M.W. is a 55-year-old interior decorator who suffered a stable fracture of the pelvis in a motor vehicle crash 4 days ago. Her past medical history is positive for osteopenia and hypothyroidism. She has multiple areas of soft tissue trauma to her legs, as evidenced by large hematomas over the entire left leg and right thigh. She also has several facial fractures from hitting the steering wheel during the crash. She is being treated by immobilization with bed rest. Her medication orders include enoxaparin 40 mg subcutaneously daily, levothyroxine 100 mcg daily, alendronate 70 mg PO weekly, oxycodone/acetaminophen 2 tablets q4hr prn, and psyllium (Metamucil) 2 tsp twice a day.
Your morning assessment findings include the following: blood pressure 128/82 mm Hg, heart rate 82 beats/min, respiratory rate 16 breaths/min, and temperature 98.2° F (36.8° C); awake, alert, and oriented ×3; swelling and ecchymoses noted on right side of face; lung sounds clear but decreased in lower lobes bilaterally; normal S1 and S2 heart sounds; bowel sounds active in all four quadrants; moves her lower extremities with difficulty; states pain is at an acceptable level but says her legs are very sore; pedal pulses 2+ bilaterally; 1+ edema around both ankles; legs warm and ecchymotic. She is eating a regular diet and drinks fluids well.
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