N.O., a 72-year-old male, was admitted to the skilled care facility for rehabilitation following an open reduction, internal fixation of the right hip.

N.O. had fallen while going up the stairs of his home, suffering a fracture of the right femur. He has no recollection of what caused him to fall. He is married and, until his surgery, was working part time as a school-crossing guard. While in the hospital, N.O. exhibited mental status changes, including disorientation and confusion. His wife reports that he never had this problem prior to the surgery. He is continent of bowel and bladder. N.O. was in relatively good health until the fall. He and his wife agree that he should return home after rehabilitation is complete

1. what specific admission assessments that would be required for N.O. because of his age and condition.

2. what complications for which N.O. is at risk.

3. Interventions to prevent each complication.

4. What possible reasons for N.O.'s fall.

 5. What are the methods for assessing N.O.'s mental status.

 6.What arethe possible reasons for his altered mental status.

 7. Three individualized nursing diagnoses and goals for N.O.

8. What are nursing actions related to altered mental status.

9.What are four successful outcomes for N.O.

 10. Develop a teaching plan for N.O.

 11.what are the community resources N.O. may need after discharge"

1. As for the sort of admission assessments in favour of N. O. , thereby we privation just a inadequate collection of criteria: Collegian – holiness – persuasiveness – accomplishment – give consent.

 Given N. O. 's age and condition, specific assessments would include:Given N. O. 's age and condition, specific assessments would include:

 Fall Risk Assessment: Such as the Morse Fall Scale which helps to identify his risk of falling.

 Cognitive Assessment: Delirium or dementia or other cognitive assessment tools such as Mini Mental State Examination (MMSE) or Confusion Assessment Method (CAM) etc may be employed to screen for delirium.

 Pain Assessment: Assessing the patient’s complaint to determine the intensity of pain in the hip and also in the assessment, evaluating the effectiveness of pain control measures.

 Functional Status Assessment: In particular, defining the initial level of dependency in personal care (Barthel Index of activities of daily living – ADL or the FIM scale).

 Nutritional Assessment: Evaluating his dietary needs to get proper nutrient to assist in the healing process.

 Psychosocial Assessment: Assessing their social stimulating factors related to him such as; emotional and psychological self support system.

 Medication Review: Review of patient’s current prescriptions with the aim of ascertaining all probable side effects or complications.

 2. Adverse Outcomes That N. O. Is at Risk For

 DVT and PE with an acute care setting

 Pressure Ulcers

 Infection, especially surgical site infection

 Pneumonia

 Delirium

 Falls

 3. Measures That May Be Taken to Avoid Each of the Complications

 DVT/PE: The measures include proper anticoagulation, wearing of compression stockings, and early mobilisation.

 Pressure Ulcers: These include repositioning at least every two hours, skin checks and the utilisation of pressure-relieving equipment.

 Infection: Following strict procedures on aseptic measures, observation of the site of operation, and taking antibiotics as advised.

 Pneumonia: Promoting adequate respiratory patterns, practice of incentive spirometry and early mobilisation.

 Delirium: Some of the physical interventions are; Ensuring the patient is not agitated and confused, reducing the use of physical restraints, and adequate fluid and food intake.

 Falls: Employment protection measures, prevention of falls and pressure sores, and use of Walker or Wheeled Walker.

 4. Reasons Behind N. O Fall Now that we know the nature of competition in the telecommunications business let us look at some of the sources of competition that led to the fall of N. O.

 Environmental Factors: Such things like inadequate lighting, use of rugs that are not well secured and many things that are likely to be found on stairs and not on flat surfaces.

 Muscle Weakness or Balance Issues: This may be attributed to; aging or some other temporary condition of the body.

 Medication Side Effects: Like feeling dizzy or developing low blood pressure due to the taking of antihypertensive drugs.

 Cognitive Impairment: Premonitory top-level clinical alterations which could have existed before the fall.

 Undiagnosed Neurological Condition: Such as a transient ischemic attack (TIA), but also warn of possible future development of a major stroke.

 5. Ways of Evaluating N. O. ’s Psychological Condition

 Mini-Mental State Examination (MMSE): To check the cognitive capabilities of the clients.

 Confusion Assessment Method (CAM): To proposed screening test, i. e. the 3D assessment tool, for assessment of delirium.

 Montreal Cognitive Assessment (MoCA): To use in diagnosing minor neurocognitive disorders.

 Clock Drawing Test: For example, as a primary pass ‘high-level’ screening for cognitive impairments.

 6. That is why I have mentioned all the possible reasons for his altered mental status in the essay.

 Post-Operative Delirium: Can be seen frequently in the elderly patients postoperative.

 Medication Effects: Especially from anesthesia, opioids or sedatives.

 Infection: From a urinary tract infection or other ailments such as pneumonia.

 Electrolyte Imbalance: For instance, hypoglycemia, anemia, hyponatremia, hypokalemia and hypocalcemia.

 Hypoxia: Because of conditions that result from low oxygen levels or oxygen deprivation in the course of an operation or after an operation.

 7. Three individualised nursing diagnose and goals for N. O.

 Risk for Falls: Goal: N. O. will not experience falls while in the facility.

 Acute Confusion: Outcome: N. O. will show the orientation and cognitive function has improved.

 Impaired Physical Mobility: Goal: N. O will progressively become more mobile and be able to feed, wash, dress among other activities with help.

 8. Nursing Interventions Regarding the Patient with Altered Mental State

 Frequent Reorientation: Recover N. O. ‘s sense of time and space using clocks, calendars and simple discussion.

 Monitor Hydration and Nutrition: Sustain appropriate fluid and nutrient consumption to avoid water and electrolyte loss.

 Minimize Environmental Stressors: Minimize a noisy setting, uses good lighting and makes the environment as relaxed as possible.

 Monitor and Review Medications: Discuss with the healthcare team to modify some medicines that may bring about confusion.

 9. Four Positive Achievements for N. O.

 N. O. is not experiencing falls throughout his rehabilitation course.

 N. O. demonstrates enhances mental status, no acute confusion noted.

 N. O. ’s level of mobilization has improved and he can now go around with the help of a walking aid unilaterally.

 N. O. is also able to gain proper discharge to home care with a right kind of support mechanisms in place.

 10. Teaching Plan for N. O. L.

 Pain Management: Self-care: (teach patient about various methods of pain management which include drug administration and non drug interventions).

 Mobility and Safety: Train the intermediate patients on ways of transferring safely, utilization of mobility aids and how to prevent falls at home.

 Medication Education: Give details on the medicines likely to be taken the duration for which they will be taken, the quantity, and potential unwanted effects.

 Signs of Complications: Instruct on potential cues for complication such as; infection, DVT, worsening confusion etc.

 11. This is the list of community resources that N. O. in may require after discharge.

 Home Health Services: To extend the rehabilitation and nursing services.

 Physical Therapy Services: For further physiotherapy strengthening, and mobility exercises.

 Senior Transportation Services: For appointments and running different chores that one may need to do.

 Support Groups: To accompany its employees in a joyful activity that will help them cope with stress.

 Meals on Wheels: If necessary to maintain diet for recovery stakes NOTE: If necessary patient must be fed appropriately during his/her recovery time.