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Case Study, Chapter 42, Management of Patients With Musculoskeletal Trauma

A 14-year-old girl fell while hiking and injured her right arm, causing obvious deformity. At the emergency room, the nurse assessed for injuries and provided pain relief. The fracture was then reduced and immobilized in a cast. The nurse instructed the patient and mother on post-care, including immobilization, rest, medication, follow-up, and potential complications. A 42-year-old man was admitted after a left below-knee amputation for a work injury. He had drains and a removable rigid dressing placed over the wound. The nurse monitored vitals and the dressing, instructing the patient on self-care and rehabilitation to promote independence.

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309 views

Case Study, Chapter 42, Management of Patients With Musculoskeletal Trauma

A 14-year-old girl fell while hiking and injured her right arm, causing obvious deformity. At the emergency room, the nurse assessed for injuries and provided pain relief. The fracture was then reduced and immobilized in a cast. The nurse instructed the patient and mother on post-care, including immobilization, rest, medication, follow-up, and potential complications. A 42-year-old man was admitted after a left below-knee amputation for a work injury. He had drains and a removable rigid dressing placed over the wound. The nurse monitored vitals and the dressing, instructing the patient on self-care and rehabilitation to promote independence.

Uploaded by

Ahmad Baolayyan
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as DOCX, PDF, TXT or read online on Scribd
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Case Study, Chapter 42, Management of Patients With

Musculoskeletal Trauma

1. Melinda Woods, a 14-year-old girl, was on a hiking trip with her


family. Melinda slipped on a wet rock and fell on her right arm. She
immediately began crying with pain. The skin is intact, but there is
an obvious deformity to the right lower arm. Her mother quickly
transports her to the emergency room of the local hospital. (Learning
Objective 3)

a. What are the initial actions of the nurse?

nurse should assess for pain ,swelling , presence of parasthesia ,paralysis


and fracture .

 Advice the mother to immobilized the arm.


 Provide ice packs to limit swelling and relieve pain.
 Provide analgesics to limit the pain.
 Support the arm with cast .
 Check for internal bleeding .
 Check the vital signs .

b. The fracture is reduced and immobilized by a cast. What


discharge instructions will the nurse provide to the patient?

 Advice for immobilization of part .


 Advice to elevate the arm .
 Advice to take long rest.
 Advice to take medication as prescribed by doctor.
 Advice for follow-up .
 Educate the mother about complications of fracture .
 Educate the mother about compartment syndrome .
 Educate the mother for excercise to maintain health of
unaffected muscles for using assistive devices.
 Patient teaching includes self care ,medication information
,monitoring for potential complications and the need for
continuing health care supervision.
 Advice do not wet the cast ,it causes rashes, itching and
infection at affected area .

2. Alan Dean, a 42-year-old patient, is admitted to the medical-


surgical unit after a left below-knee amputation (BKA) for a
traumatic injury at an industrial job. The patient has two Jackson--
Pratt drains, and a removable rigid dressing was placed over the soft
dressing after surgery. There is a large tourniquet at the bedside.
There are also ace wraps and bandaging supplies at the bedside.
(Learning Objectives 8 and 9)

a. What is the rationale for the removable rigid dressing, and


what is the role of the nurse when caring for the patient with
this type of dressing?

The removable rigid dressing is placed over the soft dressing to control
swelling, to prevent joint flexion contracture, to help shape the
residual limb, and to protect the limb from trauma when transferring
the patient. The nurse will assess the patient's vital signs, JP drains,
and the femoral pulse of the left leg and compare the pulse to the
right leg. The nurse will assess the wound in several days when the
surgeon removes the removable rigid dressing, and the surgeon will
replace the dressing if there are no complications noted.

b. On what areas should nursing care for the patient in this case
study focus?

• Monitor and provide interventions to maintain adequate tissue


perfusion to the residual limb.
• Monitor fluid and electrolyte balance and provide ordered
interventions to correct imbalances.
• Achieve adequate pain relief as reported by the patient.
• Provide strict sterile asepsis when caring for the wound, and report
abnormal findings immediately.
• Encourage patient to vent feelings about the change in body image,
and encourage the patient to look at, touch, and participate in the care
of the limb.
• Encourage patient to vent feelings, and provide additional counseling
via consults as needed to help resolve grief successfully.
• Instruct and promote achievement of independence in self-care.
• Reinforce rehabilitation to achieve physical mobility using prosthesis.

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