Based on the information provided, how will you prioritize your care, what assessments will you include and in what order?
CT scan, blood pressure, and magnetic resonance angiography
In Fred`s case, a CT scan will play a significant role in clarifying the extent of injuries from the fall and will assess any internal injuries to the bones, joints, and the brain. A CT scan of the head, the knee, and the right leg will be the preferred assessments that will further help assess the extent of the injury. For instance, a head CT scan will assess proper functioning of the brain because and the jaws because of the multiple bruises in Fred`s jaw bone which indicates that there was a direct impact of the head during the fall. The joint and the right leg X-ray will help assess the extent of the injury in the right leg and the knees because overlooking a joint dislocation or a fracture will have negative implications on Fred`s physical functions. Other important tests to consider will be his blood pressure and assess the patient pulse in the legs and feet using the magnetic resonance angiography which can be used to identify any vessel blockage and alleviate a possible myocardial infarction (Lan & Kamath, 2017).
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?
From the patient history, the patient has a history of myocardial infarction which should be considered before any potential surgery because of the potential cardiac complications that could lead to more time in the hospital or increase post-surgery mortality. Further, the patient age could also pose perioperative cardiovascular morbidity and mortality. Besides, medications such as Lopressor given to the patient affects the patient blood pressure because they are beta blockers which can interact with surgical anesthesia (Chintamani et al., 2011). Therefore, it is important to ensure the patient continue using Lopressor during the surgery to avoid possible high blood pressure.
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?
An extensive assessment of Fred`s history will be necessary to identify possible interactions of drugs, diet, and health issues which could affect the surgical outcomes after the operation. Lab tests will be required to assess the suitability of the femur repair surgery. A preoperation surgery is always undertaken a month before the femur surgery which will help in preparation and treatment of any conditions before the surgery. In this case, a diabetes test, a heart or cardiology test, obstructive sleep apnea test, a blood test, and further tests such as chest X-ray, age, and health history will also help decide on the possibility of a femur repair surgery (Lan & Kamath, 2017). In this case, Fred has a history of sleep apnea, myocardial infarction and peripheral vascular disease which will rule out the possibility of a femur repair surgery until further tests are carried out.
Chintamani, M., Asha, S., & Harindarjeet, G. (2011). Lewis's Medical Surgical Nursing. Elsevier India. P. 398
Lan, R. H., & Kamath, A. F. (2017). Does the Timing of Pre-Operative Medical Evaluation Influence Perioperative Total Hip Arthroplasty Outcomes?. The open orthopaedics journal, 11, 195.
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