Mrs. Schaffer is an 82-year-old obese female admitted to the rehabilitation center after undergoing surgery for repair of the right hip fracture from a fall at home
Mrs. Schaffer is an 82-year-old obese female admitted to the rehabilitation center after undergoing surgery for repair of the right hip fracture from a fall at home. At 72 hours postsurgery, she is receiving morphine patient controlled anesthesia (PCA) for moderate post-operative pain, with results of reduction in reported pain. She has no significant past medical history and no known drug allergies (NKDA). Her DNR documentation specifies a full code. Mrs. Schaffer’s vital signs are: T 98.9°, P 70 and regular, RR 12 and unlabored, and BP 110/76, with a pulse oximetry reading of 97% on room air (RA). She rates her pain as 5 out of 10 and refuses additional medication. Mrs. Schaffer is reluctant to move around, stating that the pain is worse when she moves. She needs the assistance of one person to move from bed to chair. She has been ordering her own meals from the cafeteria but has not eaten more than ½ of the meal that is sent. Her morning tray included eggs with sausage and a slice of toast. Her fluid intake over the past shift was 200 mL in 8 hours and her output was 180 mL. On auscultation, she has hypoactive bowel sounds and her abdomen is slightly firm and tender to deep palpation. During the evening assessment, the patient informs the nurse that she “feels constipated” and that she has not moved her bowels in days.
Treatment Orders:
Physical Therapy for ambulation
Vital Signs q shift
Regular diet as tolerated
Intake and Output q shift
Incentive spirometer q 1 hr while awake
Complete Blood Count (CBC) and Basic Metabolic Panel daily
Medications:
Morphine (MS Contin) PCA 1 mg/hour basal with 0.4 mg q 10 minutes, with 4 mg/hr lockout
Enoxaparin (Lovenox) 60 mg SQ daily
Docusate (Colace) 1 capsule daily
- Explain the pathophysiology of Mrs. Schaffer’s elimination problem.
