Reference no: EM133977096

Question

Maria Romano is a 76 year old woman admitted to the Emergency Department via ambulance. Maria fell when watering her garden and was unable to get up. She was lying in her garden for 3 hours until her daughter came home from work and found her. Maria's medical history includes osteoporosis, glaucoma and she has recently been diagnosed with early dementia. She has no significant surgical history. Maria lives with her daughter Paulina and Paulina's husband, Sam. Maria's current medications include Aspirin 75mgs daily, Alendronate Sodium 10mg orally daily & Latanoprost eye drops to both eyes nocte. She was administered Intravenous Morphine and inhaled Methoxyflurane by the paramedics. Assessment data: Airway: patent Respiratory rate: 18 breaths/min Oxygen saturation: 97% on room air Heart rate: 90 beats/min Blood pressure: 110/70 mmHg Capillary refill: 2 seconds Right leg shortened and externally rotated Right hip bruised and oedematous Right foot pink, cool to touch, no paraesthesia or abnormal sensation, pedal pulse present Alert: orientated to time and place Pain score: 5/10 on rest, 7/10 on movement Temperature: 35 C Small laceration to lower left leg Blood glucose: 9 mmol/L Intravenous cannula inserted Cephalic vein Left arm X-rays reveal an Intertrochanteric fracture of the Right femur. Maria is seen by the Orthopaedic surgeon and is scheduled for an Open Reduction and Internal fixation (ORIF) of the fracture. She has been placed on the Emergency Operating List. The Registered Nurse has just administered Intravenous Morphine 2mg and the anaesthetist has been contacted to perform a femoral nerve block. The orthopaedic registrar will visit Maria in the next 10 minutes to gain consent for the surgery. Maria is accompanied by Paulina, who is clearly upset about her mother's hospitalisation. Paulina informs you that she is so worried about how thin Maria is. She is also concerned that Maria has been falling frequently over the past few months, she purchased a walking frame for Maria but she rarely uses it. You note that Maria is upset that she is going to require surgery. She is worried about her garden and who will water it while she is in hospital.

1. Discuss the Registered Nurse's role regarding the issues related to informed surgical consent, confidentiality and privacy

2. Develop four short term goals to be achieved in the pre-operative period. These goals should relate to the problems identified in Assessment 1. Discuss who must be involved in the development of these goals

3. Discuss the nursing interventions required to meet the identified goals and preoperative patient problems (from Assessment 1). Ensure that rationales are provided for these interventions.