Scenario

Mrs Adams is an 84 year old lady transferred from the acute surgical unit to the rehabilitation unit for intensive physiotherapy and occupational therapy to assist her in regaining her mobility in preparation for discharge in 5 days. Mrs Adams is a slight lady who is approximately 150cm tall and says she weighed 48kg before coming to hospital.   She had a right total hip replacement 5 days ago following a fall in the bathroom of her home when she fractured the neck of her femur.  Her surgical wound is clean and dry with staples intact under a dry dressing.  She also has an area of redness on her right heel. She is taking paracetamol and codeine tablets 6th hourly for pain. She is also ordered heparin 5000 units subcutaneously. She is wearing compression stockings on both legs (with the right heel protected).  Mrs Adams is able to weight bear on her right leg, was transferred to the rehabilitation unit on a trolley and was assisted to walk a few steps from the trolley to the bed by a nurse supporting her elbows on either side.   Mrs Adams has been transferring from the chair to the bed under supervision with 1 nurse assisting today and has walked to the bathroom using a walking frame and had a shower sitting on a chair.  The physio has also taken her for a short walk using the walking frame and she will need to mobilise twice more today with nursing staff.  The physio notes in the chart say that Mrs Adams was hesitant but completed her walk satisfactorily.

Prior to this hospitalization she was generally well, mobile and didn’t use any mobility aids.   She has a history of being a smoker and has osteoporosis and osteoarthritis.  She lives with her husband Mr Adams who is 90 years old.

You are working the afternoon shift with a buddy registered nurse. Mrs Adam’s current pain is 2 on a scale of 1 (no pain) -10 (worst pain).   Mrs Adams is refusing to get out of bed for a walk with you and the buddy RN saying “I’ve done it once today that is enough”.  The buddy nurse has a short discussion with Mrs Adams and determines she is afraid of falling again.

(case adapted from Crisp and Taylor, 2011)

Answer the following questions referring to the case of Mrs Adams above (14 marks)

Questions

8. Identify two factors in the scenario of Mrs Adams that increase her risk of falls. Briefly explain how each increases risk.                                                  [2 marks]
9. Identify two factors in the scenario of Mrs Adams that increase her risk of skin integrity problems. Briefly explain how each increases risk. [2 marks]
10. The nurse documents the characteristics of Mrs Adam’s heel injury in the relevant form /chart used at this health service. Describe the characteristics or information that should be documented at this time by the nurse caring for Mrs Adams. [3 marks]
11. Briefly discuss three nursing interventions nursing staff could use to prevent Mrs Adam’s heel injury from deteriorating further.  [3 marks]
12. Briefly discuss two nursing interventions the nurse could implement to assist Mrs Adams to mobilize safely to the bathroom.                                 [2 marks]
13. Briefly discuss two likely short term health complications of Mrs Adams not mobilising using the walker and staying in bed. [2 marks]