HS2261 / HS2232 – Adult Nursing 2

Case Scenario:

Mona, aged 65, slipped and fell at home. She is unable to bear weight on the left lower limb. She reports severe pain localized to the left hip. Radiographic imaging confirmed a fractured left femoral neck, and she is scheduled for a left hemiarthroplasty.

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Physical examination:

General appearance: Alert, conscious, appears distressed due to pain

Extremities: Both lower limbs warmth to touch. Distal pulses present and strong over bilateral lower limbs.

Musculoskeletal: Mild swelling, tenderness, and ecchymosis noted over the left hip region. Severely restricted and painful passive range of motion of the left hip, especially in internal rotation. Height: 159cm

Weight: 90kg

Vital signs:

Temperature:37.7°C

Pulse Rate: 92 beats/ min

Respiratory Rate:23 breaths/min

Blood Pressure: 154/93 mmHg

SpO₂: 96% on room air

Pain Score: 8/10

Past medical history: Osteoporosis, Diabetes, and Hyperlipidaemia

Past surgical history: Nil

Social History: Mona is a widowed with no children and is staying alone.

Current medication:

P.O Arcoxia 90 mg OM	P.O Lovastatin 20 mg ON
P.O Omeprazole 20 mg BD	P.O Calcium Carbonate 625 mg ON
P.O Metformin 250 mg BD	P.O. Colecalciferol 1,000-unit OM -3 times per week

Laboratory Results:
FBC	Reference Range	Biochemistry	Reference Range
WBC: 8.2 x 10⁹/L	4.0 – 10.0 x 10⁹/L	Sodium: 138 mmol/L	135-145 mmol/L
RBC: 3.0 x 10¹²/L	3.6 – 4.9 x 10¹²/L	Potassium: 4.2 mmol/L	3.5 – 5.1 mmol/L
HB: 10.5 g/dL	11.5 – 15.0 g/dL	Chloride: 97 mmol/L	95-110 mmol/L
PLT: 250 x 10⁹/L	150 – 400 x 10⁹/L	Urea: 6.5 mmol/L	2.8 – 7.6 mmol/L
Other results	Reference Range	Creatinine: 95 µmol/L	50 – 90 µmol/L
HbA1c: 7.8%	< 6.4%	Venous glucose: 5.0 mmol/L	4.0 – 7.0 mmol/L
Albumin: 38 g/L	40 – 51 g/L	Calcium: 2.0 mmol/L	2.2 – 2.7 mmol/L
Vit D: 18 ng/mL	≥ 30 ng/mL	Phosphate: 1.45 mmol/L	1.12 – 1.45 mmol/L

Questions:

Define neck of the femur fracture and list the clinical manifestations of hip fracture.
List the possible risk factors of hip fracture for Mona.
Describe hemiarthroplasty.
Discuss the post-operative care for Mona.
Plan a health education and discharge plan for Mona.

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University	Anglia Ruskin University (ARU)
Subject	HS2261/HS2232 Adult Nursing

HS2261/HS2232 Adult Nursing 2 ICA 4: Care of Patient with Musculoskeletal Disorder, Singapore