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CR, 70 y/o female w/
closed fracture of neck
of R. femur following
fall…
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.
Pertinent
medications
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Hydroxychloroquine
300mg, treats
inflammation
from RA
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Psych-Social
Awake, alert,
oriented x4. Pleasant
affect, joked around.
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
Discharge plan
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.
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Pathophysiology
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.
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Reference: Guise, T. A. (2006). "Bone loss
and fracture risk associated with
cancer therapy." The Oncologist, 11(10), 11-21.
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