Question

For each of the following questions, you need to include the information from both the primary and secondary surveys BUT you need to include/address what is unique for each of these three separate situations.

Case Study 2

Situation for Assessment

Donald D. is a 32 year-old man who just arrived to your ED after falling from a roof into a rock garden. His femur is protruding through his skin. The paramedics report that he was found in a large pool of blood. He presents unresponsive, BP 60/42, HR 168.

What potential life-threatening injuries does he have?

What is the priority of care?

What interventions are needed immediately?  

Answer 1

1 There is a chance of patient developing hypovolemic shock.Because the bone is very vascular ,large quantities of blood may be lost as a result of trauma,especially in fractures of femur and pelvis.Therefore treatment should be focused on stabilizing the fracture to prevent further hemorrhage,restoring blood volume and circulation.Another complications which could arise is fat embolism syndrome and Compartment syndrome,

2The priority of care will be in the order of

• Acute pain related to fracture ,soft tissue damage,muscle spasm,and surgery.
• Impaired physical mobility related to fractured hip.
• Impaired skin integrity related to surgical incision.

Risk for impaired urinary elimination related to immobility

3 Nursing interventions are

• Observe for shock and consider preinjury blood pressure values
• Note haemoglobin and hematocrit values.
• Assess the respiratory status and ensure adequate hydration.
• Notify surgeon if patient develops shock.
• Handle the affected extremity gently,supporting it with hands or pillow.
• Apply bucks traction as prescribed
• Use pain modyfying strategies.
• Encourage patient to use pain relief measures to keep pain tolerable.
• Perform aseptic dressing changes.
• Administer prophylactic antibiotics
• Perform intermittent catheterization.
• .
• Perform intermittent