Question

J.M 30-year-old is amaintenance employee at the electric company, was seen in the emerg ency department after falling from a building roof. His right lower extremity was splinted with a hardboard splint and a large, bulky dressing. Subjective Data • Complains of severe pain in the right femur. • Expresses concern about notifying his mother about the accident and his whereabouts • Asks how long he will be off work Objective Data • Open oblique fracture of the anterolateral aspect of the femur • Obvious deformity, marked swelling, and ecchymosis in region injury • To be treated with closed reduction and a cast

the farctuntion in the femur

Questions 1. Was the immobilization of the fracture at the scene of the accident appropriate and why? 2. What is the appropriate nursing neurovascular assessment of the injured extremity? 3. What are the priority therapeutic and nursing interventions to prevent in fection? 4. What specific nursing actions should the nurse implement to alleviate Salah pain? 5. How would the nurse answer Salah question about time off from work based on the stages of fracture healing? 6. Based on the assessment data presented, what are the priority nursing diagnoses? 7. Are there any collaborative problems?

Answer 1

1. Yes, the immobilsation of fractured leg is appropriate is appropriate as immobilization prevents mobility, so that it will help the injured area to get healed soon.It can help reduce pain,swelling ,and muscle spasms.

2.The neuromuscular assessment for the extremities is done inorder to evaluate sensory and motor function as well as perfusion..The appropriate neurovascular assessment includes,checking of the dorsalis pedispulse,checking of the pain as it is an indicator of neurovascular compromise,, pain disproportionate to injury.sensory and motor function should be also checked as once neurovascular status is compromised, he reports deceased sensation, loss of sensation, numbness etc.

3. The priority therapeutic and nursing intervention to prevent infection is handwashing.as it is the best way to break the chain of infection.The nurse who is caring , should be well educated regarding the ways to determine the infection as well as how to curb the infection process.Other measures to prevent infection are; personal protective equipment usage,cleaning, disinfection and sterilisation.aspetic technique for changes in the dressing,encourage the patient to take protien-rich and calorie-rich foods to boost the immunity.limit the visitors etc.

Immobilse the fracture fragments,and proper nutrition should be encouraged.

4.Assess and record the level of pain.

• maintain immobilization of affected part.by means of bed rest,cast,splint,traction.
• elevate and support the injured extremity
• avoid use of plastic sheets and pillows under lmbs in cast
• elevate bed covers.
• explain procedure before beginning them.
• perform ROM exercise
• provide comfort measures.

5.There are three stages of healing.Inflammatory, repartaive and remodeling stages.

In inflammatory stage; hey have hematoma or fibrin clot,macrophages, inflammatory leukocytes,

In the second week, the second phase starts, which is known as reparative stage; where primary callus response occur,inflammation trigger cell division, and growth of new blood vessels.The chondrocytes secrete collagen and proteoglycans,creates fibrocartilage.

In remodelling stage,allow the bone to assume its original shape.woven bone replaces with lamellar bone.