General Survey and Health History (graded)
Casey is a 17-year-old high school student admitted to the ER with a compound fracture of the left leg obtained falling at the local skateboard park while practicing for a national competition. He has never been hospitalized before. His mother has been notified and is on her way. The EMTs gave him morphine and he reports his pain level as “okay.”
• What part of the interview and examination can be done prior to his mother’s arrival?
• As you enter the room for the first time, what should you observe as part of the general survey?
• As you complete his history, what areas are especially important?
• What are the important developmental considerations for Casey?
The Older Adult (graded)
Jean is a 68-year-old female admitted for a total hip replacement. In her interview you learn that she has a history of obstructive sleep apnea (OSA) with a neck circumference of 16 inches and snores much of the night. She is 5’7” and weighs 265 pounds. She states she is sleepy throughout the day. Her other medical history includes: hypertension treated with angiotensin II receptor blockers (ARB), Diabetic with an Hgb A1c over 8%. Hypercholesteremia treated with a Statin drug. Coronary Artery Disease (CAD) with a history of a drug eluting cardiac stent placed 14 months ago and currently on Plavix and ASA. History of gastroesophageal reflux disease (GERD) and is on Prilosec. Her husband has a history of cerebral vascular accident (CVA) several years ago.
• What medications should she take pre-op and what should she hold?
• Should Jean be allowed to continue ASA pre-operatively?
• Should cardiology be consulted on this matter?
• What are Jean’s risks for diabetes complications? What concerns do you have about her social support system?