Peter Bowman (38) is a plumber. He was just brought to the Emergency Department after falling from his roof.
An Xray revealed a fractured left femur as well as fractures of his left second and fourth ribs.
He has not sustained any other serious injuries.
He was not injured on his head and he did not lose consciousness.
Below are his assessment data
B – RRR 24 and shallow, bilateral, chest expansion, equal Air Entry
C – pale, but not diaphoretic, left feet cool and pale
D – alert and orientated towards time, place, and person.
Pain 7/10 left leg, 8/10 left side.
E – swelling of the left leg and bruising, grazes to the back, left elbow, forehead, 20 gauge intravenous (IVC) insitu left Cubital Fossa, 18 Gauge IVC insitu to right hand.
Peter has been assessed by the emergency registrar and given the following orders.
The assessment task will require you to prepare a report that discusses your interpretation of Peter’s assessment results and your subsequent nursing management.
The following sections should be included in your paper:
The Underlying Pathophysiology
Registered nurses must be aware of the abnormalities in normal physiology which can lead to the abnormal assessments we see in the clinical setting.
This scenario contains a number abnormal assessment findings.
This section will require you to:
Explain the underlying pathophysiology and causes of Peter’s injuries, including fractured bones and fractured cartilages.
A number of orders and nursing interventions are part of the clinical scenario.
These interventions must be prioritized to ensure safety and the best possible clinical outcomes for Peter.
Registered nurses need to be able to explain how the interventions they provide relate to the patient’s underlying condition.
This section requires that you:
Prioritize orders that are urgently needed in clinical terms
Give a reason for each intervention in the case study.
Each rationale should contain an explanation as to why you selected the intervention order. Also, a description of how the intervention will improve Peter’s condition based upon the underlying pathophysiology that you have discussed.
Both sections must be supported by at LEAST 10 new (less that 6 years old) credible sources.
The following are credible sources
Ppeer reviewed journal articles are high quality sources.
Guidelines for the best
Guidelines, procedures and policies for the health facility
This paper is academic writing. It should follow academic writing conventions.
Sub-headings may be used, but tables and point form should not.
This report is a clinical discussion on the case of Peter Bowman.
This report contains the following: pathophysiology of the fractures, order of nursing intervention and the reasoning behind the nursing intervention.
The report will aid in interpretation of abnormal observation, findings and objective and subjective assessment of patient condition.
Peter Bowman (38) is a man of thirty-eight years.
His occupation is plumbing.
After falling off his roof, he was taken to the Emergency Department using an ambulance.
His X-Ray showed a fractured left femur as well as fractures of his left second and fourth ribs.
He denied any loss of consciousness and said he did not hit his head.
Pathophysiology can be defined as any disease, injury, or illness that causes a disruption in the function and structure of an organ.
It is a combination physiology, pathology, and physiology.
Pathology, a medical branch that describes the conditions of an illness, and physiology, a biology discipline that refers to the mechanism of an organism’s functioning (McGurk 2012).
After falling from the roof, the patient was taken to the Emergency Department. He suffered fractured ribs and a fractured foot.
Because he fell from the roof, he was stressing his left side. The direct and sudden force caused his ribs to fracture and the femur bone to his left.
Also, he had grazes (breaking the surface of skin) to his forehead, left elbow, and back. These imply that the patient fell some distance after landing on the ground.
There was skin discoloration on the patient’s body that did not show any signs of injury, and bruises.
Bone fractures can occur due to a lot of stress or physical injury.
Justification behind patient’s symptoms
The patient complained of pain in his left leg, edema, and swelling.
In this instance, the patient’s left-leg pain and swelling was due to inflammation and a break or discontinuity in the periosteum/endosteum.
Due to a disruption in the normal physiology, femur tissue and muscles, there is edema and muscle spasms around the injury site.
Aside from bilateral chest pain, he has poor breathing due to high respiratory rate and shallow breathing.
The femur is considered the strongest, longest and most important bone in the human body. It is also crucial for proper ambulatory mobility.
The femur can sustain three types of fractures: spiral/transverse (Liu (2015)), committed (Liu (2015)), and open (Liu (2016).
The femoral bones are a tube type, with the cardinal bow. It runs from the lower trochanter up to the flexure in the femur conedyles.
During ambulation, the femur can be subject to various forces such as bending, weight bearing, and torsional forces.
These tissues could cause an abduction malformation at the proximal end of the Femoral shaft and subtrochanteric Femoral fractures.
The iliopsoas connects to the lower trochanter, causing flexion damage in the same area.
Distally, distal to the medial portion, the big addition muscle binds with the medial, causing deformity at the apex.
Femur is made up of vascular supply tissue that receives blood from the profunda fimoral artery. It regulates the flow of nutrients and blood throughout the body (Fawthrop (2015)).
The healing of a fracture is dependent on the functioning of the periosteal circulatory system.
In this case study, the patient reported left leg pain that was intense 7/10. This is due to a defect in the structure or musculature his femur.
Because the patient’s leg appears shorter than the other, he is unable to lift weights.
A second reason is the bruising and pushing of bony bits into the skin. This causes discomfort, pain, and ambulatory issues (Fawthrop (2015)).
The patient suffered a fracture to his femur, which caused a disruption in the normal flow of blood and nutrients and further disrupted the healing process.
Fracture of the femur indicates the possibility of blood leaking into the thigh.
These symptoms led to pain while walking due to weakening of the patient’s thigh bone.
Leg swelling was caused by inflammation of trauma site cells.
Fractured Ribs are ribs that protect organs and structures beneath.
The bony structure in the forelimb guards the three upper ribs.
Clavicle, scapula, or humerus act as barriers to rib injuries.
Fracture of the scapula or sternum, or first, second, rib, indicates serious risk to the vessels of your neck, spinal cord, neck and lungs.
These fractures occur as a result of an injury or direct force (Sobak, 2014).
Rib fractures are most common after blunt chest injuries. They account for the majority (non-penetrating) of thoracic injuries.
The high index of vessel injury associated with the fractures of the first and second ribs (Brown, Walters, 2012).
It causes pain while in motion and can impair oxygenation, ventilation, effective coughing, and oxygenation.
This patient experienced left side chest pain from injuries to his internal blood vessels resulting in second and fourth fractures of his ribs.
On average, he lost about 100 ml blood per rib.
The blunt trauma is most severe to the middle ribs, from the fourth to the ninth. This tends to push the spine towards the thorax, increasing the chance of hemothorax.
Paradoxical motion occurs when the normal movements in the chest are reversed. This can cause an increase in work and increased pain during breathing.
Peter complains about pain in the left side of his chest (Le, 2015).
Patients with lower oxygen stats (i.e.
Hypoventilation (normally 94%-99%, 99%) causes 90% of the patient’s abnormal O2 stats. This is caused by multiple broken ribs.
A broken rib can compromise ventilation through various mechanisms. Additionally, pain from rib fractures could lead to atelectasis and respiratory splinting.
Multiple rib fractures are also known as flail-chest. They disrupt normal diaphragmatic, costovertebral and muscle excursion, which can lead to insufficient ventilation.
Pneumothorax, and hemothorax are caused by trauma such as falling. The entry of air from the outside into the pleural cavities of the chest cavity causes the injury.
Tenseness pneumothorax can cause difficulty in breathing, labored breathing (shallow), and elevated pressure in the jugular vessels. This is also why the heart makes muffled or muffled sounds.
It also causes a drop in oxygen saturation.
Tension pneumothorax results from a puncture in a lung caused by fractured ribs.
Due to rib fractures and the shift in the mediastinum/trachea to the unaffected, elevated pressure, shallow and weak respiratory symptoms can occur.
In order to cope with the reduced tidal volumes, the patient has a high respiratory rate.
The rapid rate of respiration (RR 12-20 per min) can be explained by blood clots in lungs, stress or anxiety attacks secondary rib fracture and fracture of the femur.
Peter’s normal heart beat was 60-100 beats per min. Peter’s heart rate was 120. It is faster due to hypertension, imbalanced vasoconstriction/vasodilation and circulation of markers for inflammation.
The left foot is cold, non-diaphoretic, pale due to disruption in blood vessels.
Prioritizing Nursing Interventions
Nursing intervention can be described as the treatment and care given to a patient to heal from a medical condition or injury. These were prescribed for the patient.
The patient was brought to the ED immediately so that the appropriate treatment could be provided. Any delay can cause further complications.
A chest Xray was taken to rule out any potential intrathoracic injuries.
A nursing care plan will be developed or followed by nurses according to the symptoms and problems of the patient.
Care for patients involves the evaluation of vital signs, such as blood pressure and respiration rate, heart beat, blood Oxygen saturation, temperature, and heart rate.
They help to determine the best treatment protocol for the patient and take the appropriate life-saving measures.
It is used to reduce the complexity of clinical problems (vital measurements, 2016).
The goal of this primary survey is to treat trauma patients (Duch & Moller 2015).
These are the actions that were ordered by the doctor following primary survey. For pain management, the patient received morphine IV STAT 7.5 mg.
To normalize the O2 saturation, oxygen therapy was administered to the patient.
Over 30 minutes, 0.9% sodium chloride IL IV was administered to the patient.
After that, the patient received 0.9% Sodium Chloride IL IV for 30 minutes. The patient was then inserted with intravenous catheters (IDC) to measure hourly urine.
For early mobilization, the patient was finally placed in a high fowler position.
Pain Management: The patient needs to be relieved from pain in order to allow adequate ventilation.
The patient received 7.5mg of IV Morphine to treat his pain.
It is also called opioid (narcotics analgesics).
It works by altering the brain’s reaction to pain receptors. (Wight, King, 2014).
Oxygen therapy – Provide Oxygen therapy to maintain oxygen levels at 96% and 99%.
Low O2 stats will affect the function and health of your body cells.
In order to maintain proper cell functioning, oxygen is given to the patient. Regular assessment of vital signs takes place at regular intervals.
Electrolyte balance. Next, the patient received a litter IV fluids that was to be used to treat his or her isotonic dehydration (extracellular).
Interiano, 2012: Intravenous fluids provide the fastest way for body electrolytes to be restored. It is directly administered into the veins.
Insertion a IDC (Indwelling Urological Catheter): This device is used for evaluating the urological conditions, including the patient’s level of urine output and any abnormalities due to medication or injury (Lim, & Sirichai, 2016).
Sitting in high fowler’s position: Fowler’s position refers to the position where the patient’s head is elevated at 30, 45 and 90 degrees. These positions are broken down into low, standard, semi-high, high, and semi-high.
This is where the patient’s body is at 60-90 degrees angle.
In this position, the patient’s legs can be bent or straightened.
It can be used to feed the patient, do radiology, grooming, and when the patient has breathing problems.
This intervention is designed to maintain normal circulation, avoid nerve damage and constriction, and prevent pressure on the chest cavity.
It assists the patient with proper chest expansion and oxygenation (Ellis 2013).
Linking Nursing Interventions to Pathophysiology
For proper treatment and recovery, it is essential to connect interventions and pathophysiology.
It helps you to determine the extent of any unknown injury.
To monitor disappearance symptoms, it is important to have vital signs evaluated on a regular basis (Lim, and Sirichai (2016).
O2 therapy was administered to the patient in order to heal the fracture and increase the oxygen saturation to 96%. This was because the patient examination showed that the rib fracture had caused low O2 stats.
The pain in the patient’s ribs made it difficult for him to breathe properly. This could be treated with oxygen therapy which will help to restore oxygen levels.
For the treatment of the second and fourth rib fractures, it is important to place the patient in the high fowler’s chair.
It can help the patient recover from any vessel or intrathoracic injury.
Hematoma or pneumothorax can be treated.
To ease his pain in the left leg and chest, the patient was given 7.5mg of IV Morphine to help. It alters the brain cell receptor response to pain.
Because the femur (the strongest bone) supports the body in ambulatory motion, and anxiety relief (Shah (2015)).
After multiple trauma fractures, the patient developed internal vascular damage. This led to electrolyte deficiency in his body.
The electrolytic imbalance can be attributed to the destruction of blood vessels and capillaries.
It is possible to restore electrolytic balance and support proper blood circulation.
An Indwelling catheter was placed in the patient to aid in diagnosing urological problems such as incontinence.
It’s to detect any potential urinary malfunction due to femur injuries and associated injuries (Ellis 2013).
This discussion report on clinical representation helped to learn about the clinical nursing guidelines for treating trauma (ED fracture) patients.
After Peter Bowman suffered a left-femur fracture, second and fourth rib fractures from a fall, he was brought to the emergency room. Nurse assisted him in this report.
This report highlights the importance of understanding the pathophysiology of fractures, disease or injury to nurse in order to prepare a rational and effective nursing care plan for patient’s convalescence.
The nurse should be able identify the appropriate abnormal assessment and prioritize the care plans.
The nurse must understand the reasons and linkage of patient care with patient symptoms.
It provides guidelines and nursing management to help patients with multiple fractures.
Interventions in nursing that are friendly to older people in emergency rooms.
Nursing & Health Sciences. 14(2): 272-274.
Falls: Epidemiology, pathophysiology and relationship to fracture.
Current Osteoporosis Reports (6(4)), 149-154.
Patients with Rib Fractures.
An evaluation of randomised controlled trials that evaluated epidural analgesia in trauma rib fracture patients.
Nursing Management, 20(1) 9-9.
Essential Pathophysiology to Nursing and Health Students Richards Ann Edwards Sharon and Critical Pathophysiology to Nursing and Health Students489pp PS19.99 McGraw Hill Education.
Nursing Standard, 30, 11: 28-28.
For traumatic rib pain, elastomeric Infusion Pumps are used.
2091535 Ultrasound In Revelation Chondral Rhino Rib Fracture At an Outpatient Clinic With No Evidence of Rib Lesion on Chest Xray Film.
Ultrasound in Medicine and Biology, 41(4): S164.
Assessment and management for bone fractures.
Analysis on the Reasons for Post-Operative Dysfunction in Patients with Lower Limb Fracture.
Journal Of Nursing, 3(3), 10.
Understanding Pathophysiology-Fifth editionUnderstanding Pathophysiology-Fifth edition.
Nursing Standard 26(49), 30-30.
Management of multiple fractures of the ribs: to intubate, or not?
Nursing process of healthcare for patients with rib injuries.
A ruptured intravenous needle.
Traumatic First Rib Fractures.
Journal Of Academic Emergency Medicine 11(1), 27-30.
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