Pathophysiology of Atypical Femoral Fractures - Case Study Example

Nursing (Case Study) Name: Course: Instructor: Institution: Date of Submission: Case Study: Peter Bowman is a 38 year old plumber who has just been brought to the emergency department by ambulance after a fall from his roof. An X-ray has revealed a fractured left femur and fractures to his left second and fourth ribs. He has no other significant injuries. INTRODUCTION The case study involves thoroughly reviewing the case of Peter Bowman, whose profession is a plumber and he is 38 years old. Peter fell from the roof while working and through an x-ray conducted, it revealed he had a left femur fracture, as well as other fractures to his second and fourth ribs. After the fall Peter did not encounter any loss of consciousness and no other significant injuries. The doctors gave a number of primary surveys, which include: A-patent B-Respiratory Rate 24 and shallow, bilateral chest expansion, equal air entry C-pale, not diaphoretic, left foot cool and pale D-alert and orientated to time place and person. Pain 7/10 left leg and 8/10 left side of chest E-swelling and bruising to left leg, razes to back, left elbow and forehead, 20 gauge intravenous cannula (IVC) insitu left cubital fossa, 18 gauge IVC insitu right hand. The observations made were as follows: HR 120, BP 100/60, and RR24, SpO290% on room air, temp 36.2, and Blood sugar 5.2mmol. Based on these assumptions, the emergency register conducted, the following orders were given: Insert indwelling urinary catheter (IDC) and record hourly urine measures, 0.9% sodium chloride 1L IV over 30 mins, oxygen to keep SpO2 above 96%, sit in high folwer's position and morphine 7.5mg IV STAT. The report evaluates every detail that was associated to the fall of peter through interpreting the assessments provided in relation to the nursing management views. UNDERLYING PATHOPHYSIOLGY Pathophysiology refers to the disordered function. That is; the derangement that is seen in disease through the alternation in the function of the structural distinguished defects. Thus, it is the process where the physiology of the disordered function is give. Basically, it refers to the functional changes that linked with the injury or a disease that occurred (Nieves, et al., 2010). Femur Fracture Pathophysiology The femur is considered the strongest and largest bone with a good supply of blood since it also has a protective adjoining muscle. Thus, to fracture the femur, the shaft would need a large amount of force. On the stipulation the force is strong enough to lead to the fracture, the displacement occurs (Compston, 2011). Thus, some of the common issues that the fractured femur leads to is the significant bleeding since the supply of blood is disrupted and potential infections. The diaphyseal fractures occur due to the force exerted at the knee. If the fall was not so significant, the pathologic fracture of the femur would have been week leading to a bone weakness (Romeo, 2015). When the fracture of the femur occurs, the patient cannot put on weight on the left leg, where the broken leg is highly deformed and appears shorter than other legs. The symptoms may include the skin having breaks and bruising, and a possible bony pieces. The bruising swelling of the leg and razes to the back, which shows that severe bleeding is possible due to femoral fractures. Thus, the bone fracture may lead to possible infections, which could be treated with the antibiotics or multiple surgeries. Thus, the femur fracture should be treated with minor surgeries through intermedullary nailing or screws and plates that will lead to the re-joining of the bone fragments (Henderson, Kuhl, Fitzpatrick, & Marsh, 2011). Rib Fracture Pathophysiology On the other hand, the fractures of the rib occur due to the trauma of the chest, and other pathological issues. The severity of the ribs depends on the quantity and number of the ribs affected. The complications of fractured ribs may include punctured aorta among other damages, which is mainly linked to the three first ribs. Rib fracture leads to serious damages on the ventilation processes. The role of the chest wall helps protect organs such as ribs, scapulae, sternum through enabling the normal respiration of the body. There is a possibility of inadequate pain control leading to breathing problems. The rib fractures also lead to muscle mechanism of the normal respiration (Lafferty, Anavian, Will, & Cole, 2011). The fracture of the rib, mainly the second and fourth rib as the fractures Peter experienced is linked to the injuries such as brachial plexus or other major vessels (Sheree & Madonna, 2012). The rib fracture of Peter was caused by the direct flow when he suddenly fell. The observation on peters case did not however specify the type of fractures that the ribs encountered. However, the administered morphine and oxygen would assist in managing the pain caused by the fracturing of the ribs. NURSING INTERVENTIONS The x-ray survey showed that the respiratory rate was at 24 and shallow, bilateral chest expansion, equal air entry. The survey may have been corrected due to the pressure that the abdominal cavity increasing as Peter fell. Thus, the diaphragmatic excursions of peter was limited leading to the low and shallow respiratory rate of 24. The client was pale, which was normal since after the fall and rib fractures, the client experienced respiratory problems leading to the paleness of the peters’ body. The client was not diaphoretic meaning he did not sweat profusely. The fracture on the femur led to the left foot been cool and pale. Peter felt pain on the left leg where the femur had occurred of about 7/10 while in the chest due to the rib fractures, the pain was about 8/10. The swelling and brusing of the left leg among other parts was managed through the 20 gauge IV cannula (IVC) insitu left cubital fossa for the left leg, while the 18 gauge IVC insitu was applied for the right hand. The reported observations show that the respiration rate was at 24, heart rate of Peter was at 120, with a blood pressure of 100/60. The SpO2 90% on room air, temp 36.2, Blood sugar 5.2mmol. The observations led to Peter been treated by been inserted with an indwelling urinary catheter (IDC), which was to be recorded on hourly urine measures. The insertion of the catheter was a good call since the patient would not have been able to urinate due to the accident. That is; Peter’s accident was serious based on the ribs and femur fractures experienced. The problem is not been able to urinate but standing up or sitting up to urinate (Saint, et al., 2006). However, to eliminate the possible infectious complications on Peter’s health mainly in the urinary tract, other alternatives would have been better applied. For instance, the external catheter should have been used. The catheter is perceived as a condom catheter, which contains the devices that is fitter over the genitalia and attached to the urinary drainage bag. Therefore, it appears that the insertion of the indwelling catheter was an extreme call though a good call (Saint, et al., 2006). The best choice would have been to use the external catheter or even a suprapubic catheter, which is inserted to the bladder surgically through the bladder. The external catheters in hospitals are underused, though they are the best solutions. The external catheter conveys a low risk of infection to the patient among other complications that the indwelling catheter conveys. The external catheter only requires the selection of the right size to ensure the catheter is comfortable to the patient and fits perfectly (Saint, et al., 2006). Additionally, 0.9% sodium chloride 1L IV over 30 mins was also administered. The sodium chloride is mainly used as a key source of water and electrolytes. The 0.9% will help induce duresis. Duresis is the process of increasing the urine production of a patient. Peter has not been suffering from any urine production issues, which is why the 0.9 sodium chloride administered level seems abnormal for the condition of Peter. However, on the other hand, the 0.9% sodium chloride when administered helps in the process of hemodialysis procedures. The process helps when the sodium chloride helps in the process of removing and transferring blood. However, the procedures require the dialysis machines. The machine has membranes that help in filtering waste products from the patient’s body. However, since through the doctor survey and administered solutions, there was not any application of the dialysis machine, which leads to the conclusion that administering the 0.9% of sodium chloride was an abnormal application in Peter’s case. More importantly, given the case of Peter, the use of 0.9 sodium chloride fluid may lead to the patient been dehydrated since it will increase urine product. On the stipulation that the sodium was a right call, the periodic monitoring after every 30 minutes was appropriate since it helps identify the balance of fluid in Peter’s body. Peter was also given in addition to the sodium chloride the administration of oxygen to keep Sp O2 above 96%. The given and measure Sp 02 of in room temperature was about Sp O2 90%. The normal SP 02 should be above 98%, which shows that with the 90% of Peter based on the accident was normal. The oxygen been administered would highly help in maintaining the SP 02 above 96%, which would be normal given the condition of Peter. When the Sp 02 drops below 94% it means that the problem is real. So given that the Sp 02 of Peter was at 90%, he needed external oxygen. However, based on room air, an Sp02 of 90% stipulates its normal. Thus, based on using the room air temperature, and given the fall of Peter, 90% is way normal, which is an abnormal reading. The patient was sat in high folwer's position and given morphine 7.5mg IV STAT. The folwers position is when the patient is placed in an upright position, which is mainly like a normal sitting position. The position is not effective due to the fractured ribs, but normal due to the breathing difficulty that the patient may experience among others. It is the normal position since it promotes oxygenation and will give Peter comfort during activities such as eating and improve the drainage of uterine. The survey presented that the pain level of the patient was about 7/10 on the left leg and 8/10 on the left side of chest. Thus, on the basis of a pain scale, 8 and 7 pain numbers presents that the impact of the pain is highly severe. The pain keeps the patient from been able to engage in any activities that they normally do, since the pain and accident leads to the reference of the patient as a temporary disabled patient since they cannot function normally independently (Bhatnagar, John, & Ram, 2015). The pain on the leg was 7/10 meaning the pain was very intense since the pain has dominated their senses, which may affect the thinking of the patient. On the other hand, the pain on the side of the chest was 8/10 meaning the injury and pain is utterly horrible. The pain is very intense, which may lead to the change of personality due to the severity of the pain. Thus, given this levels of pain, the administered morphine is 7.5mg IV STAT. This will help in reducing the pain to about a bearable/ tolerable pain, or at least mild or discomforting but bearable for peter. CONCLUSION Patient receive care depending on the severity of the injury or the number of injuries. For instance, Peter’s accident led to multiple and fatal injuries such as the femur and ribs fractures. Both the femur and rib fractures are treated differently based on the fracture pathophysiology and needed nursing intervention to ensure pain is managed effectively and the fractures treated accordingly. It is important that each case is treated differently to ensure the primary survey and interventions used to treat the fractures are appropriate for the patient. It is possible to provide some treatments that are over-exaggerated for the situation, but most importantly, the solutions provided help in treating the fractures or other injuries as required. With each condition, it is important to understand the underlying pathophysiology and nursing interventions that help treat the condition effectively. Pain management is important for individuals who have femur and rib fractures for effective breathing among other issues. REFERENCES Bhatnagar, A., John, M., & Ram, N. (2015). Rib fracture fixation for flail chest: what is the benefit? Journal of the American College of Surgeons, 201 - 205. Compston, J. (2011). Pathophysiology of atypical femoral fractures and osteonecrosis of the jaw. Osteoporosis international , 2951-2961. Henderson, C. E., Kuhl, L. L., Fitzpatrick, D. C., & Marsh, J. L. (2011). Locking plates for distal femur fractures: is there a problem with fracture healing? Journal of orthopaedic trauma, 8-14. Lafferty, P. M., Anavian, J., Will, R. E., & Cole, P. A. (2011). Operative treatment of chest wall injuries: indications, technique, and outcomes. J Bone Joint Surg Am,, 97 - 110. Nieves, J. W., Bilezikian, J. P., Lane, J. M., Einhorn, T. A., Wang, Y., Steinbuch, M., & Cosman, F. (2010). Fragility fractures of the hip and femur: incidence and patient characteristics. Osteoporosis international, 399-408. Romeo, M. N. (2015). Femur Injuries and Fractures Treatment & Management. Medscape, 1-2. Saint, S., Kaufman, S. R., Rogers, M. A., Baker, P. D., Ossenkop, K., & Lipsky, B. A. (2006). Condom versus indwelling urinary catheters: a randomized trial. Journal of the Aemrican Geriatrics Society, 1055 -61. Sheree, B., & Madonna, W. (2012). Patients With Rib Fractures: Use of Incentive Spirometry Volumes to Guide Care. Journal of Trauma Nursing, 89 - 91. Read More