CR, 70 y/o female w/ closed fracture of neck of R. femur following fall at home. Pt had r. hemiarthroplasty. Current smoker, 0.2 PPD for 30 years. Chronic alcoholic, 6 beers/day.

CR, 70 y/o female w/
closed fracture of neck
of R. femur following
fall at home. Pt had r.
hemiarthroplasty. Current
smoker, 0.2 PPD for 30 years.
Chronic alcoholic, 6 beers/day.

Pt potentially has
anemia from low
RBC production;
possibly R/T alcoholism

Pertinent
medications

Pertinent labs
and procedures

Psych-Social

Discharge plan

Nursing Interventions

Pathophysiology

Pertinent Hx

Prevent complications
from hip replacement

Teach hip precautions,
provide mobility assistance
as requested, monitor for s/s
of infection and dressing

Prevent complications
from chronic hyponatremia

Monitor I&Os, restrict
fluids based on DR's
orders, monitor Na
levels in labs

Chronic alcoholism

Secondary squamous
cell carcinoma of
unknown origin

Receiving Keytruda
for treatment of
cancerous cells

Prevent atelectasis
and pneumonia from
being bed bound postop

Teach and encourage
IS use, encourage deep
breathing and coughing,
help pt mobilize and get OOB

Low HgB and Hct

Low Na+

Pt is chronically
hyponatremic
from alcoholism

Pt potentially has
anemia from low
RBC production;
possibly R/T alcoholism

Ativan

Lovenox

Folic acid

Rheumatoid
arthritis

Hydroxychloroquine

300mg, treats
inflammation
from RA

1-4mg PRN. Pt
may have withdrawal
symptoms from alcoholism

40mg. DVT prophylaxis
following an ortho surg

1mg. Pt has low
HgB and Hct

Awake, alert,
oriented x4. Pleasant
affect, joked around.

Pt is currently living in her rural home alone not close to her daughters. PT and SW recommended DC to SNF. Pt DC'd to St. Joe's Chewelah on 2/18. Both daughters involved in DC and hospital care. Pt will continue to receive rehab and physical therapy in SNF for at least 4 weeks, or until Dr clears her. This is the safest option for her until she is able to live on her own again.

Pt is Aleut with
Indian beliefs, raised in
Alaska. Picked up smoking
from her family. Raised children
teaching them about Aleuts.

Pt living alone at home,
2 daughters came to visit
before she was discharged to
help move her. Widowed, all 5
children involved in her life.

Pt stated that she gets
lonely at times, but her
cancer treatment helps
get her out of her house
and helps her socialize

Chemotherapy can cause increased bone resorption and decreases bone mass density. This bone loss tends to occur more rapidly than age-related osteoporosis, increases the risk of bone fractures, and decreases the survival rate. CR's doctors are not sure where her cancer originated, so it has been treated with Keytruda in an attempt to decreases the number of cancer cells in her body. The chemo treatment possibly caused a decrease in bone health, which may have caused the broken hip that required a hemiarthroplasty.

Reference: Guise, T. A. (2006). "Bone loss
and fracture risk associated with
cancer therapy." The Oncologist, 11(10), 11-21.