Case Study
Substance Use
Patient Profile Mrs. Carla Muller, a 78-year-old woman, is admied to the emergency department after falling and injuring her right shoulder and arm. She has been widowed for 4 years and lives alone. Recently, her best friend died. Her only family is a daughter who lives out of town. When the nurse contacts the daughter by phone, the daughter tells the nurse that her mother appears to have been more disoriented and confused over the past year when they have talked on the phone.
Subjective Data
• Is complaining of severe pain in her right shoulder and upper arm.
• Admits she had some wine in the late afternoon to stimulate her appetite.
• Has experienced several falls in the past 2 months.
• Reports that she fell after taking her sleeping pill, prescribed by her physician because she does not sleep well.
• Speaks with hesitation and slurs.
• Says she smokes about half a pack of cigarees a day.
Objective Data Physical Examination
• Oriented to person and place, but not time.
• Blood pressure 162/94, pulse 92, respirations 24.
• Bruising and edema of right upper arm.
• Tremors of hands.
Diagnostic Tests
• Radiographic examination reveals comminuted fracture of the proximal humerus necessitating surgical repair.
• Blood alcohol concentration (BAC) 26 mmol/L.
• Complete blood count: hemoglobin 106 g/L; hematocrit 0.38 (38%).
Discussion Questions
1. What other information is needed to assess Mrs. Muller's condition?
2. How should questions regarding these areas be addressed?
3. What factors may contribute to Mrs. Muller's use of psychoactive substances?
4. Priority decision: What priority nursing interventions are appropriate during Mrs. Muller's preoperative period?
5. What possible complications and other health problems may become apparent during Mrs. Muller's postoperative recovery?
6. What nursing interventions are appropriate following Mrs. Muller's surgery?
7. Priority decision: Based on the assessment data presented, what are the priority nursing diagnoses for Mrs. Muller? Are there any collaborative problems?