Mr Richards is a 79 year old man, undergoing surgical repair of a fractured hip. He has no
known living relatives. He was living at home independently when he slipped and fell in the
bathroom, fracturing his right neck of femur. He was on the floor for an indeterminate amount
of time prior to being found by a neighbour, who came to check in on him. The ambulance
was called. Paramedics found the patient on the bathroom floor in a confused state. He was
unable to accurately note the date or time, and he had no recollection of how he ended up
on the floor. During the head-to-toe assessment, it was noted that Mr Richards had
sustained a small scalp laceration over his right temporal region, which was clotted by the
time the ambulance personnel arrived. His leg was in a displaced position, and a fractured
hip was suspected. He was also noted to have a healed scar on his sternum, indicative of a
previous open-heart procedure. The paramedics also noted Mr Richards Webster pack has
not been opened this morning.
Upon arrival in the emergency department, the patient is evaluated by orthopaedic,
cardiology, and neurology specialists. His history was reviewed and revealed a previous
open-heart procedure 8 years ago, a long history of smoking prior to the cardiac procedure,
and a history of lifelong obesity. The patient's skin condition is poor. He has multiple folds of
fatty skin, and between these folds, the skin is quite dirty and malodourous, indicating poor
personal hygiene. He has a list of medications in his wallet, which identifies the following
drugs: Digoxin, Simvastatin, Frusemide, Potassium Chloride, Metoprolol and Timolol eye
drops.
Mr Richards greatest immediate need is stabilization of the fractured femur. The neurologist
deems that it is appropriate to perform the surgery under general anaesthesia and that
postoperative neurologic assessment should be initiated. The cardiologist agrees that the
patient is stable from a cardiac standpoint and that he will most likely be able to tolerate the
effects of anaesthesia. The orthopaedic surgeon performs the fractured hip repair.
Mr Richards is transferred back to the ward. His hip is positioned for optimum healing. His
vital signs are: blood pressure 182/105 mm Hg, pulse 102 beats per minute, respiratory rate
26 breaths per minute, oxygen saturation 89% on 4 litres nasal prongs, and core
temperature 34.5°C. GCS 13/15 (E 3, V4, M6). No urine is noted in the Foley catheter. He
has a right peripheral cannula, a belovac drain in situ which has drained 20mls of blood
stained fluid.
Task:
You are the registered nurse caring for Mr Richards following his surgery. Apply the clinical
reasoning cycle to this case study to establish a plan of care for Mr Richards. Use the
headings of the clinical reasoning cycle to guide your thinking.
Sample Solution