Question

Case study

An An 80 year old lady named Mary presented admitted to a unit came in with a fractured leg. She is 5 foot 7 and 165 pounds. Vital signs on arrival are is:

Blood pressure: 162/84

Heart rate: 92

Respiratory rate: 24

Temperature taken orally: 99.2

SpO2: 96% on room air (RA)

1. Document sings of physical examination
2. What information is missing from the situation? And ask patient.
3. What concerns would you have with the patient?
4. What nursing interventions would you start?
5. What discharge concerns?

This is new to me. help explain what I’ll do and why. I want to make sure I’m in the right direction

Answer 1

1. Nursing Assessment

A breif history of the traumatic episode , the mechanism of injury and the position in which the victim was found can be obtained from the patient or witness

Subjective data

Important health information

• past health history: Traumatic injury; long-term repetitive forces (stress fracture); bone or systemic diseases,prolonged immobility, osteopenia, osteoporosis
• Medications; Corticosteroids ( Osteoporotic fracture); analgesics
• Surgery or other treatments: First aid treatment of fracture , previous musculoskeletal surgeries
• Place special emphasis on the region distal to the injury

Assessment findings following fracture include the following:

• Deformity (loss of normal bony contours) or unnatural positon of the affected limb
• Edema and ecchymosis
• muscle spasm
• Tenderness and pain
• Warmth at the site
• Loss of function
• Numbness, tingling, loss of distal pulses
• Grating (crepitus)
• Open wound over injured site or exposure of bone

2. Neurovascular Assessment

Musculoskeletal injuries may cause changes in the neurovascular status of an injured extremity

• The neurovascular assessment should consist of a peripheral vascular assessment (color, temperature,capillary refil,peripheral pulses and edema) and peripheral neurologic assessment (sensation,motor function and pain). Throughout the neurovascular assessment, compare both extremities to obtain an accurate assessment
• Assess an extremity's color (pink,pale,cyanotic) and temperature (hot,warm,cool,cold) in the area of the injury. pallor or cool to cold extremity below the injury could indicate arterial insufficiency
• A warm cynotic extremity could indicate poor venous return
• Next assess capillary refil (blanching of the nail bed), it should be less than 3 seconds
• Compare pulses on both extremities to identify differences in rate and quality
• A diminished or absent pulse distal to the extremity indicate vascular dysfunction and insufficiency
• Assess peripheral edem, a pitting edema is presented with severe injury

3.Emergency interventions

Initial

• Treat life-threatening injuries first
• Ensure airway, breathing and circulation
• Control external bleeding with direct pressure or sterile pressure dresing and elevation of extremity
• Check neurovascular status distal to injury before and after splinting
• Elevate injured limb if possible
• Do not attempt to straighen factured or dislocated joint
• Do not manipulate protruding bone ends
• Apply ice packs to affected area
• Obtain X-rays of affected limb
• Administer tetanus and diphtheria prophylaxsis if there is a break in skin integrity
• Mark location of pulses to facilitate assessment
• Splint fracture site, including joints above and below fracture site

Ongoing monitoring

• Monitor vital signs , level of consciousness, oxygen saturation, neurovascular status an pain
• Monitor compartment syndrome characterized by excessive pain, pain with passive stretch of the affected extremity muscles, pallor, paresthesia and late signs of paralysis and pulselessness
• Monitor for fat embolism (dyspnea, chest pain, temperature elevation)

4.

Patient-Caregiver teaching Guide Following application of a Cast

Dos

Do n'ts

1.Apply ice (covered inside a plastic bag) directly over the fracture site for the first 24 Hrs 2.Check with health care provider before getting fibre glass cast wet 3. Dry cast thorougly after exposure to water Blot dry with towel Use hair dryer on low setting until cast is thoroughly dry 4. Elevate the extremity above the level of the heart for first 48 Hrs 5.Move joints above and below cast regularly 6.Use hair dryer on cool setting for itching 7.Report signs of possible probelms to health care provider Increasing pain despite elevation,ice and analgesia Swelling associated with pain and discoloration of toes or fingers Pain during movement Burning or tingling under the cast Sores or foul odor under the cast 8. Keep appointment to have fracture and cast checked

1.Get cast wet 2.Remove any padding 3.Insert any objects inside cast 4.Bear weight on new cast for 48 Hrs 5.Cover cast with plastic for prolonged periods