Jack Buun, a 69 years old malewas brought to the emergency department (ED) via ambulance following a fall in hisgarden. During the fall, he twisted him arm and fellright on the lateral aspect of his right hip. On examination the paramedics reported an externally rotated and shortened right leg. Following the injuries and pain, Jack could not to get up. His inability to get up compelled his, wife, Ethel to call an Ambulance. Treatment necessitatedan emergency surgery under general anaesthetic for his femoral neck fracture. Jack also was subjected to a hemiarthroplasty. Past medical history shows that Jack was treated for hypertension that he has since managed to control.To ensure pain management, he was prescribed 20mg Morphine, 100mg Tramadol, 40mg Paracoxib, 1g Paracetamol and 0.625mg of droperidol; all administered intravenously.
Upon Examination, Jack’s blood pressure and pulse rate were at a high of 145/80 and 120 respectively. Further observations revealed that he had a low respiratory rate of 10, myosis, mild pains and was also drowsy but rousable to voice commands. Considering Jack’s age, hypertension and high heart rate, habitual aerobic exercises are beneficial in that it lowers the resting heart rate, high blood pressure and respiratory rates (Stefano et al., 2012). Most Perioperative issues are normally very high among the elderly. Jack being 69 years old, on average, may have three or four medical complications that often limit normal functioning and mobility. Since most patients in this age bracket are already on multiple medications that may impact the administration of anesthesia, polypharmacy is a major concern in Jack’s case. Therefore, substantial effort should have been put in to realize a full and accurate list of all previous medications taken by Jack including both prescription and over the counter medications (Sheila 2018). An accurate preoperative medication list is helpful in the postoperative setting when patients are admitted as inpatients after surgery.
Old patients, who are usually not steady after undergoing surgery like in Jack’s case, aremostly marshaled from their beds from the first day after operation to start dynamic and aerobic exercises. I recommend that Jack will be allowed to exercise with the amount of weight that his limb is comfortable with.Normally, it is challenging for old patients who have low upper body strength to manage the physiotherapy with extra weights on them that they can’t manage.After operation complications and risks may arise mostly in patientsin Jacks age bracket because of their advanced years and their bodies being already weak. Jack also needs thorough respiratory exercises, timely operations and quick mobilization,cautioushandling of fluid and electrolyte refillingin an effort to bar secondary complications such as Pneumonia, congestive heart disorder, heart attacks, irregular heartbeat,ulcers, blockage of blood vessels, andurinal system infections, that may likely occur. Swelling and loss of colour of the skin has been rercorded in a few cases after hip operation. (Kenneth 2013). Application of antibiotics prior to surgery has been embraced as anorm in managing limp fracture patients and is the main reason why the cases of infections are relatively low.
According to Stefano, et al. (2012), the 20mg Morphine that was administered during or after surgery may have caused the pin point eyes and reduced his respiratory rate. Nausea may have been triggered by the 100mg Tramadol that was given to Jack before and after the hip surgery but was appropriately neutralized by the 0.625mg of droperidol administered in the post anaesthetic recovery unit. Surgery is associated with suffering, pain and even death, and, however minor, is a shattering event for anyone, for the family and mostly for an old person. Giving Jack adequate, understandable and objective information is his right. His capillary rate was slow which might have led to shock, because of lack of sufficient blood flow to the body tissues as a result of issues regarding to the circulatory system. Initial signs included general body weakness, high heart rate, abnormal respiratory rates, sweating, anxiety, and high dehydration. The most important thing is for Jack to get up and moving as quickly as possible. The faster he is up and about, the faster will feel better and mobilizing will also help with other problems like preventing blood clots and help in significantly managing the post-surgery pain. This also prevents Deep vein thromboses (clots) which are usually as a result of stagnant blood flow which is in turn caused by being bedridden for a prolonged period of time (Robert 2008). In Jack’s case though, there should be some precautions with certain movements after surgery in order to prevent dislocation and consequent falls.
Jacks’ decreased respiratory rate, drowsiness and nausea may have been as a result of the Morphine administered during and after surgery. Jack being a hypertensive patient, plus the morphine administered may have jointly caused the myosis (pinpoint eyes). Upon review of the medication administered during and after surgery, it can be noted that Morphine and Tramadol are not recommendable as they triggered hypertension crisis, nausea and drowsiness.Paracoxib, Paracetamol and Droperidol,however, did not openly exhibit adverse effects on the patient therefore can be recommended for use during rehabilitation process. Prior to the fall, Jack was under antihypertensive medications to manage his high blood pressure preexisting condition which may have exacerbated OH and consequently led to his fall in his garden. Dehydration is another factor that might have made a significant contribution to the fall. Taking Jacks’s age in to consideration, carrying out blood tests is recommended as trips can be worsened by complications with an elderly patient’sblood cells, or by over or under concentration of sodium in the blood.Universally, a total blood count (CBC) and a confirmation of electrolytes and kidney operations (“chem-7”) are the best starting points. His mild pain and discomfort seem to have beenas a result of his age – older people like Jack reactto pains in toes, joints and spinal cord.
Vascular assessment conducted on Jack’s right lower limb revealed that the skin warmth and peripheral pulse were normal. However, several other results revealed there might be still some underlying issues which needed further attention. For instance, the dorsalispedis test indicated that his pulse was thread and weak therefore hard to palpate and easily obliterated with slight pressure. This shows that Jack could be having a significant reduction in the flow of blood to the left ventricle which signifies the possibility of other complications like tracheal obstruction, asthma or emphysema. This explains why Jacks respiratory rate was recorded as being slightly lower than the normal range of persons of his age. On the other hand, Jack’s affected limb skin colour was recorded to be abnormally pale implying a significantly inadequate arterial supply. Notably, poorcirculation is not a medical condition in itself; instead, it is brought about by other health issues. Therefore, it’s vital to cure the basic sources, in preference to just the symptoms (Kenneth & Joseph, 2013). Various medical conditions can activate poor circulation the frequent ones being obesity, diabetes and heart conditions(Jennifer, 2014 & Jose, David, 2016; Mario, Giuseppe, James, 2013). Jack being a hypertensive patient, the inadequate arterial supply is most probably as a result of his pre-existing condition. The Limb Neurological Test however, revealed a normal movement.
After learning of Jacks fall, thorough blood cell count should have been carried out to establish the cause of the fall. The past history of medication and treatment of the patient should have been considered to avoid a contradiction in further medication. For instance, the Morphine and Tramadol administered to Jack before and after surgery may have triggered other side effects like Nausea and Myosis (Robert, 2008). This information should have been obtained from Ethen Jack’s wife. Normally, Ethen should have been asked to come with all previous medications Jack has been using since at their age recalling the drugs by name might be a big challenge. Notably, no appropriate antibiotics were initiated during surgery as should be the case. Metronidazole suppositories are majorly applied in bowel surgery and should be administered 2-4 hours before it starts, to avoid surgical infections. Having taken into consideration Jacks age and his hypertensive history (Gabriella, 2017), I recommend routine and suitable aerobic strengthening exercises to be conducted by a physiotherapist to manage and ensure free flow of blood and avoid clotting, manage the upper weigh and also help in keeping the blood pressure at required levels. These exercises will also help in managing and gradually reducing the after surgery pain (Sheila & Sara, 2018).
Jack is very hopeful of making a full recovery despite the minor setbacks he has experienced so far after the surgery. He hopes to make a progressive recuperation at his home soon under the watch of his wife Ethen. However, Ethen also being a bit elderly, he hopes to convince one of his grandsons to come and stay with them to help in exercises and drug administration for a period of six months. I also recommend the use of an assistive device (e.g. a walker) through the help of a physiotherapist to prevent future falls and injury at least until he heals completely. I also recommend Home Safety Self-Assessment to minimize the possibility of future falls as a result of household items like tables and chairs accidentally knocking him down .
References
Stefano G.B., Ptá?ek R., Kuželová H., Kream R.M. (2012). “Endogenous morphine: up-to-date review 2011” Folia Biol.
Sheila R.B., Sara E. N. (2018).Perioperative Care of the Elderly PatientCambridge University Press – Medical
Gabriella B. (2017).Perioperative Care of the Elderly.Cambridge University Press.
Kenneth K., Joseph Z. (2013).Hip Fractures: A Practical Guide to Management.Springer Science & Business Media.
Robert, K.L. (2008). Hip and Knee Surgery: A Patient’s Guide to Hip Replacement, Hip Resurfacing, Knee Replacement, and Knee Arthroscopy.
Jennifer W. E. (2014).Health Services Research and Evidence-Based Medicine in Hand Surgery.An Issue of Hand Clinics.
Jose J. D., David T. E.(2016).Medical Complications in Acute Care Surgery: The Management of Difficult Clinical Scenarios. Springer.
Mario B., Giuseppe L., James R. S. (2013). Springer Science & Business Media, Medical Recent Advances in Geriatrics
Giuseppe M., Guido G., Josep R.(2014). Manual of Hypertension of the European Society of Hypertension, Second Edition.CRC Press.
Levett-J.T.(2018).Clinical reasoning: learning to think like a nurse, Second edition. Melbourne, Vic. Pearson Australia
Kronborg, L., Bandholm, T., Palm, H., Kehlet, H., & Kristensen, M. T. (2016). Physical activity in the acute ward following hip fracture surgery is associated with less fear of falling. Journal of aging and physical activity, 24(4), 525-532.
Brent, L., Hommel, A., Maher, A. B., Hertz, K., Meehan, A. J., & Santy-Tomlinson, J. (2018). Nursing care of fragility fracture patients. Injury.
Essay Writing Service Features
Our Experience
No matter how complex your assignment is, we can find the right professional for your specific task. Contact Essay is an essay writing company that hires only the smartest minds to help you with your projects. Our expertise allows us to provide students with high-quality academic writing, editing & proofreading services.
Free Features
Free revision policy
$10Free bibliography & reference
$8Free title page
$8Free formatting
$8How Our Essay Writing Service Works
First, you will need to complete an order form. It's not difficult but, in case there is anything you find not to be clear, you may always call us so that we can guide you through it. On the order form, you will need to include some basic information concerning your order: subject, topic, number of pages, etc. We also encourage our clients to upload any relevant information or sources that will help.
Complete the order form
Once we have all the information and instructions that we need, we select the most suitable writer for your assignment. While everything seems to be clear, the writer, who has complete knowledge of the subject, may need clarification from you. It is at that point that you would receive a call or email from us.
Writer’s assignment
As soon as the writer has finished, it will be delivered both to the website and to your email address so that you will not miss it. If your deadline is close at hand, we will place a call to you to make sure that you receive the paper on time.
Completing the order and download