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.

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.

Preoperatively, Paulina shared her concerns regarding Maria's low weight and recent frequent falls. Maria has a walking frame but rarely uses it. Maria shared concerns about her garden and who will care for it while she is in hospital.

Maria has undergone an Open Reduction and Internal fixation (ORIF) of the fractured Right Neck of Femur under Spinal and General Anaesthesia.

Maria was nauseated in the Post anaesthetic care unit (PACU) and vomited a small amount of green fluid. IV Metoclopramide was administered with good effect.

Post-operative surgical antibiotic prophylaxis and pharmaceutical and mechanical thromboprophylaxis are ordered. An intravenous PCA of Morphine is ordered together with regular Paracetamol.

The surgeon has ordered the drain tube to removed on Post-Operative day 2 (after review)

Discharge is scheduled for post-operative day 5.

Observations on return to the ward

Airway: patent Respiratory rate: 16 breaths/min, Oxygen saturation: 97% on room air

Heart rate: 84 beats/min, Blood pressure: 100/60 mmHg, Capillary refill: 2 seconds Intravenous therapy Cephalic vein Left arm: Hartmanns solution 8 hourly

Dressing to Right hip: Intact with small amount of bright red ooze on dressing Redivac drain tube in situ: patent – 200 mL of bright red drainage

Bromage score: 2 Dermatome level: L2

Right foot pale, cool to touch, pedal pulse present, slight paraesthesia in toes

Graduated compression stockings in situ

Alert: orientated to time and place, Pain score: 1/10 on rest, 3/10 on movement

Temperature: 36 C

Maria sustains a skin tear on her lower right arm as you release the bed rails after transferring her to her room.

Questions

1. Discuss the elements of open disclosure that are required in this situation. (100 words).
2. Identify four postoperative/anaesthetic problems or issues from the data presented. Briefly discuss the factors that pre-dispose Maria to these problems* (200 words)
3. Discuss the nursing interventions that you would employ to prevent/manage the identified problems. Ensure a rationale is provided for each intervention* (650 words)*
4. Discuss how you would evaluate the effectiveness of these nursing interventions (150 words)
5. Reflect on what you have learned from completing this case study and how this learning will inform your clinical practice (100 words)