Osteopenia and Intertrochanteric Femur Fracture Displacement

[mofokittykat]

Please Help!

I have a case study which is worth 50% of my final grade, if anyone could be of assistance that would be greatly appreciated.

The case study involves a 45-year-old female from Mexico. She has an unknown medical history as she was adopted. She had a bone density test a year ago and was diagnosed with Osteopenia, she tripped and fell over her cat and and was diagnosed with a fractured right hip. The X-ray shows Intertrochanteric Femur Fracture Displacement. She doesn't tolerate pain very well as she drank 3 bottles of wine through out the day before admitting herself into the hospital. She smokes 20 cigarettes a day. She is 5'4" tall and 110 pounds. She is on the following medications prozac, hyaluronic acid, salmon oil, shark cartillage, and ibuprofen. She has had two caesarean-sections hysterectomies and did not tolerate the anesthesia. During evaluation her husband continuously interupts and answers questions about her health history on her behalf.

I need to do four nursing diagnoses, as well as goals, interventions and evaluations. I need to identify two patient problems post-op and pre-op.

Does anyone have any ideas on how to approach this, where to start and where to end off? I could really use some feedback and assistance. It would be greatly appreciated.

Thanks

[Daytonite, BSN, RN]

you are being asked to write a plan of care for this patient. that is what a case study involves. a case study is a care plan in an essay form. you need to utilize the nursing process to accomplish this. start with step #1 and work your way through all the 5 steps (they are listed below). the first 3 steps will encompass most of this paper. assessment will be a huge part of it. look up osteopenia and what the causes of it are. how many people do you know that would even think of ingesting 3 bottles of wine as a pain killer? think maybe there is an alcohol problem here? the fact that her husband is disruptive and a 45-year old fractures a hip after tripping over a cat sounds suspicious to me. i would look up the signs and symptoms of spousal abuse to make sure i'm not missing something here. you will find the type of surgical repair needed to fix her hip addressed in the encyclopedia of surgery. the link to it is listed on the medical disease information/treatment/procedures/test reference websites below.

1. assessment (collect data from medical record, do a physical assessment of the patient, assess adl's, look up information about your patient's medical diseases/conditions to learn about the signs and symptoms and pathophysiology)
   
   • a physical assessment of the patient
     
   • assessment of the patient's ability and any assistance they need to accomplish their adls (activities of daily living) with the disease
     
   • data collected from the medical record (information in the doctor's history and physical, information in the doctor's progress notes, test result information, notes by ancillary healthcare providers such as physical therapists and dietitians
     
   • knowing the pathophysiology, signs/symptoms, usual tests ordered, and medical treatment for the medical disease or condition that the patient has. this includes knowing about any medical procedures that have been performed on the patient, their expected consequences during the healing phase, and potential complications. if this information is not known, then you need to research and find it.
     
     • use: https://allnurses.com/forums/f205/medical-disease-information-treatment-procedures-test-reference-websites-258109.html - medical disease information/treatment/procedures/test reference websites
       

[*]determination of the patient's problem(s)/nursing diagnosis (make a list of the abnormal assessment data, match your abnormal assessment data to likely nursing diagnoses, decide on the nursing diagnoses to use). it helps to have a book with nursing diagnosis reference information in it. there are a number of ways to acquire this information.

• your instructors might have given it to you.
  
• you can purchase it directly from nanda. nanda-i nursing diagnoses: definitions & classification 2007-2008 published by nanda international. cost is $24.95 http://www.nanda.org/html/nursing_diagnosis.html
  
• many authors of care plan and nursing diagnosis books include the nanda nursing diagnosis information. this information will usually be found immediately below the title of a nursing diagnosis.
  
• the nanda taxonomy and a medical disease cross reference is in the appendix of both taber's cyclopedic medical dictionary and mosby's medical, nursing, & allied health dictionary
  
• there are also two websites that have information for about 75 of the most commonly used nursing diagnoses that you can access for free:
  
  • http://www1.us.elsevierhealth.com/evolve/ackley/ndh7e/constructor/
    
  • http://www1.us.elsevierhealth.com/merlin/gulanick/constructor/index.cfm
    

[*]planning (write measurable goals/outcomes and nursing interventions)

• goals/outcomes are the predicted results of the nursing interventions you will be ordering and performing. they have the following overall effect on the problem:
  
  • improve the problem or remedy/cure it
    
  • stabilize it
    
  • support its deterioration
    

  [*]how to write goal statements: see post #157 on thread https://allnurses.com/forums/f50/careplans-help-please-r-t-aeb-121128-7.html

  • interventions are of four types
    
  • assess/monitor/evaluate/observe (to evaluate the patient's condition)
    
    • note: be clear that this is assessment as an intervention and not assessment done as part of the initial data collection during step 1.
      

    [*]care/perform/provide/assist (performing actual patient care)

    [*]teach/educate/instruct/supervise (educating patient or caregiver)

    [*]manage/refer/contact/notify (managing the care on behalf of the patient or caregiver)

[*]implementation (initiate the care plan)

[*]evaluation (determine if goals/outcomes have been met)