Question

Orthopedic Nursing Patient Scenario

Mary Jane is an 81-year-old woman was admitted to hospital after a simple fall, complaining of hip pain and inability to walk. The affected right leg appeared internally rotated. Passive motion was painful, and active movement was impossible secondary to pain. The patient has several chronic medical problems including as DM, Hypertension and Ischemic Heart Disease. Treatment in the Accident and Emergency Department was centered around her diagnosis of a fractured right femur. She lives in a nursing home, although she was independently ambulant. She has now been admitted to your Orthopedic Unit for further management. Chief Concern:  Severe, sharp pain on movement 9/10  Inability to bear weight, sit-up or ambulate PHH (Past Health History):  appendectomy age 15, fractured clavicle age 19.  laminectomy (L4‐5) 17 years ago due to a work related injury. Medications History:  acetaminophen 500 mg PO q6h  Insulin 70/30 12units SC, AM and PM  Enalapril 10mg PO BD  Atenolol 25mg PO OD  Aspirin 81mg PO OD  Calcium 600mg PO OD Physical Exam:  BP 160/94 P 103 regular R 24 T 37.2  Conscious and alert but appears anxious, GCS 13/15  Height 188 cm, weight 118 kg  IVF in progress, 0.9% Nacl to left anti-cubital fossa  Skeletal Traction to right leg with 15 pounds weights in place  Urinary catheter in situ, on free drainage  TED stocking in place to left lower limb Labs: XRay: X-ray shows a transverse fracture of the femur. The break is a straight horizontal line across the shaft. Social History:  Trinidadian born, graduated form 5 high school  worked on an assembly line in manufacturing company; is physically demanding  smokes 1pk/day x 18 years, occasional marijuana use; drinks beer ~ 2/week.  recently lost a long‐time friend at the nursing home to cancer  spouse died 8 years ago (MI)  no children, 1 sister alive she lives abroad Family History  Mother died of heart disease  Father died of prostate cancer

1. Describe the pathophysiology of bone fractures and complications

2. Are the signs and symptoms associated with a femur fracture, consistent with the presentation by Mrs. Jane?

3. Outline the medical and surgical treatment of a femur fracture.

Answer 1

Answer to 1st question:

The pathophysiology of bone fractures:

The femur bone fractures are usually happen when falling from high places or accidents and this result in the fracture of more than one bone. The severe pain starts after the fracture and it takes long time for heal. when the fracture happens, person can not stand or put the weight on leg and bruise of skin can be seen on that place.The bleeding is severe in that place and fat reaches to the lungs through the blood  and blood clots forms in between the fracture fragments and it takes longer period for healing. The bone mass is low or person already has accident history or age are most common factors for fractures.

Complications:

fractures has complications like excessive bleeding and damage in the soft tissue area , neurovascular injury, infection develops from that fracture area if it is untreated, person experiences trauma from injury . it can further develop into complications if proper treatment is not taken, it leads to embolism of fat , blood clots formation in between the fracture tissues, and also joints become stiff then it is difficult to heal.

Answer to 2nd question:

The signs and symptoms of Mary jane femur fracture's presentation here is consistent like severe pain while moving.

Answer to 3rd question:

The femur fracture treatment is depend on the location of fracture bone and the severity of fracture of more than one bone . The casting of bone and traction is done on the femur bone fracture as treatment and also gives pain relief medication for controlling of pain and also for the infection spread stopping from bone fracture.

-Surgically, the femur bone is cast with medical devices like rod or plate is placed on the bone to hold bone in correct place until it heals.