Question

Mr. Thathurts is a 38-year-old male who was involved in motorcycle crash. He was riding his motorcycle when he was cut off in traffic by a car trying to pass him. He landed on his right side on the road. He was wearing a helmet, did not hit his head and has been conscious since the accident. At the scene, EMS noted that Mr. Thathurts’ only complaint was severe right leg pain. On arrival to the ER, the patient complained only of his right thigh hurting and having spasms, which were very intense. He has had a CT of his abdomen and pelvis to rule out internal injury which negative. He had some basic labs drawn in the ER which were “normal”, and his blood alcohol level was negative. He had an x-ray of his right femur which shows a compound closed fracture of the right femur.

Mr. Thathurts reports he does not have any medical problems and does not take any medication at home. His wife is with him.

Assessment:

Most recent set of vitals: Pulse 90, Respiratory rate 14, BP 150/92, O2 sat 98% on room air and his pain is 5/10. He received dilaudid 1 mg IV about 20 minutes ago.

Neuro: Alert and oriented to person, place, time and situation. PERRLA.

Respiratory: Lungs are clear and equal. He is on room air.

Cardiovascular: His vitals have been stable in the ER. “Normal” heart sounds and brisk capillary refill.

Abdomen: Soft, flat with active bowel sounds.

Musculoskeletal: Right leg is in a temporary pneumatic traction device from EMS. Unable to tell if there is deformity because the device is covering his right thigh. His pedal pulses bilaterally are strong with brisk capillary refill, his right leg is slightly cooler than his left.

GU: he does not have a foley catheter

He has a 20 g Angiocath in the left antecube that has 0.9% Normal Saline infusing. He has had a Tdap IM injection and 2 doses of dilaudid 1 mg IV with the last dose about 20 minutes ago.

Recommendations:

He will need a traction bed for Buck’s traction set up.

Admission Orders:

1. Admit to medicine service with orthopedic consult.

2. Condition: stable

3. Diet: NPO

4. Activity: Bed Rest

5. Code status: Full

6. Allergies: None

7. Medications:

• 0.9 % Normal Saline IV at 125 mL/hr continuously
• Hydromorphone 1 mg IV every 3 hours prn for pain
• Narcan 0.4 mg IV q 5 minutes prn for respiratory depression
• Diazepam 5mg IV q 6 hours prn for muscle spasms
• Ancef 1 gm IV on-call to OR
• Ondansetron 4 mg IV q 6 hours prn for nausea

8. Remove Hare traction and replace with Buck’s traction to right leg at 20 lbs counter traction.

9. Neurovascular checks every four hours.

10. Consult anesthesia for pre-op evaluation

11. Portable CXR in AM x 1.

12. Portable X-ray right femur A/P and lateral after traction placement.

13. Continuous pulse ox.

The patient arrives to the inpatient unit from the emergency department. He is on the emergency department stretcher with the Hare traction device in place.

You call the shots!

How will you orchestrate moving him from the ER cot to the bed to minimize pain and keep the femur fracture stable? Click or tap here to enter text.

After you get him transferred to the bed. What are your immediate nursing priorities?

1. Click or tap here to enter text.

2. Click or tap here to enter text.

3. Click or tap here to enter text.

What are your assessment priorities?

A. Click or tap here to enter text.

B. Click or tap here to enter text.

C. Click or tap here to enter text.

What teaching should be done with the patient and the wife about Buck’s traction?

Click or tap here to enter text.

Answer 1

Answer 1. To shift the patient from ER cot to bed, 3 4 person will be required according to the age, weight and health issue with the patient . They are the caregivers, who first check on patients status, any support systems attached to his body, etc. In this case, the care givers has to place the cot near the bed and the attachments are separated forbthe time being, so that they do not interfere while shifting. The sheet below the patient or the slider is used to shift him. These caregivers together will pick the patient in that sheet from four corners without creating any imbalance and pain to the patient. Then slowly but carefully the patient is placed onto the bed. In this whole time, the patient is awakened and in full senses.

Answer 2. As a nurse, the priority steps would be to ensure that the patient is not feeling any pain while shifting. Then the temporary attachments or any support that was removed before, need to be settled again. Then the health chart should be made regarding the treatment and the medications of patient which will be hanged to his bed for further aspects. Lastly, the patient should be ensured of feeling fine, comfortable at that position and arrangements.

Answer 3. The patient education involves to sit in or stay in proper position so as the bone repair is not hindered. The bed adjustments should be made accordingly. Medicines should be taken on time and the diet should be taken in proper manner. His wife should be taught to help him in moving or in taking sides. She needs to help him uplifting him morally beacuse much movements are not feasible with tractions. The moral support is important among all.