Case Scenario: An 86-year-old female was transported byambulance to the emergency department (ED) for evaluation afterexperiencing an unwitnessed fall in a local nursing home. Thepatient resided at the nursing home and had a medical history ofsevere dementia and osteoporosis. The patient arrived to the EDalone without family or staff from the local nursing home. Uponarrival to the ED, the patient was triaged by nursing staff. Thetriage documentation noted the patient’s vital signs were stable,that she was a poor historian and complained of “hurting all over”.After triage was completed, the patient was taken to a bed in theED treatment area, which was located approximately 20 feet from thenurses’ station, but not in direct view of the station. Theregistered nurse assigned to the patient documented that thepatient was confused, uncooperative and incontinent. The nursingassessment was completed and noted the patient to be an elderlymale at risk for falls. Specific interventions were also documentedto implement fall interventions, to include side rails up, placecall bell within reach of patient, maintain bed in low position,and consider patient placement close to nursing station. Two hourslater, the patient was evaluated by the ED practitioner. Thepractitioner noted the patient was restless and ordered a sedationmedication in preparation for diagnostic tests which included a CTscan of the head, and imaging studies of the knee, pelvis and ribs.The assigned nurse administered the ordered sedative and the testswere completed in the diagnostic imaging department. The patientwas returned to her bed in the ED treatment area. The results ofthe diagnostic tests were reported as negative. Following thepatient’s return to the ED, the nurse assisted the patient to thebathroom, noting that she was able to walk independently, but hadan unsteady gait. The nurse left the room after returning thepatient to her bed, placing the side rails up and the call bellwithin reach of the patient. Thirty minutes later, housekeepingstaff found the patient yelling, laying on the floor on her rightside, next to her bed. Staff immediately responded and the patientwas assessed by the ED practitioner. Following the departmentprotocol, staff applied a cervical collar to the patient’s neck,placed her on a backboard and then lifted her to a stretcher. Thepatient complained of pain in his right hip, and his right leg wasnoted to be shortened and internally rotated. The patient underwentadditional diagnostic tests, and the hip x-rays results confirmed afractured right hip. Following her return from the imaging, thepatient was moved to a bed closer to the nursing station. Thepatient was later admitted to the hospital from the ED andevaluated by an orthopedic surgeon the following morning. Surgicalintervention for the hip fracture was recommended by the surgeonand the patient’s son provided consent for the procedure. Thepatient underwent an open reduction and internal fixation of hiship fracture. Post-operatively, the patient developed pneumoniawhich required antibiotic therapy and lengthened hishospitalization. She was subsequently discharge back to the nursinghome. Despite having the diagnosis of dementia, the patient wasable to ambulate prior to this hospitalization, but her activitylevel is now limited to a wheelchair. Instructions: Make an NCPbased on the case scenario above.
Provide atleast 3 nursing diagnoses: 2 actual nursing diagnosis,and 1 potential or risk nursing diagnosis. Make a different NCP foreach nursing diagnosis. Make sure to submit your files in PDFForm.
