Assessment of the musculoskeletal system and pain

• 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.

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.

1. 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.
2. 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?
3. 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?

STOPPED IN HIS TRACKS

CLASS: I am certain that most of you have encountered a patient like Fred.  They are vibrant and engaged elderly people who suffer a fall and sustain what can be life threatening injuries.  His situation is complicated by his age (the condition of his vital organs and musculoskeletal system), his previous medical history and his current medication regimen.   Be sure to consider each of these complications as you create your plan for his nursing care.  

References:

Chamberlain College of Nursing (2019) NR305 RN Health Assessment.Week 7 lesson Downers Grove, IL Online Publication