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dlinn
1 month ago
10

You are working in the emergency department when M.C., an 82-year-old widow, arrives by ambulance. Because M.C. had not answered

her phone since noon yesterday, her daughter went to her home to check on her. She found M.C. lying on the kitchen floor, incontinent of urine and stool, and stating she had pain in her right hip. Her daughter reports a medical history of hypertension, angina, and osteoporosis. M.C. takes propranolol (Inderal), denosumab (Prolia), and hydrochlorothiazide, and uses a nitroglycerin patch. M.C.’s daughter reports that her mother is normally very alert and lives independently. On examination, you see an elderly woman, approximately 100 pounds (45 kg), holding her right thigh. You note shortening of the right leg with external rotation and large amount of swelling at the proximal thigh and right hip. M.C. is oriented to person only and is confused about place and time, but she is able to say that her "leg hurts so bad." M.C.’s vital signs (VS) are 90/65, 120, 24, 97.5F (36.4C), SpO2, 89%. She is profoundly dehydrated. Preliminary diagnosis is a fracture of the right hip.Considering her medical history and that she has been without her medications for at least 24 hours, explain her current VS.Based on her history and your initial assessment, what 3 priority interventions would you expect to be initiated?M.C.’s daughter states, "Mother is always so clear and alert. I have never seen her act so confused. What’s wrong with her?" What are 3 possible causes for M.C.’s disorientation that should be considered and evaluated?
Health
1 answer:
Ket [1.5K]1 month ago
8 0

Answer:

Explanation:

found on the kitchen floor, experiencing incontinence of urine and stool, while expressing pain

in her hip. Her daughter mentions her medical history includes hypertension, angina, and osteoporosis. M.C. is on a regimen of propranolol (Inderal), a nitroglycerin patch, indapamide (Lozol), and conjugated estrogen

(Premarin) daily. M.C.'s daughter notes that her mother is typically very alert and lives on her own.

Upon examination, you find an elderly woman, weighing around 100 pounds, grasping her right thigh. You observe

that the right leg appears shortened and rotated externally, with significant swelling at the upper thigh

and right hip area. M.C. is only aware of her identity and is disoriented regarding time and place, but she can clearly express

her intense leg pain. Her vital signs are 90/65, 120, 24, 97.5° F (36.4° C); her oxygen saturation is at 89%. She is

severely dehydrated. The initial diagnosis suggests a fracture of the right hip.

Taking into account her medical background and that she hasn’t taken her medications for at least

24 hours, provide an explanation for her current vital signs.

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