Question

Module 06 Assignment – Designing a Care Map

Purpose of Assignment

Assist students to develop a care plan that includes safe discharge information for a client with musculoskeletal trauma.

Course Competency

• Explain components of multidimensional nursing care for clients with musculoskeletal disorders.

Instructions

Mr. Harry Roost is a 78-year old male being discharge after a fracture of his right tibia and fibula. He has a long leg cast that he will need to wear for the next 8 weeks. The nurses have observed him using a hanger to scratch the skin under the cast. The nurse have reminded him each time that he is not to put anything down his cast. He also sits on the side of the bed for long periods with his leg in a dependent position. He also gets up to go to the bathroom without calling for help. The staff have observed him hopping to the bathroom without using his crutches.

Develop a care map for Mr. Roost using the template directly after these instructions. Include information important for his discharge home. For this assignment, you will need to include three nursing diagnoses, outcomes, and nursing interventions with rationale.

Answer 1

Nursing Assessment :-

Assess the following before and after cast application:

Evaluate the client’s pain, noting severity, nature, exact location, source and alleviating and exacerbating factors.

Access neurovascular status.

Inspect for and document any skin lesions, discoloration, or no removable foreign material.

Evaluate the client’s ability to learn essential procedures, such as applying slings correctly, crutch walking, or using a walker.

#. Nursing Diagnosis:-

Impaired physical mobility related to the cast

Impaired skin integrity related to lacerations and abrasions

Risk for peripheral neurovascular dysfunction and related to physiologic responses to injury and compression effect of cast

Nursing Management :-

Support an exposed cast, with the palms of your hands to prevent indentations.

Ensure that the stockinet is pulled over rough edges of the cast.

Elevate the casted extremity above the level of the heart.

Provide covering and warmth to uncasted areas.

Expose the fresh plaster cast to circulating air, uncovered, until dry (24 to 72 hours). Expose the fresh synthetic cast until it is completely set (about 20 minutes).

Instruct the client to avoid wetting the cast. Instruct him to dry a synthetic cast with a hair dryer on cool setting if it gets wet.

Initiate pain relief measure if indicated.

Encourage position changes.

Elevate the affected body part.

Provide analgesics as appropriate.

Promote nonpharmacologic pain relief measures, such as guided imagery, relaxation and distraction.

Observe for signs and symptoms of cast syndrome with clients who are immobilized in large casts, such as a body or hip spica cast.

Report abdominal pain and distention, nausea and vomiting, elevated blood pressure, tachycardia, and tachypnea which are physiologic effects of cast syndrome.

Any client who is claustrophobic is at risk for psychological cast syndrome, which includes acute anxiety and possible irrational behavior.

Provide nursing care for compartment syndrome, if indicated. Observe for signs and symptoms and discuss and assist with treatments.

Notify the health care provider immediately if signs or symptoms of other neurovascular complications occur.

Notify the health care provider if “hot spots” occur along the cast; they may indicate infection under cast.

Provide client and family teaching.

Encourage isometric exercises to strengthen muscles covered by the cast. Promote muscle-strengthening exercises for the upper body if crutches are to be used.

Advise the client to promptly report cast breaks and signs and symptoms of complications (i.e. circulatory compromise, cast syndrome, and hot spots).

Warn the client against inserting sharp objects (e.g. coat hanger to scratch itchy skin under the cast). Instruct him to use a cool air from a dryer to help alleviate the itch.

Teach the client appropriate cast care, depending on the type of cast.

Encourage safety precautions (e.g. avoid walking on wet floors, watch throw rugs, be careful with stairs).

Teach the client skin care and muscle-strengthening exercises for the affected body part after cast removal.

Encourage mobility and active participation in self-care.

Reinforce health care provider instructions on the amount of eight bearing allowed.