Problem
Ruby, an 86-year-old, thin, osteoporotic woman, gets up on to a stepstool to reach something on the top shelf of her cabinet. She loses her balance and falls onto her left side. She finds that she cannot sit up without pain. Her daughter later finds her and calls an ambulance to take her to the emergency department. Per radiograph, left femoral fracture is present. Surgery is scheduled for open reduction with internal fixation. Blood clot prevention injections and pain medicine are prescribed. Next the patient is monitored for postoperative anemia and infection. After discharge, Ruby has rehabilitation for inpatient and then nursing home temporary care for 30 days. She is discharged to her daughter's home with home health and assistive equipment.
I. How will you use the information to prepare for today's visit?
Today's visit
Chief complaint: "I am still recovering from my fall last month and now am staying at my daughter's but want to go home."
Objective: Blood pressure 100/60 mm Hg, pulse 87, respiratory rate 20.
II. What additional subjective data are you seeking?
III. What additional objective data will you be assessing?
IV. Are there any national guidelines you want to consult for the postoperative and rehabilitation care of this patient with an ORIF related to osteopenia of the left femur?
V. What tests will you want to order as part of this follow-up visits?
VI. Are there any new differential diagnoses you need to consider?
VII. What is your plan of care?
VIII. What additional patient teaching may be needed?
IX. Are there additional community resources to consider?
X. Will you be looking to add any referrals for this patient?