Author Question: While recovering in the CCU, M.M. tried to get up out of the bed, fell, and fractured her right ... (Read 57 times)

xroflmao · **on:** Jun 25, 2018

While recovering in the CCU, M.M. tried to get up out of the bed, fell, and fractured her right humerus. Because of the surgical risks involved, M.M. was treated conservatively and put in a full arm cast. She is transferred back to your floor.

A case manager (CM) has been asked to evaluate M.M.'s home to see whether she can be discharged to her own home or will need to stay in a long-term care facility.

Identify at least eight things that the CM would assess.

M.M.'s nutritional intake over the past few weeks has been poor. She also has increased
nutritional needs because of her fractured arm. What are some of the nutritional needs that
should be met? What would you recommend to help her with this?

Question 2

M.M.'s physician calls your unit to find out what is happening. Using SBAR, what information would you need to convey at this time?

The hospital's staff physician is coming to the floor immediately to evaluate the patient. In
the meantime she orders furosemide (Lasix) 40 mg IV push STAT. You have only 20 mg in
stock. Should you give the 20 mg now, and then give the additional 20 mg when it comes up
from the pharmacy? Explain your answer.

rnehls · **Reply #1 on:** Jun 25, 2018

Answer to Question 1

What sort of support will she have at home for activities of daily living (ADLs), self-care, home
maintenance, and so on?
Is there telephone service?
How many steps are in the home or apartment? Are her bedroom and a bathroom downstairs?
Is there a danger of tripping on throw rugs, loose carpeting, and so on?
Are there handrails in stairways?
How wide are the doorways?
Where are the bathrooms? Does she have to negotiate steps to get there?
Can the toilet seat be raised and railings applied?
Is the lighting adequate?
What is she going to do for meals, grocery shopping, and laundry?
Can she get to a refrigerator? Will she be able to heat her meals?
Will someone check on her every day? Help her with medications?
Does she have sufficient lower body strength to ambulate independently and safely?
Are there Spanish-speaking health care workers available to work with M.M.?

It is important that M.M. get a consultation with a registered dietitian (RD) who will assess her
additional nutritional needs. This should be completed as soon as possible and certainly before
discharge.
She is going to need help meeting her increased caloric, protein, calcium, vitamin, and mineral
needs to promote healing. The RD can assist with suggesting supplements that can help with
intake of these nutrients yet still avoid increasing her sodium and fat intake.
Have the family bring food from home.

Answer to Question 2

Following SBAR (Situation, Background, Assessment, Recommendation), you would first identify
yourself, the patient, and her admitting diagnosis. For background, you would tell the physician that
the patient speaks Spanish only, and that she was admitted because of heaviness in her chest off
and on over the past few days and with signs of HF. Describe how she vomited once she was assisted
onto the bedpan and that her skin was clammy; report your assessment findings, VS, and what you
have done so far. The assessment of the situation is that M.M. might be experiencing an MI, and
you would anticipate a transfer to the coronary care unit and medications to maintain cardiac and
respiratory function.

Give the 20 mg furosemide to start treatment. However, you should know that response to
furosemide is dose related; 20 mg now plus 20 mg later does not equal the same response as
40 mg given at one time. You need to make the physician aware that you gave only 20 mg and ask
how much more the physician wants to give when it becomes available. The physician might say,
Give another 20 later or Give 40 later when it gets here. Call the pharmacy and have furosemide
brought to the floor STAT or send someone to get it.