M.S. is a 67 year-old Hispanic female

M.S. is a 67 year-old Hispanic female – medical diagnosis right rotator cuff surgery. She has a history of chronic pain. She describes in two main locations, the base of her neck and her lower back. The pain radiates to the arms, neck, and legs. The pain is a 6-7/10. She takes ibuprofen to ameliorate the pain and applies hot compresses this brings the pain down to 4/10. The pain is constant. She also has extreme fatigue that at times leaves her bedridden. M.S. is in no isolation precautions. Vital signs are BP: 105/70, HR: 68, RR: 12, temperature: 97.2 Respiratory: Breath sounds are clear and present bilaterally with no adventitious sounds. Cardiovascular: S1, S2 present with no murmurs, clicks or additional sounds. Capillary refill is brisk at less than 2 seconds. No signs of clubbing. Neurological: She is A/O x 4. GI/GU/I&O: Abdomen is flat and symmetric. Gastric sounds are present in all quadrants. M.S. reports of normal bowel movements, at least twice a day. Last bowel movement in the morning. She has no complaints urinating, but reports that has UTIs at least 4 x year. Integumentary: Skin is even color appropriate for ethnicity throughout. There are no lesions, wounds, or incisions. M.S. has no tattoos. The skin is warm and dry with good elastic recoil. Psychological/Family Support: M.S. lives by herself with her dog and expresses feeling lonely. She has a strong relationship with her children (daughter and two sons) but they live in a different state. May need financial assistance, she is a retired teacher with minimal income. Medical history: scoliosis, high cholesterol (managed with diet and initially drug), colon resection – 7 inches of the sigmoid (2012), ptosis (2008), thyroid removal (2007), and ptosis (2001). Does not have a POA, will, or advance directives. Medications: Boniva, Pravastatin (she does not take because she is afraid of having problems with her ptosis again), Ibuprofen. Medical Diagnosis: Right rotator cuff surgery to correct a full rotator cuff tear Pathophysiology: Age is the most common factor for rotator cuff disease. It is a degenerative process that is progressive.[3] Smoking is a known risk factor. A systematic review demonstrated increased rates and sizes of degenerative tears along with symptomatic tears seen in smokers; this has the potential to increase the number of surgeries.[4] Another risk factor is family history. In a study of rotator cuff disease in those under 40 years of age, there was a significant correlation between individuals with RC disease up to third cousins. [4] Interestingly, poor posture has also been shown to be a predictor of rotator cuff disease. Tears were present in 65.8% of patients with kyphotic-lordotic postures, 54.3% with flat-back postures, and 48.9% with sway-back postures; tears were present in only 2.9% of patients with ideal alignment.[4] Other risk factors include trauma, hypercholesterolemia, and occupations or activities requiring significant overhead activity.Rotator cuff injury runs the full spectrum from injury to tendinopathy to partial tears, and finally complete tears. Age plays a significant role. Injuries ranged from 9.7% in those 20 years and younger increasing to 62% in patients 80 years and older (whether or not symptoms were present).[1] Increasing age and those with unilateral pain are also at risk for a tear in the rotator cuff of the opposite shoulder. In a study comparing patients with unilateral shoulder pain, the average age for a patient having no cuff tear was 48.7 years. After age 66, there is a 50% likelihood of bilateral tears. Additionally, age was linked to the presence and type of tear but did not correlate with tear size.[1] Unfortunately, there is a lack of good evidence on the optimal treatment of tears in patients younger than 40.[2] The tears tend to be more traumatic and likely respond to surgery better, but the role of non-surgical management needs to be better defined. questions bring out assessment nursing diagnosis measurable expected outcomes interventions evaluation safety communnication infection control reference

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