Case study Maria Romano is a 76 year old woman admitted to the Emergency Department via ambulance. Maria fell when watering her garden and was unable to get up.

Case study

Maria Romano is a 76 year old woman admitted to the Emergency Department via ambulance. Maria fell when watering her garden and was unable to get up. She was lying in her garden for 3 hours until her daughter came home from work and found her.

Maria's medical history includes osteoporosis, glaucoma and she has recently been diagnosed with early dementia. She has no significant surgical history. Maria lives with her daughter Paulina and Paulina's husband, Sam.

Maria's current medications include Aspirin 75mgs daily, Alendronate Sodium 10mg orally daily & Latanoprost eye drops to both eyes nocte.

She was administered Intravenous Morphine and inhaled Methoxyflurane by the paramedics.

Assessment data:

Airway: patent

Respiratory rate: 18 breaths/min    Oxygen saturation: 97% on room air

Heart rate: 90 beats/min     Blood pressure: 110/70 mmHg     Capillary refill: 2

seconds

Right leg shortened and externally rotated       Right hip bruised and oedematous

Right foot pink, cool to touch, no paraesthesia or abnormal sensation, pedal pulse present

Alert: orientated to time and place       Pain score: 5/10 on rest, 7/10 on movement

Temperature: 35 C

Small laceration to lower left leg

Blood glucose: 9 mmol/L

Intravenous cannula inserted Cephalic vein Left arm

X-rays reveal an Intertrochanteric fracture of the Right femur. Maria is seen by the Orthopaedic surgeon and is scheduled for an Open Reduction and Internal fixation (ORIF) of the fracture. She has been placed on the Emergency Operating List. The Registered Nurse has just administered Intravenous Morphine 2mg and the anaesthetist has been contacted to perform a femoral nerve block. The orthopaedic registrar will visit Maria in the next 10 minutes to gain consent for the surgery.

Maria is accompanied by Paulina, who is clearly upset about her mother's hospitalisation. Paulina informs you that she is so worried about how thin Maria is. She is also concerned that Maria has been falling frequently over the past few months, she purchased a walking frame for Maria but she rarely uses it. You note that Maria is upset that she is going to require surgery. She is worried about her garden and who will water it while she is in hospital.

Questions

• After reviewing the information above, identify the assessment data/information/risk factors that would contribute to a diagnosis of a fractured neck of femur (100 words)?
• Discuss the pathophysiology of osteoporosis and how this may have increased Maria's risk of sustaining a fracture (50 words).
• Identify five additional assessments you would undertake to identify priorities for holistic person centred care in the pre-operative period. Provide a brief rationale for each (200 words).
• Consider and briefly discuss any legal and ethical considerations relating to informed surgical consent, confidentiality and privacy from this scenario (200 words).
• From your analysis of the data provided, identify four patient problems in the pre- operative period (50 words)