Mr. Chopra is a 75-year-old male client who presents to the emergency department after experiencing a fall in the shower. He reports pain of 9/10 to the right side of his chest, which is worsened with inspiration and brushing noted at multiple sites of the body. Mr. Chopra previously used a cane to mobilize at home and within the community, however, he is currently unable to mobilize to the bathroom himself and reports increasing pain with mobilization. The neurological assessment indicates a GCS of 15, and the CT head shows no bleed despite having hit his head. X-ray imaging indicates two complete fractures to the right lower ribs, with hairline fractures noted to the right pelvis and a dislocated right shoulder. Multiple lacerations are also noted to bilateral knees, right forearm and bilateral palms. No changes to his continence or GI status are noted. The right shoulder is approximated back into the socket and a sling is applied to the right arm. Mr. Chopra is to be seen by physiotherapy, and occupational therapy once admitted onto a unit.
Mr. Chopra is accompanied by his grandson, who is translating for Mr. Chopra as he speaks very minimal English. Upon taking his medical history you note he has hypertension, dyslipidemia, and type 2 diabetes. He is a retired truck driver who came to Canada in the 1980s, with his wife and son. His wife passed away three years ago from breast cancer, and his son passed away five years ago from a car accident. He currently lives with his daughter-in-law and his grandson who are his primary caregivers. His daughter-in-law works full-time as an accountant for a small company close to their home, and his grandson is currently in grade 12 and preparing to apply for university.
Mr. Chopra is admitted to the rapid assessment unit (internal medicine) to clear up beds within the busy emergency department. The plan of care is to transition Mr. Chopra to the internal medicine team for pain management. He also will need to be assessed by physio therapist (PT) and occupational therapist (OT), but he does not require an orthopedics consult. Mr. Chopra’s pain is managed with oral hydromorphone 1-2 mg PRN q4hr, and hydromorphone 2mg PRN before physiotherapy. He is also scheduled to take acetaminophen, 500 mg Q6hr, and PRN, up to the maximum daily dose of 4g.
Upon PT and OT assessment, they deem that Mr. Chopra is a two person assist with a 2-wheel walker to the bedside commode for now and needs assistance with dressing himself. He is able to independently feed himself and engage in other self-care behaviours. They recommend transitioning Mr. Chopra to inpatient rehab as he is an ideal candidate who is very motivated to engage in rehab once his pain is better controlled, as he still reports a pain level of 7/10 pain with ambulation. However, they are concerned that he is pushing himself too hard as he is reluctant to ask for help from the nursing staff and tries to mobilize without his walker. He is embarrassed to ask the female nursing staff to assist him to the bathroom, as it is not seen as culturally appropriate. He often tries to mobilize on his own with just his cane, increasing his risk for another fall. Mr. Chopra expresses that he wants to get back to his previous mobility quickly so that he can go home, not make his daughter-in-law and grandson worry about him and for him to become more of a burden on them.