A patient in the second week of rehabilitation after hip surgery is experiencing increasing pain, swelling, and redness at the surgical site, accompanied by low-grade fever. The laboratory workup shows an elevated white blood cell count and C-reactive protein level. Which nursing intervention should be prioritized to address the patient's current condition?

B) Administer prescribed antibiotics and closely monitor the patient's response to the treatment.

A) Encourage the patient to ambulate as much as possible to prevent deep vein thrombosis.

B) Administer prescribed antibiotics and closely monitor the patient's response to the treatment.

C) Apply warm compresses to the affected area to reduce pain and swelling.

D) Increase the patient's fluid intake to promote renal clearance of inflammatory markers.

A patient in rehabilitation following hip surgery presents with increased swelling, redness at the surgical site, low-grade fever, and an elevated white blood cell count with neutrophilia. Considering the patient's history of diabetes and hypertension, what is the most appropriate nursing intervention to prioritize in this situation?

A) Increase the frequency of vital signs monitoring and assess for signs of systemic infection.

B) Initiate a high-intensity exercise program to improve mobility and prevent deconditioning.

C) Discontinue the prescribed antibiotic regimen until further diagnostic tests confirm an infection.

D) Advise the patient to limit all physical activity to prevent further complications.

A patient with a history of diabetes and hypertension is being treated with antibiotics for an infection. Despite improvements in fever and white blood cell count, she exhibits increased fatigue, occasional confusion, elevated blood pressure, and mild proteinuria. What is the most appropriate nursing intervention to address her current symptoms and prevent further complications?

A) Increase her fluid intake and monitor for signs of dehydration.

B) Administer a higher dose of antibiotics to enhance infection control.

C) Consult with a dietitian to modify her diet for better glycemic control.

D) Initiate a low-sodium diet to address her elevated blood pressure.

A patient with a history of diabetes is currently being treated for an infection with antibiotics. Her blood glucose levels have been occasionally spiking to 250 mg/dL, and she shows signs of fatigue and confusion. Her blood pressure is elevated at 150/95 mmHg, and urinalysis reveals mild proteinuria. Based on these findings, which nursing intervention is most critical to prioritize at this time?

B) Increase the frequency of blood glucose monitoring and adjust insulin therapy as needed

A) Administer a bolus of IV fluids to correct potential dehydration

B) Increase the frequency of blood glucose monitoring and adjust insulin therapy as needed

C) Initiate a low-protein diet to protect renal function

D) Administer antihypertensive medication to lower blood pressure immediately

A patient with diabetes and hypertension is experiencing altered mental status, elevated blood pressure, and worsening renal function. The healthcare team has adjusted her medication regimen to protect renal function and manage her hypertension. Which nursing intervention is most appropriate to ensure safe and effective care for this patient?

B) Monitor daily weights and assess for signs of fluid overload.

A) Encourage the patient to increase fluid intake to flush out toxins.

B) Monitor daily weights and assess for signs of fluid overload.

C) Administer additional antihypertensive medication to quickly lower blood pressure.

D) Restrict sodium intake to prevent further electrolyte imbalances.

A patient with diabetes and hypertension is experiencing lethargy, disorientation, and worsening renal function. The healthcare team has adjusted her medication regimen to protect her kidney function and manage her blood pressure. Which nursing intervention is most appropriate to monitor the effectiveness of the revised medication plan?

C) Measure the patient's urine output and daily weight.

A) Monitor the patient's blood glucose levels every four hours.

B) Assess the patient's level of orientation every shift.

C) Measure the patient's urine output and daily weight.

D) Check the patient's serum potassium levels once per shift.

A patient with a history of hypertension and recent medication adjustments presents with respiratory distress and hyponatremia. Which nursing intervention is the most appropriate to address both respiratory and electrolyte concerns?

B) Implement fluid restriction and monitor serum electrolytes closely.

A) Administer a loop diuretic to aggressively manage fluid overload.

B) Implement fluid restriction and monitor serum electrolytes closely.

C) Increase oral fluid intake to correct hyponatremia.

D) Recommend a high-sodium diet to address hyponatremia.

A patient with a history of hypertension and recent diuretic adjustment develops respiratory distress with bilateral rales and hyponatremia. What is the most appropriate initial nursing intervention to address the patient's respiratory status while considering her electrolyte imbalance?

B) Implement fluid restriction and monitor respiratory status closely.

A) Increase the diuretic dose to reduce fluid overload.

B) Implement fluid restriction and monitor respiratory status closely.

C) Administer a hypertonic saline solution to correct hyponatremia.

D) Place the patient in a supine position to improve ventilation.

A patient with worsening hyponatremia and respiratory alkalosis is being treated with hypertonic saline and CPAP. Which of the following nursing interventions is most critical in monitoring for complications of treatment?

C) Performing frequent neurological assessments to detect changes in mental status.

A) Monitoring serum sodium levels every 6 hours.

B) Assessing for signs of fluid overload, such as peripheral edema and crackles in the lungs.

C) Performing frequent neurological assessments to detect changes in mental status.

D) Evaluating the patient's respiratory rate and effort every 4 hours.

A patient with hyponatremia and respiratory alkalosis is being treated with hypertonic saline and CPAP. Which nursing intervention is most appropriate to prevent complications associated with these treatments?

D) Regularly assess neurological status to detect changes early.

A) Increase the rate of hypertonic saline infusion to quickly correct sodium levels.

B) Monitor respiratory rate and depth closely to prevent hypoventilation.

C) Restrict fluid intake to 500 mL per day to manage fluid overload.

D) Regularly assess neurological status to detect changes early.

Hip fracture rehabilitation - Nursing Case Study

Pathophysiology

• Primary mechanism: Hip fractures often result from osteoporosis, where decreased bone density weakens the bone structure, making it susceptible to fractures even with minimal trauma. Rehabilitation aims to enhance bone strength and prevent further deterioration through weight-bearing exercises and nutrition.

• Secondary mechanism: Post-fracture, there is significant muscle atrophy and joint stiffness due to immobilization. Rehabilitation focuses on restoring muscle function and joint mobility through physical therapy, which aids in regaining balance and coordination, crucial for preventing future falls.

• Key complication: Impaired mobility after a hip fracture can lead to prolonged bed rest, increasing the risk of complications like deep vein thrombosis and pressure ulcers. Early mobilization and regular repositioning are vital in rehabilitation to mitigate these risks and promote recovery.

Patient Profile

Demographics:

67-year-old female, retired school teacher

History:

• Key past medical history: Osteoporosis, hypertension, type 2 diabetes

• Current medications: Alendronate, Lisinopril, Metformin, Calcium with Vitamin D supplements

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Persistent pain and limited mobility post-hip surgery

• Key symptoms: Swelling around the surgical site, low-grade fever, difficulty bearing weight on the affected leg

• Vital signs: Blood pressure 150/95 mmHg, heart rate 105 bpm, respiratory rate 22 breaths per minute, temperature 100.4°F

Section 1

New Complications:

During the second week of rehabilitation, the patient began experiencing increasing difficulty with mobility exercises and reported worsening pain localized around the surgical site. Upon evaluation, the physical therapist noted increased swelling and redness, suggesting a potential post-surgical infection. The patient's low-grade fever persisted, and her vital signs showed a slight elevation in heart rate to 110 bpm and a blood pressure reading of 155/98 mmHg, indicating possible systemic involvement. Given these changes, the rehabilitation team collaborated with the attending physician to reassess the patient's condition.

A subsequent laboratory workup was ordered to investigate the suspected infection. The results revealed an elevated white blood cell count of 13,500 cells/mcL, with a notable increase in neutrophils, supporting the suspicion of an infectious process. Additionally, a C-reactive protein (CRP) test showed elevated levels at 15 mg/L, further corroborating the inflammatory response. An X-ray of the affected hip was performed to rule out any hardware complications or osteomyelitis, which was unremarkable except for soft tissue swelling. Based on these findings, the patient was started on an appropriate antibiotic regimen, with careful consideration of her penicillin allergy, to address the suspected infection.

The development of this complication requires a reevaluation of the patient's rehabilitation plan. The focus shifted to managing the infection while maintaining as much mobility as possible without exacerbating symptoms. The nursing staff increased the frequency of monitoring for any signs of systemic complications, such as septicemia, given her underlying conditions of diabetes and hypertension, which could predispose her to more severe outcomes. The multidisciplinary team emphasized the importance of coordinated care, involving regular communication between the surgical, nursing, and rehabilitation teams, to ensure a comprehensive approach to the patient's recovery and to prevent further setbacks.

Section 2

As the antibiotic regimen commenced, initial assessments over the next few days revealed a mixed response to treatment. The patient's low-grade fever showed signs of resolution, and her white blood cell count gradually decreased to 11,500 cells/mcL, indicating a positive response to the antimicrobial therapy. However, despite these improvements, the patient began to exhibit signs of increased fatigue and occasional confusion, particularly in the afternoons. Her vital signs remained slightly unstable, with heart rate fluctuating between 100-105 bpm and blood pressure readings persistently elevated at around 150/95 mmHg.

These new symptoms prompted the healthcare team to consider additional factors that might be contributing to her condition. Given her history of diabetes, the team checked her blood glucose levels more frequently, noticing occasional spikes up to 250 mg/dL, which could be contributing to her altered mental status and fatigue. Furthermore, the patient's urine output decreased, raising concerns about possible dehydration or renal involvement. A urinalysis was performed and revealed mild proteinuria, which, along with her elevated blood pressure, suggested a need to evaluate her renal function more closely.

In light of these findings, the healthcare team focused on optimizing her diabetes management and hydration status, recognizing the potential impact on her recovery process. The multidisciplinary team, including endocrinologists and nephrologists, was consulted to adjust her diabetic treatment plan and ensure renal function was closely monitored. The team also emphasized the importance of maintaining a delicate balance between controlling the infection and managing her chronic conditions to prevent further complications and ensure a smooth rehabilitation process. This comprehensive approach was crucial in adapting the care plan to the patient's evolving needs, highlighting the importance of clinical reasoning in complex cases.

Section 3

As the healthcare team continued to address the patient's complex needs, they observed a notable change in her status. Despite efforts to optimize her diabetes management and improve hydration, the patient's confusion and fatigue persisted. On the fourth day of her revised care plan, the patient became increasingly lethargic and more disoriented, prompting a thorough reassessment of her condition. Her vital signs revealed a heart rate of 110 bpm and blood pressure that had risen further to 160/100 mmHg. These changes, coupled with the patient's ongoing symptoms, suggested that her condition was not improving as expected.

In response, the team ordered additional diagnostic tests, including a comprehensive metabolic panel and brain imaging, to rule out any acute neurological issues. The metabolic panel revealed a serum creatinine level of 2.0 mg/dL, indicating worsening renal function, while her electrolyte levels showed mild hyponatremia at 130 mEq/L. The brain imaging did not reveal any acute changes, suggesting that her altered mental status was more likely related to metabolic imbalances or the progression of underlying conditions. These findings necessitated a reevaluation of her medication regimen, particularly the potential nephrotoxic effects of her current drugs and the impact of her diabetes treatment on her electrolytes.

The healthcare team, now with the input of a nephrologist, adjusted her medication plan to better protect her renal function while addressing her blood pressure and glycemic control. They initiated a cautious diuretic regimen to manage her hypertension and fluid status, monitoring her closely for any further electrolyte disturbances. This comprehensive approach underscored the need for meticulous clinical reasoning in the face of evolving complications, ensuring that each intervention was carefully balanced to support her overall recovery and minimize the risk of additional setbacks.

Section 4

As the healthcare team closely monitored the patient's response to the adjusted medication regimen, they observed a temporary stabilization in her condition. Her blood pressure gradually began to decrease, settling at 145/95 mmHg, and her heart rate slightly improved to 100 bpm. However, her mental status showed only modest improvement, with intermittent episodes of confusion and lethargy still present. The team remained vigilant, understanding that her renal function and electrolyte balance were critical focal points in her overall recovery process.

On the sixth day of her revised care plan, the patient developed a new complication: she began to exhibit signs of respiratory distress. Her respiratory rate increased to 24 breaths per minute, and auscultation of her lungs revealed bilateral rales, suggesting fluid accumulation. Concerned about the possibility of volume overload due to the diuretic regimen, the team ordered a chest X-ray and additional lab tests to evaluate her fluid status and assess for potential pulmonary edema. The chest X-ray confirmed mild pulmonary congestion, and her repeat metabolic panel showed a further drop in sodium to 128 mEq/L, indicating worsening hyponatremia.

This new development necessitated a reassessment of her fluid management strategy. The healthcare team, including the nephrologist and a pulmonologist, collaborated to adjust her diuretic therapy, aiming to balance the need for fluid removal with the risk of exacerbating her hyponatremia. They implemented a more conservative approach, utilizing fluid restriction alongside careful monitoring of her electrolyte levels. This approach required precise clinical reasoning to ensure that interventions remained aligned with the patient's evolving needs, highlighting the complexity of managing concurrent complications while striving for optimal recovery outcomes.

Section 5

On the seventh day of the patient's revised care plan, the healthcare team noted a change in her clinical status. The patient began to exhibit increased drowsiness and was less responsive during morning rounds. Her family reported that she was more difficult to rouse and seemed more disoriented than usual. Concerned about these changes, the team reassessed her neurological status and ordered additional laboratory tests to investigate potential underlying causes.

The results of the new diagnostic tests revealed a further decline in sodium levels, now at 125 mEq/L, indicating worsening hyponatremia. Additionally, her arterial blood gas analysis showed a respiratory alkalosis with a pH of 7.48 and partial pressure of carbon dioxide (PaCO2) at 32 mmHg, suggesting that her respiratory status was contributing to her altered mental state. Her oxygen saturation remained stable at 94% on room air, but the team remained vigilant given the combination of hyponatremia and respiratory changes.

In response to these findings, the healthcare team adjusted the patient's management plan. They initiated a more aggressive sodium correction protocol with cautious use of hypertonic saline, while continuing to monitor her fluid balance closely. The pulmonologist recommended respiratory support in the form of continuous positive airway pressure (CPAP) to improve her alveolar ventilation and reduce the work of breathing. These interventions aimed to address both her electrolyte imbalance and respiratory status, requiring the team to engage in complex clinical reasoning to balance the risks and benefits of treatment strategies. As the team implemented these changes, they remained focused on the patient's overall recovery trajectory, aware of the potential for further complications and the need for ongoing vigilance.