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Rachel Leong

on 25 October 2012

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Transcript of Bones

BP: 119/87 mmHg
HR: 124 bpm
Spo2: 92% on 3L/min O2

a hyperextended chest, a chronic cough, bilateral crepitations and ronchi, and densities seen on chest X-ray (what could this be?)

severe pain in his right leg, and an X-ray pelvis revealed a right neck of femur (NOF) fracture

He was conscious but not oriented to time, place or person.

Blood test results revealed high white blood cell counts (13.4) and low hemoglobin levels (11.8) Palliative care of a hip fracture patient using the RLT model BONES When we say BONES, YOU MIGHT THINK... Mr K

84 year old Malay man

slipped from a chair

c/o pain at right hip

no loss of consciousness

no nausea or vomiting But seriously, this presentation is about Mr K. Mr K's past medical history Neurological Pulmonary Others COPD Chronic Dyspnea Post-TB Bronchiectasis History of a past fall (a year ago) with SDH BPH Visual Impairment Fully dependent on his caregiver for ADLs UPON EXAMINATION at A&E, Mr K had 1. IV Tazocin for pneumonia

2. Continuous 3 L/min oxygen via nasal prongs for SOB

3. Not suitable for surgical repair of his right NOF fracture
(co-morbidities and poor pre-morbid status)

4.Administered 5mg of mist morphine every 6 hours to relieve his acute pain

5. DIL/DNR- poor prognosis, aggressive measures will only prolong Mr K’s suffering

6.Further diagnosed with delirium secondary to sepsis, constipation and pain Initial Management Goals of care: symptomatic and palliative for his pain, sepsis/pneumonia and SOB.

Team and family agreed for palliative discharge and referral to a mobile clinic for home care. Objectives 1. Pleasure to meet you, Mr K
2. Past medical history
3. At the A&E
4. Initial Management and Prognosis
5. Goals
6.Nursing Problems Identified
7. Conclusion GOALS Top 4 Nursing Problems identified by RLT 1&2. Communicating and Maintaining Safety

3. Breathing

4. Mobility (HAHA) delirium secondary to pain (from where?)

severe pain ->impaired cognition ->induces delirium. (Nie et al., 2012)

ineffective two-way communication between Mr K and the healthcare providers PREDISPOSING FACTORS + PRECIPITATING FACTORS = Nursing Management (Robinson et al., 2008) (cc) image by nuonsolarteam on Flickr 1&2. Communicating and Maintaining Safety -Adequate administration of pain relief to provide comfort

-World Health Organisation’s (WHO) definition of palliative care: ENHANCE QOL

-For delirium, assess and document fluctuations in the patient’s functioning

-Orientation to Mr K about his surroundings to promote awareness Fascia iliacus block ordered by the pain management team. Nursing care for Mr K: assess and identify pain frequently using valid assessment tools to ensure satisfactory pain relief. (Johansson et al., 2012) 3. Breathing Mr K has pneumonia, there is a ten times greater probability of CAP in COPD patients. (Mullerova et al., 2012)

The aim for palliative care for
Mr K:
-management of dyspnea and
- providing oxygen therapy
(YES REALLY) Nursing Management Administer oxygen and monitor saturation(HOW?)

Salbutamol Nebuliser and proper positioning

Suctioning PRN

Administer antibiotics to curb infection 4. Mobility Goals of nursing care would be to prevent any potential complications like pressure sores because of prolonged bed rest

Mr K may have compartment syndrome as a result of the trauma from his NOF fracture. Nursing Management High risk areas for pressure sore development: Heels and sacral

Elevating the heels VS redistributing the pressure

5Ps- ?? Heels are fully lifted off! The basic principle of palliative care is the relief of pain and other symptoms, (Morrison & Meier, 2004) and in Mr K’s case, reducing the risk of other potential related complications. CONCLUSION What could this be? 1. Foreign body in lung
2. Pneumonia
3. CA liver
4. Breast lump According to the Ministry of Health, Chronic Obstructive Pulmonary Disease (COPD) ranks seventh out of the top 10 principal causes of death in Singapore. COPD patients also tend to have a high hospitalisation rate, with more frequent re-admissions. Singapore statistics References are in my essay
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