Question

Subjective assessment

A 64-year-old lady who has just had the cast removed after 6/52 of immobilization for a Colles’ fracture of her right wrist. She has been referred to physiotherapy for exercises.

The patient tripped and fell on an uneven section of the pavement while hurrying to the bus stop on her way to work.

After the application of the cast on the day of injury, the patient did not receive any instruction regarding the prevention of joint stiffness or swelling before being sent home.

She had no problems that she felt were worth reporting during the time of immobilization.

Objective assessment

A thin, slightly stooped woman.

Holding right wrist in left hand in guarded position across her body.

Her hand and fingers are swollen and quite pink with scaly and flakey skin.

There is a visible deformity/bulge just above the wrist from the fracture callus.

Pain present when the fracture site is touched and when moving her hand and finger joints. Pain in her shoulder when lifting her arm to dress.

ROM limited from pain and stiffness in the shoulder and from swelling, pain and stiffness in the wrist, hand, thumb and finger joints.

Right handgrip strength is 25% of her left (right dominant).

Her stated goal is to ‘get back to normal.’

Questions

1. What underlying factors or conditions would you consider in this situation?

2. What other assessments would you consider important with this patient (i.e. labs, imaging)?

3. Provide at least TWO nursing diagnoses for this patient.

Thanks

Answer 1

Joint stiffness is a common problem associated with plaster cast. Due to the immobility of the part for days will lead to stiffness of the joint. Through physiotherapy we can restore th mobility of the joint. Other causes such as due to any dislocation from the position may lead to stiffness of joints. Malformation of the fracture is another reason. This will affect the movement as well as injuries to nearby structures.

2,

Proper assessment of patient is needed. Through xray we can identify any dislocation or malformation of fractures. CT scan also help as to understand the bone formation and status of fracture and bone.And also done physical examination to identify the ROM of the joint. And assess the need of physiotherapy.

3,

Acute pain. While we are trying to move the joint it may painful to patient.

Activity intolerence related to restricted movements. Due to the joint stiffness at wrist of hand there is limited activities can performed by the person.