Mrs. Thompson is exhibiting signs of acute confusion and restlessness following a recent fall, with a Glasgow Coma Scale score of 13. Considering her condition and recent findings, what is the most appropriate initial nursing intervention to address her altered mental state?

B) Reorient Mrs. Thompson frequently to time, place, and situation.

A) Encourage oral fluid intake to prevent dehydration.

B) Reorient Mrs. Thompson frequently to time, place, and situation.

C) Administer prescribed opioids for pain management.

D) Start oxygen therapy at 2 L/min via nasal cannula.

A nurse is caring for Mrs. Thompson, who presents with acute confusion, pain, and physical signs suggestive of a hip fracture. The nurse notes an elevated white blood cell count and a left shift, indicating a possible infection. Which intervention should the nurse prioritize to address the patient's current condition?

D) Monitor vital signs and prepare for a chest X-ray to assess for pneumonia.

A) Administer prescribed antibiotics to address the suspected infection.

B) Prepare Mrs. Thompson for immediate hip surgery to prevent further complications.

C) Initiate a fall prevention protocol to ensure patient safety.

D) Monitor vital signs and prepare for a chest X-ray to assess for pneumonia.

Mrs. Thompson is being managed for both a femoral neck fracture and aspiration pneumonia. Which nursing intervention is most important to prioritize for preventing complications related to her respiratory condition?

B) Encourage incentive spirometry use every hour while awake

A) Administer analgesics as prescribed to ensure comfort

B) Encourage incentive spirometry use every hour while awake

C) Monitor her hemoglobin levels due to potential blood loss

D) Prepare her for early mobilization to prevent deep vein thrombosis

Mrs. Thompson is being prepared for potential surgical intervention for a displaced femoral neck fracture while concurrently being treated for aspiration pneumonia. Which nursing intervention is a priority to optimize her condition for surgery and manage her pneumonia effectively?

C) Monitoring oxygen saturation closely and adjusting supplemental oxygen to maintain levels above 92%.

A) Administering analgesics prior to deep breathing exercises to manage hip pain.

B) Encouraging oral fluid intake to prevent dehydration from fever and increased respiratory effort.

C) Monitoring oxygen saturation closely and adjusting supplemental oxygen to maintain levels above 92%.

D) Initiating passive range of motion exercises to maintain joint mobility in the affected leg.

A nurse is caring for Mrs. Thompson, who is being treated for pneumonia and preparing for surgical intervention for a hip fracture. Given her current laboratory results, what is the most appropriate nursing intervention to address her mild hyponatremia while ensuring adequate respiratory function?

C) Restrict free water intake and continue monitoring electrolyte levels.

A) Increase her oral fluid intake to enhance hydration.

B) Administer hypertonic saline to correct the hyponatremia rapidly.

C) Restrict free water intake and continue monitoring electrolyte levels.

D) Encourage high-sodium dietary intake to increase serum sodium levels.

Mrs. Thompson's current laboratory findings indicate mild hyponatremia and an ongoing infection, with her oxygen saturation intermittently dropping to 90% on room air. Considering her current clinical picture and the priority of preparing her for surgical intervention, what is the most appropriate nursing intervention at this time?

C) Administer supplemental oxygen and encourage incentive spirometry use.

A) Increase her oral fluid intake to correct hyponatremia.

B) Initiate a high-sodium diet to address her low sodium levels.

C) Administer supplemental oxygen and encourage incentive spirometry use.

D) Restrict fluid intake to prevent potential fluid overload.

A nurse is caring for Mrs. Thompson, who has shown signs of deteriorating neurological and respiratory status post-surgery. Given her current metabolic acidosis, fluctuating oxygen saturation, and suspected sepsis, which nursing intervention should be prioritized to stabilize her condition and address the underlying issues?

C) Initiate the sepsis protocol by administering broad-spectrum antibiotics.

A) Increase the rate of intravenous fluids to address possible hypovolemia.

B) Prepare to administer a blood transfusion to correct her anemia.

C) Initiate the sepsis protocol by administering broad-spectrum antibiotics.

D) Adjust her supplemental oxygen to maintain saturation levels above 95%.

A nurse is caring for Mrs. Thompson, who is showing signs of potential sepsis following recent surgery. Which of the following interventions should the nurse prioritize to address her current condition and support her recovery?

A) Administer broad-spectrum antibiotics and monitor for culture results.

B) Increase fluid intake to improve blood pressure and oxygen saturation.

C) Prepare for immediate surgical intervention to repair the hip fracture.

D) Initiate mechanical ventilation to stabilize respiratory function.

A nurse is monitoring Mrs. Thompson, who is exhibiting signs of potential acute respiratory distress syndrome (ARDS) while being treated for sepsis. Given her current condition, which of the following interventions should the nurse prioritize to address her respiratory status and prevent further complications?

C) Initiate mechanical ventilation to support respiratory function.

A) Administer high-flow oxygen therapy to improve oxygen saturation.

B) Position the patient in a prone position to enhance lung expansion.

C) Initiate mechanical ventilation to support respiratory function.

D) Increase fluid administration to maintain blood pressure.

A nurse is caring for Mrs. Thompson, who is experiencing complications from sepsis, including potential acute respiratory distress syndrome (ARDS). Her oxygen saturation occasionally drops to 86%, and she exhibits increased work of breathing with diminished breath sounds. Which of the following interventions is the most appropriate for the nurse to anticipate to support Mrs. Thompson's respiratory function?

B) Prepare the patient for invasive mechanical ventilation.

A) Initiate high-flow nasal cannula oxygen therapy.

B) Prepare the patient for invasive mechanical ventilation.

C) Administer diuretics to reduce potential fluid overload.

D) Increase intravenous fluid administration to improve perfusion.

hip fracture - Nursing Case Study

Pathophysiology

• Primary mechanism: Osteoporosis leads to decreased bone mineral density, making bones fragile and more susceptible to fractures, particularly in the hip, which bears significant weight and stress.

• Secondary mechanism: Falls, often due to impaired balance or environmental hazards, are a common trigger for hip fractures in individuals with weakened bone structure.

• Key complication: A hip fracture can result in impaired mobility, potentially leading to complications such as deep vein thrombosis or pulmonary embolism due to prolonged immobility.

Patient Profile

Demographics:

65-year-old female, retired school teacher

History:

• Key past medical history: Osteoporosis, hypertension

• Current medications: Calcium supplements, Lisinopril

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Severe pain in the right hip after a fall

• Key symptoms: Inability to bear weight on the right leg, swelling and bruising around the hip, developing confusion and restlessness

• Vital signs: Blood pressure 150/95 mmHg, heart rate 110 bpm, respiratory rate 22 breaths/min, temperature 38.2°C (100.8°F)

Section 1

As the nursing team begins the initial assessment, they note that the patient, Mrs. Thompson, is exhibiting signs of acute confusion, which may be indicative of delirium. This is concerning considering her recent fall and the possibility of a hip fracture. The team performs a focused neurological assessment to evaluate her mental status further, acknowledging that her confusion and restlessness could stem from multiple factors, including pain, infection, or even a reaction to the trauma. Her Glasgow Coma Scale score is slightly reduced at 13, with disorientation to time and place.

The physical assessment reveals significant swelling and ecchymosis around the right hip area. The leg appears shortened and externally rotated, classic signs suggestive of a hip fracture. Given her osteoporosis, these findings align with the suspicion of a femoral neck fracture. The nursing team prioritizes pain management, administering acetaminophen as she has no known allergies to it, while cautiously avoiding opioids due to her confusion.

Laboratory tests are ordered, including a complete blood count (CBC) and basic metabolic panel, to rule out any underlying infection or electrolyte imbalance contributing to her altered mental state. An elevated white blood cell count of 15,000/mm³ with a left shift is noted, raising the suspicion of an infectious process, possibly pneumonia, given her elevated temperature and respiratory rate. These findings necessitate further investigation and intervention to prevent complications such as sepsis. The team prepares Mrs. Thompson for imaging studies, including an X-ray of the hip, to confirm the fracture diagnosis, while also considering a chest X-ray to assess for any pulmonary involvement. This comprehensive approach allows for a timely identification of both orthopedic and potential infectious complications, setting the stage for the next steps in her care journey.

Section 2

The imaging studies confirm the presence of a displaced femoral neck fracture on the right side, necessitating an urgent orthopedic consultation to discuss surgical intervention. Concurrently, the chest X-ray reveals a mild infiltrate in the right lower lobe, consistent with aspiration pneumonia, which could explain the elevated white blood cell count and respiratory symptoms. Mrs. Thompson's vital signs show a persistent low-grade fever of 100.8°F, a respiratory rate of 24 breaths per minute, and a heart rate of 104 beats per minute, suggesting her body is mounting a response to the infection.

In light of these findings, the nursing team collaborates with the medical team to initiate a broad-spectrum antibiotic regimen, taking into account her renal function and potential drug interactions. They also implement supportive measures such as supplemental oxygen to maintain her oxygen saturation above 92% and encourage deep breathing exercises to prevent further pulmonary complications. The interdisciplinary team emphasizes the importance of monitoring her fluid and electrolyte status closely, given her increased insensible losses due to fever and increased respiratory effort.

As Mrs. Thompson stabilizes, her confusion begins to resolve slightly, indicating that addressing the infectious component is contributing positively to her cognitive state. However, the team remains vigilant for any signs of deterioration, such as worsening respiratory status or hemodynamic instability, which could signify progression to sepsis. Plans are made to optimize her condition for potential surgical repair of the hip fracture, balancing the need for prompt orthopedic intervention with the imperative to manage her pneumonia effectively. This dual focus ensures that both immediate and long-term outcomes are prioritized, setting the stage for ongoing assessment and adaptation of her care plan.

Section 3

As the interdisciplinary team continues to manage Mrs. Thompson's condition, a new set of laboratory results returns, providing further insight into her current status. The complete blood count reveals a white blood cell count that remains elevated at 14,500/mm³, indicating ongoing infection, but with a slight downward trend suggesting a modest response to the antibiotic therapy. Her blood urea nitrogen and creatinine levels are stable, reflecting adequate renal function despite the infection and increased insensible losses. Electrolyte analysis shows a mild hyponatremia with a serum sodium level of 132 mEq/L, which prompts the team to review her fluid management strategy, carefully balancing the need for hydration with the risk of fluid overload given her respiratory status.

In addition to the lab results, a follow-up chest X-ray is ordered to assess the progression of the pneumonia. The imaging reveals that the infiltrate in the right lower lobe has not significantly worsened, and there is no evidence of pleural effusion, which is reassuring in the context of her current treatment plan. However, the respiratory team notes subtle signs of atelectasis, likely due to her limited mobility and shallow breathing, emphasizing the importance of continued incentive spirometry use and regular repositioning to enhance lung expansion.

With these findings, the care team conducts a thorough reassessment of Mrs. Thompson. Her vital signs show a slight improvement in her respiratory rate, now at 22 breaths per minute, and her heart rate has decreased to 98 beats per minute, suggesting partial resolution of her systemic inflammatory response. Despite these improvements, her oxygen saturation intermittently drops to 90% on room air, necessitating ongoing supplemental oxygen. The team continues to monitor her closely for any signs of clinical deterioration, as they prepare to transition her towards surgical intervention for her hip fracture once her pneumonia is more controlled. This delicate balancing act between managing her acute infection and preparing for orthopedic repair remains the central focus of her care trajectory.

Section 4

As Mrs. Thompson's care progresses, the interdisciplinary team notes a change in her status that warrants immediate attention. During a routine assessment, the nurse observes that Mrs. Thompson is increasingly lethargic and more difficult to rouse than in previous assessments. Her Glasgow Coma Scale score has decreased to 13 from a baseline of 15, indicating a new neurological concern. Concurrently, her blood pressure has dropped to 100/60 mmHg, and the previous improvement in her heart rate has reversed, now spiking to 110 beats per minute. Her oxygen saturation continues to fluctuate, intermittently dipping to 88% even with supplemental oxygen, indicating a potential worsening of her respiratory status.

In light of these changes, the team orders a series of additional diagnostics to identify the underlying cause. A repeat complete blood count shows a further decrease in hemoglobin to 10.5 g/dL, suggesting possible bleeding or inadequate erythropoietic response. Given the recent surgical history and ongoing infection, there is concern for potential sepsis or evolving anemia. Blood cultures are drawn to rule out bacteremia, and an arterial blood gas is ordered, revealing a pH of 7.32 with a bicarbonate level of 18 mEq/L, consistent with metabolic acidosis. These findings prompt the team to initiate a sepsis protocol, including broad-spectrum antibiotics while awaiting culture results, and to assess the need for a possible blood transfusion.

This shift in Mrs. Thompson's condition underscores the complexity of her care and highlights the need for vigilant monitoring and prompt intervention. The team discusses the challenges of balancing her fluid status to address both the hyponatremia and the risk of fluid overload. They also consider the potential need for mechanical ventilation support if her respiratory status continues to decline. As the team navigates these developments, they remain focused on stabilizing Mrs. Thompson to ensure she is fit for eventual surgical repair of her hip fracture, recognizing that her recovery trajectory is intricately linked to the resolution of these acute complications.

Section 5

As the team implements the sepsis protocol, Mrs. Thompson's condition is closely monitored for any response to the interventions. Within a few hours, her vital signs show a subtle yet crucial shift. Her heart rate stabilizes slightly at 100 beats per minute, and her blood pressure remains steady, although still low, at 105/65 mmHg. Despite these efforts, her oxygen saturation remains unstable, occasionally dropping to 86%, indicating a persistent respiratory challenge. The team decides to administer a blood transfusion, given her hemoglobin level of 10.5 g/dL and signs of anemia, to improve oxygen delivery and support her hemodynamic status.

The interdisciplinary team reconvenes to reassess her fluid management plan, given the delicate balance required to address both the risk of fluid overload and her ongoing hyponatremia. Her electrolyte panel reveals a sodium level of 130 mEq/L, suggesting mild improvement, but vigilance is necessary to prevent further complications. Additionally, her repeat arterial blood gas shows a slight improvement in metabolic acidosis, with a pH of 7.35 and a bicarbonate level of 20 mEq/L, indicating a positive initial response to the interventions.

Despite these developments, new complications arise when Mrs. Thompson exhibits increased work of breathing and diminished breath sounds on auscultation, raising concerns about the potential onset of acute respiratory distress syndrome (ARDS). The team discusses the potential need for mechanical ventilation support, weighing the risks and benefits given her fragile state. This decision is pivotal as they aim to stabilize her respiratory function while continuing to address the underlying sepsis and prepare her for the eventual surgical repair of her hip fracture. The team remains vigilant, ready to adapt their plan as Mrs. Thompson's condition evolves, ensuring they remain one step ahead in her complex care journey.