Substance Misuse and Abuse Case
C.M., a 78-year-old white woman, is admitted to the
emergency department after falling and injuring her
right hip. 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 contacted
by phone, the daughter tells the nurse that her
mother has appeared more disoriented and confused
over the past few months when she has talked to her
on the phone.
• Is complaining of severe pain in her right hip
• Admits she had some wine in the late afternoon to stimulate her
• 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
• Speech is hesitant and slurred
• Says she smokes about one-half pack of cigarettes a day
• Oriented to person and place, but not time
• BP 162/94, pulse 92, respirations 24
• Severe pain and tenderness in the right hip region
• Tremors of hands
• X-ray reveals a subtrochanteric fracture of the right femur requiring
• Blood alcohol concentration (BAC) 120 mg/dL (0.12 mg%)
• Complete blood count: hemoglobin 10.6 g/dL, hematocrit 33%
1. What other information is needed to assess C.M.’s condition?
2. How should questions regarding substance use be addressed?
3. What factors may contribute to C.M.’s use of psychoactive substances?
4. Priority Decision: What are the priority nursing interventions during
C.M.’s preoperative period?
5. What possible complications and other health problems may become
apparent during C.M.’s postoperative recovery?
6. Priority Decision: What are the priority nursing interventions after
7. Delegation Decision: How would you use the following nursing personnel on the postoperative unit to carry out the priority interventions
that you identified in question 6: registered nurse (RN), licensed practical nurse (LPN), unlicensed assistive personnel (UAP)?
8. Priority Decision: Based on the assessment data presented, what are
the priority nursing diagnoses? Are there any collaborative problems?
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