes mellitus (NIDDM), sleep apnea, and degenerative joint disease.
Medications include: aspirin, Plavix, Lopressor, Lisinopril, and Metformin.
After reviewing the above scenario please answer the following questions.
- Based on the information provided, how will you prioritize your care, what assessments will you include and in what order? Please provide rationale for your response.
- Considering this patient’s age, injury, past medical history, and list of current medications, what, if any, concerns do you have related to his potential need for surgery?
- Should surgery to repair his right femur be required; what type of clearance and pre-op orders would you anticipate receiving related to his diet, meds, lab work, and so on?
According to Obrist, Rogan & Hilfiker (2016), approximately 25% of people over 65 years of age and living at home fall each year and about 20% of the falls require medical attention. They go on to say that the mortality rate of hospitalized patients from a fall is high and yet, Fred has been admitted to your floor after a fall.
This week we are being asked to prioritize our assessment, and plan for a possibility of surgery.
I’m interested to see how you will plan care for our patient. What findings will you key in to? What do you anticipate your upcoming orders to be? What kind of patient/family education will you deliver to Fred and his wife?
Reference:
Obrist, S., Rogan, S., & Hilfiker, R. (2016). Development and evaluation of an online fall-risk questionnaire for nonfrail community-dwelling elderly persons: A pilot study. Current Gerontology & Geratrics Research, 1-16. doi:10.1155/2016/1520932
Expert Solution Preview
Introduction:
In this scenario, an 83-year-old male, Fred, has been admitted to the medical-surgical unit after a fall at a local casino. He has a medical history of several conditions and is currently taking multiple medications. As a medical professor in charge of creating assignments and answers for medical college students, we will answer the following questions regarding Fred’s care.
1. Based on the information provided, how will you prioritize your care, what assessments will you include and in what order? Please provide rationale for your response.
In prioritizing Fred’s care, the first assessment should be a comprehensive musculoskeletal examination to assess the extent of his injuries, including checking for any fractures or dislocations. Additionally, a neurological assessment should be conducted to evaluate his cognitive function, including memory, sensation, and movement. Since Fred is reporting pain, pain assessment should also be a priority to provide adequate pain management. His vital signs must be continuously monitored, and he should be monitored for any signs of shock, which could arise as a result of the fall.
2. Considering this patient’s age, injury, past medical history, and list of current medications, what, if any, concerns do you have related to his potential need for surgery?
Fred’s advanced age, medical history, and current medication list are all factors that could increase the risk of post-operative complications. Additionally, his current conditions of PVD and NIDDM can impair wound healing, and the use of aspirin and Plavix may further increase bleeding risk during surgery. Therefore, potential postoperative risks should be thoroughly evaluated before making any decisions regarding surgery, and alternatives to surgery should be considered.
3. Should surgery to repair his right femur be required; what type of clearance and pre-op orders would you anticipate receiving related to his diet, meds, lab work, and so on?
If surgery is required, there should be a comprehensive preoperative evaluation conducted to assess Fred’s fitness for surgery. Clearance from his primary care physician and other specialists should be obtained, and necessary lab work should be ordered to ensure that he is medically stable for the procedure. Additionally, dietary and medication adjustments may be required to minimize the risks of surgery and postoperative complications. Education should be provided to Fred and his wife about the process of obtaining clearance and preparing for surgery.
In conclusion, providing comprehensive care to an elderly patient with a complex medical history requires an in-depth assessment and evaluation of risks and benefits before making any decisions regarding treatment. It is also essential to involve the patient and their family in decision-making and provide education that is easy to understand and appropriate for their comprehension level.
