Wk 8 Assignment: Concept Map – Fractured Hip with Postoperative Complications [due Mon]
Assignment Content
Read the following scenario:
M.M., a 76-year-old retired schoolteacher, is postoperative day 2 after an open reduction and internal fixation (ORIF) for a fracture of his right femur. His preoperative control prothrombin time/international normalized ratio (PT/INR) was 11 sec/1.0 and his activated partial thromboplastin time (aPTT) was 35 sec- onds. He has been on bed rest since surgery. At 0800, his vital signs (VS) are 132/84, 80 with regular rhythm, 18 unlabored, and 99 F (37.2 C). He is awake, alert, and oriented with no adventitious heart sounds. Breath sounds are clear but diminished in the bases bilaterally. Bowel sounds are present and he is taking sips of clear liquids. He is receiving an intravenous (IV) infusion of D5 12 NS at 75mL/hr in his left hand, and orders are to change it to a saline lock this morning if he is able to maintain adequate oral fluid intake. He has orders for oxygen (O2) to maintain Spo2 over 92%, but he has been refusing to wear the nasal cannula. His laboratory work shows Hct, 34%; Hgb, 11.3 mg/dL; K, 4.1 mEq/L; aPTT, 44 sec. Pain is controlled with morphine sulfate 4 mg IV as needed every 4 hours, and he has promethazine (Phenergan) 25 mg IV q4h if needed for nausea. He is receiving heparin 5000 units subcutaneously bid, taking docu- sate sodium (Colace) PO once daily, and wearing a nitroglycerin patch.
Consider the following complication:
At 1830 you answer M.M.’s call light and find him lying in bed breathing rapidly and rubbing the right side of his chest. He is complaining of right-sided chest pain and appears to be restless.
You check his VS, with these results: blood pressure (BP) 98/60; P 120; R 24. You note he is restless and slightly confused. The pulse oximeter reads 86%, so you start him on 6 L O2 by nasal cannula (NC). You identify faint crackles in the posterior bases bilaterally. The heart monitor on lead II shows nonspecific T wave changes.
Think through the following related to M.M.’s condition:
Etiology and pathophysiology
Risk factors
Signs and symptoms
Diagnostic procedures
Medication and treatment
Nursing interventions, including patient education
Potential complications
Complete a concept map using the template.
Show interrelationships of all components.
Prioritize the nursing interventions related to complications.
Include at least three peer-reviewed sources to support your concept map, and an APA-formatted reference page.
Submit your assignment.
Resources
Center for Writing Excellence
Reference and Citation Generator
Grammar and Writing Guides
Learning Team Toolkit
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