Case Presentation Mrs. Lydia M

Case Presentation

 Mrs. Lydia Martin, an 88-year-old widow, lives alone independently in her single-story home. During the middle of the night, Mrs. Martin fell in her home while walking to the bathroom. Unable to get up, she crawled to reach her phone and dialed 911. She was transported to the emergency department and underwent diagnostic tests including hip and femur xray and computed tomography, which confirmed a left femoral neck fracture. Her past medical history includes anxiety, osteoporosis, arthritis, and cataracts.

Mrs. Martin underwent an open reduction internal fixation procedure. Following surgery, she had a compression dressing with ice to the left hip, a Foley catheter, antiembolism stockings, a sequential compression device, and an order to use the incentive spirometer every hour while awake. Her medications included hydrocodone bitartrate 7.5 mg/acetaminophen 750 mg (Vicodin ES) two tabs by mouth every 4 hours as needed for pain and enoxaparin (Lovenox) 40 mg daily subcutaneously. The day after surgery, the physical therapist began to work with Mrs. Martin; the goal of the session was to get her out of bed to a chair. During the aempted transfer, Mrs. Martin’s surgical site was painful, and her Foley catheter was pulled, causing pelvic pain. She screamed in pain and refused to continue the process. Mrs. Martin was anxious and fearful of pain and became worried that she would never walk again and would end up in a nursing home. She was unwilling to move and declined physical therapy over the next 3 days. Mrs. Martin became constipated and lost her appetite. She also developed a stage 2 pressure ulcer over her sacrum. Eventually, on post-op day 4, Mrs. Martin agreed to work with the physical therapist. By this time, she experienced significant weakness and fatigue and was unable to move independently. Mrs. Martin was later transferred to a rehabilitation center to continue regaining her mobility.

Case Analysis Questions

1. Did Mrs. Martin have any risk factors prior to her injury? If so, what were they?

 2. What complications emerged as a result of Mrs. Martin’s immobility?

3. How do the collaborative interventions help to improve her mobility?