An 80-year-old White male was admitted s/p L hemiarthroplasty yesterday after a fall. No other acute injuries were treated. Patient is married and his wife and daughter are at the bedside. Patient has a history of type 2 diabetes but does not require medication normally, though he is currently on a sliding scale of insulin since surgery. He had an Ivor-Lewis esophagectomy secondary to adenocarcinoma of the esophagus and stomach 9 months ago. He also had gamma knife radiation for a left temporal mass ( 7 months agol which was found coincidentally when diagnosed with a CVA. He has a port-a-cath in his right upper chest which is not accessed. He has a left-hand peripheral IV of normal saline at 100 cc / hour and the pump that is alarming (which is what brought you into the room). His IV site is swollen and red. He is alert and oriented X s 3. HOB must be at 30 degrees at all times. Patient is 6 feet 6 inches tall and weighs 168 pounds. Skin is extremely fragile and tears easily. He currently has a reddened area over his coccyx, though skin is intact. Patient must not drink fluids within 30 minutes of meals, must eat a small, high-protein meal every 2 to 3 hours, and must rest at least 20 minutes after eating; otherwise he experiences dumping syndrome. Vitals: BP 150/68 (supine); P 70; R 24; O2 at 97% on room air. Breath sounds diminished in lower lobes bilaterally. Bowel sounds are decreased in all quadrants. Left hip dressing is dry and intact. Client states his pain is a 6 out of 10; he was last medicated 4 hours ago and has asked to have pain medicine and nausea medicine at the next opportunity. Pedal pulses are present bilaterally, no swelling. Blood work indicates Hgb of 8.1. When PT attended earlier, patient stood at bedside with walker and assistance, but quickly became nauseous and weak and was unable to transfer to the chair. Client lives with wife of 60 years. There are two steps into the residence, and patient was independent with all ADLs prior to the fall. He is currently resting; a soft meal was brought in, but patient has refused to eat or drink since he fell 2 days ago. Based on this case answer the following tasks and questions: 1. List the relevant cues. 2. What additional information do you need? 3. Which cues require immediate attention, and which need attention, but are not urgent? 4. Which are the most likely hypotheses? Which of these are serious? 5. Generate solutions based on evidence. 6. What actions should be taken and in what order? 7. How and when would you evaluate the outcomes?
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An 80-year-old White male was admitted s-p L hemiarthroplasty yesterda.docx
1. An 80-year-old White male was admitted s/p L hemiarthroplasty yesterday after a fall. No other
acute injuries were treated. Patient is married and his wife and daughter are at the bedside.
Patient has a history of type 2 diabetes but does not require medication normally, though he is
currently on a sliding scale of insulin since surgery. He had an Ivor-Lewis esophagectomy
secondary to adenocarcinoma of the esophagus and stomach 9 months ago. He also had gamma
knife radiation for a left temporal mass ( 7 months agol which was found coincidentally when
diagnosed with a CVA. He has a port-a-cath in his right upper chest which is not accessed. He
has a left-hand peripheral IV of normal saline at 100 cc / hour and the pump that is alarming
(which is what brought you into the room). His IV site is swollen and red. He is alert and
oriented X s 3. HOB must be at 30 degrees at all times. Patient is 6 feet 6 inches tall and weighs
168 pounds. Skin is extremely fragile and tears easily. He currently has a reddened area over his
coccyx, though skin is intact. Patient must not drink fluids within 30 minutes of meals, must eat a
small, high-protein meal every 2 to 3 hours, and must rest at least 20 minutes after eating;
otherwise he experiences dumping syndrome. Vitals: BP 150/68 (supine); P 70; R 24; O2 at 97%
on room air. Breath sounds diminished in lower lobes bilaterally. Bowel sounds are decreased in
all quadrants. Left hip dressing is dry and intact. Client states his pain is a 6 out of 10; he was
last medicated 4 hours ago and has asked to have pain medicine and nausea medicine at the next
opportunity. Pedal pulses are present bilaterally, no swelling. Blood work indicates Hgb of 8.1.
When PT attended earlier, patient stood at bedside with walker and assistance, but quickly
became nauseous and weak and was unable to transfer to the chair. Client lives with wife of 60
years. There are two steps into the residence, and patient was independent with all ADLs prior to
the fall. He is currently resting; a soft meal was brought in, but patient has refused to eat or drink
since he fell 2 days ago. Based on this case answer the following tasks and questions: 1. List the
relevant cues. 2. What additional information do you need? 3. Which cues require immediate
attention, and which need attention, but are not urgent? 4. Which are the most likely hypotheses?
Which of these are serious? 5. Generate solutions based on evidence. 6. What actions should be
taken and in what order? 7. How and when would you evaluate the outcomes?
