What are some special precautions that should be taken with older adults when performing a physical assessment of the musculoskeletal system?

End of life case study
November 1, 2019
Visionary
November 8, 2019

Fred is an 83-year-old male who is being admitted to the medical-surgical unit status post fall. He is alert and oriented and reports that while visiting a local casino with his wife Margaret earlier this evening, he tripped over a curb and fell landing on his right side. After receiving morphine in the emergency room prior to transfer to your unit, Fred is rating his pain at 6/10. He has multiple bruises from his jawbone to his knee as well as a slight rotation of his right leg.

Past medical history includes: myocardial infarction (MI) x 2, peripheral vascular disease (PVD) with bilateral iliac stents, non-insulin-dependent diabetes mellitus (NIDDM), sleep apnea, and degenerative joint disease.

Medications include: aspirin, Plavix, Lopressor, Lisinopril, and Metformin.

After reviewing the above scenario please answer the following questions.

Based on the information provided, how will you prioritize your care, what assessments will you include and in what order? Please provide rationale for your response.

Considering this patient’s age, injury, past medical history, and list of current medications, what, if any, concerns do you have related to his potential need for surgery?

Should surgery to repair his right femur be required; what type of clearance and pre-op orders would you anticipate receiving related to his diet, meds, lab work, and so on?

What are some special precautions that should be taken with older adults when performing a physical assessment of the musculoskeletal system?

Fred underwent an open reduction, internal fixation (ORIF) of his right femur and is now being prepared for discharge to his home with physical therapy. Please describe the education and resources that you will include in his discharge plan to help ensure that he and his wife Margaret are prepared to resume his care at home.

 

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