Title: Case Study

Task: To complete this case study, you will be required to critically analyse patient data and provide an effective care plan for evidence-based nursing care. Using a broad range of literature sourcesincluding clinical practice guidelines, systematic review and evidence summaries, and recent journal publication, support your nursing care plan with quality evidence. Please ensure you use a recognised referencing format- preferably APA 6th edition as per SCU School of Health and Human Sciences policy- and include all citations. The word count allows 10% leeway for in-text citations, but does not include the reference list

Background: Olive Huang has been admitted to hospital following a fall at home. As a result of the fall she has sustained a fractured neck of femur, and is to be prepared for a surgical procedure- an open reduction and internal fixation (ORIF) - to repair this fracture. Olive has a history of atrial fibrillation, and has recently changed her thromboprophylactic medication from Warfarin to Rivaroxaban. She also takes Amiodarone and Thyroxine. Olive lives in a granny flat underneath her son's house. She is normally independent with activities, but does not drive. She attends her local community centre a few times each week.

Questions:

1. Olive was not sure what caused her fall. Paramedics were concerned that it may have been as a result of a syncopal episode, as Olive can't really remember what happened. Her son is concerned about the risk of anticoagulation therapy and injury from falls. Consider what nursing interventions may help reduce this risk, and explain why anticoagulation is necessary (300-400 words).

2. Olive's anticoagulation medication has changed. Explain the differences between these two medications (Warfarin and Rivaroxaban), and the potential impact this has for Olive. Consider how bleeding risk will be managed in the intraoperative phase, and what implications this will have for nursing care (300-400 words).

3. Even a non-displaced neck of femur fracture can cause significant pain. Olive has complex pain management requirements. Describe the differences between regional anaesthesia- in this case, a femoral nerve block, patient controlled analgesia, and the use of oral analgesia (300-400 words).

4. Discharge planning is an essential part of perioperative management. Consider appropriate interventions to make the transition successful, and create a plan of care to meet Olive's needs, listing 2-3 concerns and your plan of nursing care to meet these (300-400 words).