Nr305 Week 7: Assessment of the Musculoskeletal System and Pain
Nr305 Week 7. This week’s graded discussion topic relates to the following Course Outcomes (COs).
CO1 Utilize prior knowledge of theories and principles of nursing and related disciplines to explain expected client behaviors, while differentiating between normal findings, variations, and abnormalities. (PO 1)
CO2 Recognize the influence that developmental stages have on physical, psychosocial, cultural, and spiritual functioning. (PO 1)
CO3 Utilize effective communication when performing a health assessment. (PO 3)
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.Nr305 Week 7: Assessment
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?Nr305 Week 7: Assessment
Nr305 Week 7: Assessment Answer
Given the information provided, my priority in caring for Fred is to conduct a comprehensive assessment that encompasses both vital signs and a focused inquiry into his pain experience. Given the administration of morphine prior to transfer, I would particularly scrutinize any changes in blood pressure, recognizing that morphine can induce hypotension as a side effect. Utilizing a pain scale, I would prompt Fred to rate his pain on a scale of 2-10 and delve into specifics regarding the location, nature, exacerbating factors, and any radiation of the pain.Nr305 Week 7: Assessment
To further gauge the extent of joint involvement, I would assess the range of motion in the affected extremities, recognizing that limitations in range of motion can be indicative of joint disease (Jarvis, 590). Concurrently, a meticulous examination of radial and pedal pulses on both sides, skin color, temperature, and the presence of edema is warranted. The identification of swelling holds particular significance as it signals joint irritation (Jarvis, 589). To alleviate any discomfort, I would offer interventions such as ice packs, heat packs, or repositioning.Nr305 Week 7: Assessment
Expanding the assessment to include Fred’s neurological status, I would evaluate his level of consciousness, assess PERRLA (pupils equal, round, reactive to light, and accommodation), and thoroughly examine his head for potential injuries. Despite his alert and oriented state in the ER, recognizing the dynamic nature of medical conditions, especially post-fall, prompts the implementation of neurological assessments every two hours in my facility.
Contemplating Fred’s age, injury, medical history, and current medications, my concern revolves around the potential necessity for surgery. Notably, Fred is on Plavix, increasing his risk of bleeding, which must be discontinued seven days prior to surgery. Additionally, his history of stents introduces further considerations.
In addressing these concerns, it is imperative to collaboratively formulate a care plan that optimizes Fred’s overall well-being, taking into account the complexities associated with his medical history and potential need for surgical intervention. This approach aligns with the holistic principles of nursing care, emphasizing the integration of comprehensive assessments and patient-centered interventions.
