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?
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