Brief History.
B.W., a 75-year-old woman, fell at home and experienced a sudden sharp pain in her left hip. She was unable to walk and was taken to a nearby hospital where x-ray examination showed an impacted fracture of the left hip. The patient was alert and oriented at the time of admission. She had a history of arteriosclerotic cardiovascular disease and diabetes mellitus, which were managed successfully by various medications. The patient was relatively obese, and a considerable amount of osteoarthritis was present in both hips. Two days after admission, a total hip arthroplasty was performed under general anesthesia. Meperidine (Demerol) was given intramuscularly as a preoperative sedative. General anesthesia was induced by IV administration of thiopental (Pentothal) and sustained by inhalation of sevofl urane (Ultane). The surgery was completed successfully, and physical therapy was initiated at the patient’s bedside on the subsequent day.
Problem/Influence of Medication. At the initial therapy session, the therapist found the patient to be extremely lethargic and disoriented. She appeared confused about recent events and was unable to follow most commands. Apparently, she was experiencing some residual effects of the general anesthesia.
1. How can the therapist safely begin rehabilitation given this patient’s confusion?
2. Can any interventions help the patient overcome the residual anesthetic effects?
