Fracture Management for Primary Nursing Care - Assignment Example

Nursing By + CASE STUDY On assessment of the patient data in the case study of Mr. Ben Casey the actual health problems include fracture of the left femur and tibia due to trauma sustained in the motor vehicle accident. The surgery was aimed at fixating the fracture through the use of locking compression plates and screws (Ciocco 2014, pp. 123-29) . From the patient data it is evident that the patient has hemorrhagic anaemia due to loss of close to 2000 millilitres of blood due to the accident and also surgery. This is also evident from the recorded dropping blood pressure in the observation chart to a last recorded 110/75 millimetres of mercury. For this reason, the patient has been transfused packed red blood cells and commenced on normal saline and Hartmann’s solution to restore the lost volume of blood. In addition, the patient is experiencing moderate pain from the trauma of the tibia and femur. On the assessment made on assessing pain, level when the patient is at rest and with movement Ben Casey records a 4 on the scale. In order to alleviate this health condition and accord comfort to the patient the physician prescribed paracetamol tablets of 1-gram dosage to be taken 6 hourly to relieve pain. Among the identified potential health, problems according to assessment of Ben Caseys data include avascular necrosis. This will occur in areas beyond the fracture due to compromise of the internal blood supply to the bone tissue of the left tibia and femur (Ciocco 2014, p. 145). In addition, there is high potential for Ben Casey developing osteopenea of the left tibia and femur due to the disuse (Pudner 2010, pp. 204-16). This is possible due expected long period of immobilisation of the left leg together with diffuse reduction of bone density. Apart from disuse, this occurs also due to dysfunction of blood flow regulation and autonomic nervous system conduction to the site of the fracture. Apart from the local complications, other potential systemic complication due to the fracture of the femur, which is a long bone Ben Casey, is likely to develop fat embolism. Fat embolism occurs from release of fat from the injured site and into the blood stream that can be benign or get lodged in the tiny capillaries of the pulmonary, neurological, or coetaneous systems (Pudner 2010, pp. 193-99). In addition, other potential health problem includes development of infection at the surgical site due to the indwelling FG 14 bellovac drain at the femoral surgical. This is because the drain provides a communication between the linen on the outside and the body tissue, which provides a pathway for invasion by microorganisms. Regarding hemorrhagic anaemia, the corresponding signs and symptoms as observed in this case scenario include loss of close to 2000 millilitres of blood. Since an average person has approximately 5 to 6 litres of blood. Loss of close to 1000 or more millilitres of blood translates to loss of about 30% of the entire blood volume in the body. The corresponding signs and symptoms included hypotension with a recorded blood pressure of 110/75 millimetres of mercury at 0930 hours. In addition, Mr Ben Casey temperature was gradually dropping to a recorded 36.2 degree centigrade at 1445 hours indicating hypothermia. The patient also had a pronounced tachycardia with a recorded 90 beats/minute at 0830 hours that slightly resolved to 80 beats per minute at 1445 hours after intravenous infusion. Finally, the patient experienced remarkable tachypnoea of close to 25 breaths per minute at 0830 hours that resided slightly to 18 breaths per minute at 1445 hours after infusion. The corresponding signs and symptoms of the fracture as found in the case scenario include severe pain and bleeding due to distortion of the bone and surrounding tissues. The patient had a self-reported pain level of 9/10 on the left leg that was unbearable. Finally, there was swelling at and around the site of the fracture on the left leg as noted in the neuromuscular observation chart. In regards the pathophysiology of the signs and symptoms of haemorrhagic anaemia, the remarkable hypotension is due to a reduction in the circulating blood volume due to haemorrhage at the site of the fracture and surgery. The trauma causes rapture of blood vessels in the left leg causing haemorrhage (Hausman & Ignatavicius 2012, pp. 62-9). The tachycardia is due to the compensatory mechanism of the heart to meet the perfusion demands of the entire organ systems. With depleted blood volume, the heart has to pump more rapidly to circulate the limited volume of blood to meet the perfusion demands resulting in tachycardia (Hausman & Ignatavicius 2012, p. 183). The tachypnoea is due to the compensatory mechanism of the respiratory system to be able to meet the oxygenation demands of the rapidly pumped blood into the lungs. This results in the rapid breathing by the patient. The pathophysiology of hypothermia also is a consequence of the haemorrhage. The remaining blood volume is unable to effectively distribute the heat generated from areas with high metabolism activities such as the liver to the entire body especially extremities. This is also because of reduced metabolism activities of the cells due to reduced perfusion rates that avail the metabolites. Regarding the pathophysiology of the signs and symptoms of fractures, the severe pain is due to the disruption of the blood vessels in the bone marrow and the periosteum. This consequently causes severing of the nerve fibres that supply the bone causing immense pain (Winkelman, Ignatavicius & Workman 2013, p. 203). Bleeding occurs from the damaged terminals of the blood vessels supplying the bone marrow, periosteum, and the surrounding muscles. The swelling seen in the observation chart is an inflammatory response to the bones necrotic tissues and debris from the fracture site (Ciocco 2014, p. 125). This begins with the formation of a hematoma or clot at the fractured ends of the bone and necrosis of the ends that are no longer being perfuse therefore triggering the inflammation. Swelling is the visible sign of vasodilatation and accumulation of exudates containing inflammatory leukocytes and mast cells (LeMone & Burke 2008, p. 67). The visible distortion and limited mobility is due to the anatomical alteration of the left leg comprising of bone and macular displacement. Muscular and bone distortion at and around the site result in lack of adequate support of the leg resulting in limited mobility. The appropriate nursing interventions for hemorrhagic anaemia include regular monitoring of the patients blood pressure, pulse, and respirations. The rationale behind this intervention is that cardiopulmonary manifestations such as tachycardia and tachypnoea are usually experience by the patients as compensatory mechanism by the heart and lungs to supply adequate oxygen to tissues (Johnson 2008, p. 87). The intended outcome is to ensure blood pressure in within a range that delivers adequate perfusion to tissues. In addition, nurses should also assist or suggest to the patient to change positions slowly while at the same time monitoring for dizziness during activities. This intervention is important in reducing risk of injury from falls since postural hypotension causes dizziness or fainting that can cause the client to experience falls (Johnson 2008, p. 235). The intended outcome is patient safety during care. The appropriate nursing interventions for the fracture of the left tibia and femur include regular assessment of the type and location of the patients pain (Rodts 2011, pp. 183-89). The rationale is because pain causes clients discomfort during care and periodic assessment assists in gauging effectiveness of the analgesic therapy. In addition, uncontrolled pain is a sign of other neuromuscular complications. The intended outcome is that the patient describes and rates the pain on a 0- 10-pain scale. Patient expresses confidence in the analgesic therapy. It is also important for the nurse to handle the left leg gently and provide it with support using pillow. This is important in immobilisation and minimizes pain due to muscle spasms. The expected outcome is that the patient is comfortable, relaxed, and minimizes movement of the left leg. The above interventions have a potential of being highly effective in the management of Mr Ben Caseys case. This is because the interventions focus on the individualized needs of the patient and emphasizing of the holistic approach of care. The intended outcome of the interventions can be measured through assessing the patient physical and psychological status. For example, when the patient continuously moves with increasing level of comfort is an indicator of achievement of the outcomes. In addition, if the patient expresses satisfaction in the analgesic regimen by actions such as playing a role in his care by asking for analgesics indicates the effectiveness of the interventions (Rodts 2011, p. 287). In cases where the outcomes are not, reaching the plan would include more of interprofessional collaboration. For example, if the client expresses dissatisfaction in pain control medications, the prescribing doctor will increase or change the medication. In addition, continuous pain will warrant for imaging to rule out underlying pathology of the left leg such as avascular necrosis or osteomyelitis. LABORATORY SESSION Preparing to receiving a postoperative patient The preparation involved in order to receive a postoperative patient is important in tackling possible postoperative complications such as hemodynamic instability and collapse of the airway. The main goals of the postoperative care are to maintain cardiovascular stability and airway patency (Eiff, Hatch & Higgins 2012, p. 237). In the preparation of receiving a postoperative patient, the necessary equipments and supplies are assembled. The equipments assembled include drip stands, receivers, linen, emergency tray and postoperative charts. Any additional item or special consideration will be communicated to the receiving nurse at the unit (Knippa & Sommer 2011, pp. 331-37). A warm comfortable bed is made ready in the postoperative patients room. The receiving nurse alerts the doctor on duty about the expected patient coming from operation. On arrival of the patient, the receiving nurse gets the baseline data from the post-anaesthetic care unit (PACU) nurse. The receiving nurse reviews the postoperative orders, admits the patient to the prepared room, perform the initial assessment on the patient immediately, and execute the orders. Information from the PACU nurse The PACU nursing staff should provide information about the patients demographic data that is the name, age, sex, and next of kin (Eiff, Hatch & Higgins 2012, p. 346). In addition, the nurse should also give the baseline information highlighting the diagnosis, type of surgery done, the site of operation, unexpected preoperative occurrences, medications that are already administered to the patient and the postoperative orders. Assessments when receiving patient from PACU Assess the breathing patterns of the patients and if ordered administer supplemental oxygen to the patient. This is important in ensuring and maintains a patent airway thus preventing hypoxemia. Airway obstruction also causes hypoventilation (Phipps 2011, p. 45). The postoperative nurse should asses for the signs of cardiovascular shock by checking for pallor, cyanosis of the tongue and lips, cold extremities. In addition, take the vital signs of blood pressure pulse and respirations in order to ensure hemodynamic stability (Phipps 2011, p. 87). Move onto the surgical site and asses for any drainage and note its characteristics in terms of colour, amount, and consistency. This is important is detecting haemorrhage or gapping of the wound due to surgical strain and provide early interventions. Ensure that the input and output chart is establish and asses the urine output or the patients urge to void. This is important monitoring renal clearance of the operative drugs and establishing fluid balance in the body (Pudner 2010, p. 345). Asses the level of pain and its quality, location, the timing, aggravating factors, and relieving factors. Pain assessment is important in gauging the effectiveness of the analgesic therapy and exploring the relevant methods of according client comfort throughout the care. Postoperative complications The long periods of immobility, bed rest, and low cardiac output together with the pooling of blood in the extremities predispose the postoperative patients to deep venous thrombosis (LeMone & Burke 2008, p. 334). The postoperative nurse should watch out for calf pain or cramp that is solicited by dorsiflexion of the ankle. This is followed by tenderness and sweeping of the entire leg, causing fever and chills. Another potential complication is hematoma due to concealed bleeding (LeMone & Burke 2008, pp. 265-68). The nurse should watch out for bulging and delayed healing of the wound. In addition, wound sepsis is a life threatening complication of surgery. The postoperative nurse should look out for wound swelling, discharge, tenderness, and pain. Systemic manifestations of wound sepsis include elevated pulse and temperature. Finally, wound dehiscence and evisceration is a life threatening gapping of the wound and exposure of wound contents (Phipps 2011, p. 67). The postoperative nurse should without for postoperative vomiting and patients subjective statement stating, “the wound is giving way." Priority care within the first hour of admission The priority care will focus on establishment and monitoring of the pain management using the prescribed analgesics and maintaining a patent airway. Equal priority will be accorded to the circulatory system through monitoring of the vital signs of blood pressure, pulse, and intravenous infusion to ensure cardiovascular stability. Bibliography Ciocco, M. 2014, Fast Facts for the Medical- Surgical Nurse. New York: Springer Publishing Company. Eiff, M., Hatch, R. and Higgins, M. 2012, Fracture management for primary nursing care. Philadelphia: Saunders/Elsevier. Hausman, K., Ignatavicius, D. and Ignatavicius, D. 2012, Clinical companion for Medical- surgical nursing. Philadelphia: Saunders. Johnson, J. 2008, Handbook for Brunner & Suddarths textbook of medical-surgical nursing (11th ed.). Philadelphia: Lippincott Williams & Wilkins. Knippa, A. and Sommer, S. 2011, Registered nurse adult medical surgical nursing. [Sitwell, KS]: Assessment Technologies Institute. LeMone, P. and Burke, K. 2008, Clinical handbook for medical-surgical nursing. Upper Saddle River, N.J.: Pearson/Prentice-Hall. Phipps, W. 2011, Medical surgical nursing: Concepts and clinical practice (4th ed.). St. Louis: Mosby Year Book. Pudner, R. 2010, Medical surgical nursing of orthopedic patient. Edinburgh: BaillieÌ€re Tindall. Rodts, M. 2011,Orthopedic nursing . Philadelphia: Saunders. Winkelman, C., Ignatavicius, D., Workman, M. and Ignatavicius, D. 2013, Clinical companion, Ignatavicius Workman, Medical-surgical nursing. St. Louis, MO: Elsevier Saunders. Read More