MS Case Study

Mr. Jones is a 74 year-old white male who presents to the clinic stating, my
knees, hands, and hips all seem to hurt. My joints are so stiff when getting up
in the morning I cannot even walk my dog. Patient admits to the pain diminishing
somewhat after his morning shower.
Patient History:
Patient lives independently in his own house. He has a grandson who helps with
yard work when he is limited by joint pain. The patient states he has been
independent with ADLs and most daily activities. He recently lost his wife to
cancer two years ago and takes pride in his independence. He has a history of
type 2 diabetes mellitus and has a 60 pack-year smoking history that is now
complicated by chronic obstructive pulmonary disease (COPD).
Physical Assessment reveals:
Patient weight is 230lbs, 56, B/P 139/68, T 98.7, R 18, P 64. Heberdens &
Bouchards nodes and deformity of the knee joints are noted with a decreased
range of motion.
QUESTIONS:
1. What disease process do you suspect WS has?
2. What are the usual symptoms noticed in this disease process?
3. How would you expect the patient to describe his pain?
4. To confirm the presumed clinical diagnosis what tests would you expect the
physician to order? What would you expect to find on the tests consistent with this
diagnosis?
5. What treatment modalities would be expected during this time to alleviate his
symptoms or prevent future

A year later this patient is brought to the hospital through the emergency
department. He fell on an ice patch outside his home. It appears he may have
sustained a fracture to his right hip.

Subjective Data:

Complains of excruciating pain and tenderness in right hip

Objective Data:

Blood pressure: 166/94, respiratory rate: 36, crackles & expiratory wheeze
heard throughout
Diaphoretic and pale skin
Pain not relieved with morphine
Diagnostics: X-ray right hip reveals: extracapsular fracture
Labs: Hematocrit: 30%, hemoglobin: 15 , WBC: 15,000

Collaborative Care:

Right hip repair with compression plate and bone screws

Cefazolin (Ancef) 1 gm IV every 8 hours
Intake and output for 48 hours postoperatively
Morphine sulfate per patient-controlled analgesia pump

QUESTIONS:
6. How does this patients preexisting medical conditions predispose him to
postoperative complications?
7. What are the most common postoperative complications this patient may develop?
Why?
8. What are the important pre- and post operative nursing interventions for this patient?
9. What are the priority nursing interventions?
10. Based on the data presented, write one or more appropriate nursing diagnosis.