I attempted to reorient Kathy throughout the day.
I made several adjustments to my care plan to keep Kathy
safe in an effort to decrease her anxiety and her delirium,
such as shutting off the television and limiting
the number of people in the room to maintain a calm
environment. Her medications were also adjusted in
an attempt to decrease her disorientation. The Dilaudid
PCA setting was decreased to 0.4 mg and the
ketamine to 0.2/mg/kg/h. This provided an improvement
in Kathy’s delirium. However, pain control became
an increasing problem to balance. The use of
nonsteroidal antiinflammatory drugs (NSAIDs) is considered
to be the first line of treatment in a patient
with arthritic changes in the hip. NSAIDs are often
not preferred by the orthopedic surgeons at our institution
because of concerns about postoperative bleeding.
However, an exception was made in the case of
Kathy, and she was allowed to have intravenous Torodol
for two doses. Kathy did not experience a difference
in her pain level following the addition of
Torodol.