Question

pls i need more detailed information based on this case scenario.

This assignment examines the care needed for an Orthopedic patient in your care. Your patient has been admitted to your floor and is testing your knowledge of his condition. As in previous assignments, you will have a week to complete the requirements. You will need to write a discussion of the pathology behind your patient's diagnosis. Be sure to include complications and treatments necessary to bring your patient back to a healthy state. Also, include the top five Care Plans for this patient Your information should be complete and exact. How and what would you want to be taken care of if you were in the same situation? The Scenario - A 30 year old man has been admitted to your unit. The history you were given upon arrival was about his involvement in a MVA. The car he was riding in hit along the passenger side and he was trapped in the car for two hours. Rescue was able to free him using the "Jaws of Life" device. He experienced a mild loss of consciousness going between periods of fully alert and oriented x3 to periods of decreased levels of alertness. At these times, he was difficult to arouse by the first responders. Upon arrival to the ED, x-rays show fractures to his right leg and pelvis. The tib-fib fracture was an open fracture. The femur fracture was closed but spiral in nature. The pelvis fracture is in the area of the pubic crest and bone. Your patient has been to surgery and had his leg fractures repaired. He continues to come out of anesthesia with periods of wakefulness and sleep. When awake, he is oriented x3 and able to follow commands Vital signs are stable at T 97.6, P 78, R 20, and BP 130/72. Lungs clear to all fields, 02 present at 21/min, Respirations even and unlabored. Heart R.R,R, mild edema to right leg S/P surgical procedure, cap refill good to lower extremities, good sensation noted when patient is awake. Abdomen soft, flat, BS+x4 quads, Foley catheter in place draining clear, golden urine with streaks of blood noted. D5NS running at 125cc/hr. to left arm, 20g in place with redness or edema. External fixators noted to right lower leg, sites clear, no redness noted, no drainage noted, leg elevated on two pillows, dressing noted to upper right leg, lateral aspect, dry and intact, minimal drainage noted DI 8

Answer 1

# Diagnosis of the patient is Fracture . Fracture of the pelvis ,femur ,tibia and fibula due to motor vehicle accident .

# Fracture:-

-a break in the integrity of a bone

-occur because of trauma, neoplasms, or increased stress on bones, sudden twisting motion , extreme muscle contraction . When the bone is broken , adjacent structures are also affected , resulting in soft tissue edema , hemorrhage into the muscles and joints ,joint dislocations , ruptured tendons ,severe nerves ,and damaged blood vessels . Body organs may be injured by the force that caused the fracture or by the fracture fragments .

# Types of fracture :-

- Complete

- Incomplete

- Comminuted

- Closed

- Open

#. Complications of fracture are :-

Early complications :

- shock

- fat embolism

- compartment syndrome

- venous thromboembolism

- pulmonary embolism

Delayed complications :

- delayed union

- malunion

- nonunion

- avascular necrosis of bone

- reaction to internal fixation

- complex regional pain syndrome

- heterotopic ossification

# . Treatment include :-

- Setting the bone

If you have a displaced fracture, your doctor may need to manipulate the pieces back into their proper positions — a process called reduction. Depending on the amount of pain and swelling you have, you may need a muscle relaxant, a sedative or even a general anesthetic before this procedure.

- Immobilization

Restricting movement of a broken bone is critical to healing. To do this, you may need to wear a splint, sling, brace or cast. If your broken bone requires a cast, your doctor will likely wait until the swelling goes down, usually five to seven days after injury. In the meantime, you'll likely wear a splint. Your doctor may ask you to return for more X-rays during the healing process to make sure the bones haven't shifted.

- Medications

To reduce pain and inflammation, your doctor may recommend an over-the-counter pain reliever. If you're experiencing severe pain, you may need to take a prescription medication that contains a narcotic for a few days.

- Therapy

Rehabilitation begins soon after initial treatment. In most cases, it's important, if possible, to begin some motion to minimize stiffness while you're wearing your cast or sling. After your cast or sling is removed, your doctor may recommend additional rehabilitation exercises or physical therapy to restore muscle strength, joint motion and flexibility.

- Surgery

Surgery is required to stabilize some fractures. If the fracture didn't break the skin, your doctor may wait to conduct surgery until the swelling has decreased. Keeping your injury from moving and elevating it will decrease swelling. Fixation devices — such as wires, plates, nails or screws — may be needed to maintain proper position of your bones during healing. Complications are rare but can include infection and lack of bone healing.

#. Nursing care plan:

Nursing Assessment

Assessment of the fractured area includes the following:

Close fracture. The patient with close fracture is assessed for absence of opening in the skin at the fracture .

The fractured site is assessed for signs and symptoms of infection.

# Diagnosis

Based on the assessment data gathered, the nursing diagnoses developed include:

Acute pain related to fracture, soft tissue injury, and muscle spasm.

Impaired physical mobility related to fracture.

Risk for infection related to opening in the skin in an open fracture.

Risk for Trauma: Falls

Risk for Peripheral Neurovascular Dysfunction

Risk for Impaired Gas Exchange

Impaired Skin Integrity

Deficient Knowledge

# Planning and goals developed for a patient with fracture are:

Relief of pain.

Achieve a pain-free, functional, and stable body part.

Maintain asepsis.

Maintain vital signs within normal range.

Exhibit no evidence of complications.

# Nursing Management

1. Prevent infection

Cover any breaks in the skin with clean or sterile dressing.

2. Provide care during client transfer.

Immobilize a fractured extremity with splint in the position of the deformity before moving the client; avoid strengthening the injured body part if a joint is involved.

Support the affected body part above and below fracture site when moving the client.

3. Provide client and family teaching.

Explain prescribed activity restrictions and necessary lifestyle modification because of impaired mobility.

Teach the proper use of assistive devices, as indicated.

4. Administer prescribed medications, which may include opioid or nonopioid analgesics and prophylactic antibiotics for an open fracture.

5. Prevent and manage potential complications.

- Observe for symptoms of life-threatening fat embolus, which may include personality change, restlessness, dyspnea, crackles, white sputum, and petechaie over the chest and buccal membranes. Assist with respiratory support, which must be instituted early.

- Observe for symptoms of compartment syndrome, which include deep, unrelenting pain; hard edematous muscle; and decreased tissue perfusion with impaired neurovascular assessment findings.

- Monitor closely for signs and symptoms of other complications.

6. Patient education regarding different factors that affect fracture healing

7. Factors that enhance fracture healing

- Immobilization of fracture fragments

- Maximum bone fragment contact

- Sufficient blood supply

- Proper nutrition

- Exercise: weight bearing for long bones

- Hormones: growth hormone, thyroid, calcitonin, vitamin D, anabolic steroids

8. Factors that inhibit fracture healing

Extensive local trauma

Bone loss

Inadequate immobilization

Space or tissue between bone fragments

Infection

Local malignancy

Metabolic bone disease (Paget’s disease)

Irradiated bone (radiation necrosis)

Avascular necrosis

Intra-articular fracture (synovial fluid contains fibrolysins, which lyse the initial clot and retard clot formation)

Age (elderly persons heal more slowly)

Corticosteroids (inhibit the repair rate)