RT Book, Section A1 Jobst, Erin E. A1 Panus, Peter C. A1 Kruidering-Hall, Marieke SR Print(0) ID 1192815536 T1 General Anesthetics T2 Pharmacology for the Physical Therapist, 2e YR 2020 FD 2020 PB McGraw-Hill Education PP New York, NY SN 9781259862229 LK accessphysiotherapy.mhmedical.com/content.aspx?aid=1192815536 RD 2024/03/29 AB CASE STUDYA.F. is a 72-year-old woman who sustained a right proximal femoral fracture secondary to a fall down eight concrete stairs outside a medical office building. She was on her way to see her physician for an annual checkup and lost her balance while stepping onto the top step. A.F. was transported and emergently admitted to the hospital for an open reduction internal fixation (ORIF) of the right femur. Physical therapy evaluation was initiated 24 hours after surgery. Upon chart review, the therapist noted that the operation report was unremarkable and the surgeon established non-weightbearing status on the right lower extremity. The anesthesia report showed the patient received balanced anesthesia of inhaled nitrous oxide for induction followed by desflurane and intravenous anesthetics including midazolam and fentanyl. Postoperatively, A.F. is receiving pain medications as needed. Upon evaluation, the therapist noted that A.F. was extremely difficult to arouse and very lethargic. Nursing reported that the patient had a restful evening and that she had not requested additional pain medication. The therapist made several unsuccessful attempts to sit A.F. at the edge of the bed. The therapist, with the assistance of three aides, transferred the patient dependently to a cardiac chair for slow mobilization to an upright posture. During this activity, A.F. was somnolent and unable to carry on a conversation with the therapist. The patient was transferred back to bed with the ceiling lift. After reading the therapist’s initial evaluation, the hospital discharge planner shared with the therapist that she felt that A.F. should likely be discharged to a skilled nursing facility. The therapist requested that any recommendation about discharge destination be deferred by at least one day.