Question

Jack, a 10-year old boy, is riding his bicycle on the way home. Suddenly, a dog ran in front of his path, causing him to swerve towards the canal. Jack fell through the canal and his bicycle landed on top of him. The emergency room physician took his x-ray and later on informed Jack’s parents that their son had a closed fractured on his right arm.

Instructions:

1. Complete an APIE for Jack
2. Create Nursing Diagnosis for Jack
3. Create a Teaching Plan for Jack

Answer 1

Assessment-
Signs of a broken forearm include:
arm pain that gets worse with wrist or elbow movement.
pain or swelling in the forearm, wrist or hand.
a noticeable abnormality, such as bent arm or wrist.
difficulty using or moving the arm normally.
warmth, bruising or numbness in the forearm or wrist.
numbness in the hand.
In childrens, the usual plan is to attempt closed reduction followed by cast immobilization. There does not appear to be a significant difference between a single sugar-tong splint and a long arm cast in this setting. Childhood obesity appears to increase the risk of malreduction and subsequent manipulations with closed reduction and casting.
Implement-Use broad bandages (where possible) to prevent movement at joints above and below the fracture. support the limb, carefully passing bandages under the natural hollows of the body. place a padded splint along the injured limb. place padding between the splint and the natural contours of the body and secure firmly.
Physical Examination-
Clinical examination should include a careful neurologic evaluation of the motor and sensory functions of the radial, median, and ulnar nerves.

2) Pain, swelling, tenderness and bruising in your upper arm. Limited motion in your upper arm and shoulder. Deformity of your injured arm. Shortening of the arm compared to your uninjured arm (if pieces of fractured bone are separated far apart). Parts of fractured bone visible through broken skin (an open fracture).
Risk for Trauma: Falls
Acute Pain
Risk for Peripheral Neurovascular Dysfunction
Risk for Impaired Gas Exchange
Impaired Physical Mobility
Impaired Skin Integrity
Risk for Infection
Deficient Knowledge
Risk for Injury
Self-Care
Deficit Constipation, and other Nursing Diagnoses

3) You have a break or fracture of both bones in the forearm. The bones are out of place and must be set to make them straight again. This fracture usually takes 8 to 12 weeks to heal completely. Initial treatment is with a splint or cast. Severe injuries may need surgery to repair. Keep your arm raised to reduce pain and swelling. When sitting or lying down, raise your arm above heart level. You can do this by placing your arm on a pillow that rests on your chest or on a pillow at your side. This is most important during the first 48 hours after injury. Apply an ice pack over the injured area for 15 to 20 minutes every 3 to 6 hours. You should do this for the first 24 to 48 hours. To make a cold pack, put ice cubes in a plastic bag that seals at the top. Wrap the bag in a clean, thin towel or cloth. Never put ice or an ice pack directly on the skin. As the ice melts, be careful that the cast or splint doesn’t get wet. You can place the ice pack inside the sling and directly over the splint or cast. Keep using ice packs as needed to ease pain and swelling. Keep the cast or splint completely dry at all times. Bathe with your cast or splint out of the water. Protect it with 2 large plastic bags, one outside of the other, each taped with duct tape at the top end or use rubber bands. If a fiberglass splint or cast gets wet, you can dry it with a hair dryer on a cool setting. You may use over the counter pain medicine to control pain, unless another pain medicine was prescribed. If you have chronic liver or kidney disease or ever had a stomach ulcer or GI bleeding, talk with your healthcare provider before using these medicines.