Managing Mark's Fracture- Nursing Case Study Assessment Answer

Nursing Case Study Assignment

Assignment Task

Mark Mason is a 24 year old male who fell off his motorbike whilst riding in the bush. A riding mate witnessed the fall and called an ambulance to transport Mark to hospital. On arrival he complained of pain rated 9/10 in his lower left leg, which had an obvious deformity, significant swelling and a 5cm lacerated wound. Mark had no other medical problems.

An x-ray confirmed the diagnosis of an open fracture of the left tibia and fibula. After review by the orthopaedic team, it was arranged for Mark to undergo surgery for open reduction and internal fixation (ORIF) of the fracture. The repair of the fracture would involve the insertion of a metal rod and screws (GK nail). You are looking after Mark on the ward pre-operatively. His left leg is in a split cast; and his current vital signs are: T-36.4oC, HR-80bpm, RR-18pm, BP-136/72mmHg, O2-95% RA, and pain score 10/10 on movement. Assume nothing, if data is not stated, you should state that it is not known or information has not been provided, and advise what actions you would take.

Introduction

Introduction

Burzotta & Noble, (2011) said that the aim of every nurse or any nursing management is to ensure that a patient regains full independence of his/her own. Nursing management must transform the temporary dependence condition of a patient to self-sustenance condition. As a result, every nurse must be committed to his task to ensure that the patients receive the best medical attention. From McCrae’s (2012) perspective, they have to use effective evidence-based strategy to ensure that the patient recovers his normal functions. There are some complications that might arise along the way such as differential diagnosis that might cause many problems. Therefore, it is the responsibility of every member of the team to carry out effective diagnosis through skin examination to determine the extent of the fracture and to determine what they have to do. Thus, this paper is going to look at a case situation of Mark who fell from a motor bike and wounded the lower part of his left limb. He was taken to the hospital, and when diagnosed, the doctor said that he needed to undergo an operation. However, before the operation; the nurse together with the interdisciplinary team has to work effectively through team work to assess the condition keenly to help Mark undergo a safe and successful operation. The team has to apply a nursing model called Roper-Logan-Tierney framework to ensure that an effective assessment with the right procedures have been used to enable Mark’s left limb to recover its functions.

Background of the Condition

Mark was rushed to the hospital while his limb was seriously bleeding as a result of the fracture developed from the accident. The fracture was quite long, about 5cm long and was on the lower part of the lower left limb. The first aid diagnosis that was conducted first revealed that the soft tissues had been injured making Mark lose a lot of blood. The doctor said that it was a type III open fracture from a skin examination conducted. The non-operative procedures could not apply in the situation of this wound because the intra-articular structure has been displaced. As a result, Mark has to undergo an operation to restore the condition of the limb or else it might be worse to an extent of cutting his left leg.

There are several potential risks at the wound should the nurses and the interdisciplinary team decide to perform an extended immobilisation to the wound. One of them is growth arrest which might affect Mark in future in such a way that he might never walk again as he does. Mark’s body poorly reacts to extended immobilisations since his mal-unions failed to respond to non-operative treatment. Poor nursing assessment structures and differential diagnosis is highly possible to mark as a result of poor body reactions to extended immobilisation which means that nurses have to conduct an effective pre-surgery procedures to Mark’s fracture in order to avoid the effect of this problem.

Vital Signs

When Mark was presented to the hospital, he was complaining of severe pain in the lower part of his left leg. The pain was diagnosed by the nurse and was rated 9/10. There were other signs and symptoms that were diagnosed to determine his level of dependence and also to establish the activities of daily living (ADL). His respiratory rate (RR) was 18pm, his blood pressure (BP) was found to be 136/72mmHg, his body temperature was measured and found to be at 36.4ºC while his heart beats in terms of pulse rate was 80bpm. Later, his respiratory flow was also measured to find out how his body was reacting to the drugs and other medicines given to him. Other questions asked about him were his diet and life style, and he provided the following information; he does not smoke, he has no any noticed allergy to anything, and other body conditions were okay as he had no any other healthy problem. The diagnosis of his condition showed that the only problem noticeable in his body was that the blood pressure and the pulse rate were on the maximum.

The table below shows how nursing management processes could be successful to be successful after recovery.

Prevention

Effective prevention of the fracture from developing other problems requires that the nursing team identifies several activities of daily living (ADL) from Mark. The information is obtained directly from Mark, and it includes temperature control, pulse rate, respiratory rate among others. They also need to identify other external factors that could be potential effects of Marks condition such as the political, social, cultural and economic environment. Mark was waiting to undergo a surgery operation in his lower part of his left leg, and the operation was to restore his normal conditions. They are supposed to restore his pulse rate to be on average of around 72-74bpm there to show that he is improving. They are also supposed to bring his blood pressure to the normal range between 120/80 mmHg to 160/90 mmHg.

Alligood, (2014) says that the nursing team must start first by examining the skin keenly in order to determine its reaction to medicine and pathogens. According to Venes (2013), this skin examination has to be done thoroughly so as to avoid some usual problems that posses much risk such as differential diagnosis from happening to Mark. It will help to diagnose the wound effectively and address the condition effectively thus preventing failure of the operation that might in future lead to amputation of the whole limb. According to Cardwell et al. (2011), an effective clinical representation has to be established to ensure that the diagnostic feature is well addressed in order to avoid preliminary mistakes that might cost the whole operation from happening. Therefore, it means that the interdisciplinary team has to prepare early, and afterward investigation in the case of differential diagnosis so as to correct the situation on time before the situation worsen. Every member of the team has to understand that in every nursing management procedures, especially before the surgery, inconveniences may happen that if not well addressed could result to patient suffering more in the future.

According to Dalton et al. (2012), everyone on the nursing team has to have the basic and necessary knowledge and experience to nursing procedures in order to have the confidence in the decisions they make about the fracture and what needs to be done. It follows that a fracture on the lower part of the limb is dangerous in such a way that it can affect important vessels such as the main arteries and veins supplying blood and nutrients to the leg. As Quine et al. (2012) say that for the normal restoration of the condition of the leg and proper healing, the team needs to keenly apply the Roper-Logan-Tierney Framework, and identify the necessary activities of living associated with the condition and the factor affecting it. This is because Mark’s fracture poses an acute spreading bacterial infection which might damage the tissues and cause inflammation of the skin especially the epidermis.

The nurse has to give Mark basic patient’s knowledge so as to avoid physical movements or extreme activities that could affect him. Mark needs to be taught how to take care of him-self throughout in order to avoid unnecessary movements that could make the fracture not heal or become hard to operate. According to Gulanick & Myers (2013), this basic education is very essential since the patient know what is happening to him and knows the changes in the condition so as to give him hope of healing. According to Carpenito-Moyet (2013), careful adherence to this processes and procedures by the nurse and the referral team or the interdisciplinary team will make Mark undergo a successful surgery and recover his initial condition and functions on the lower part of the limb. It will also prevent Mark from losing his left leg as the nursing management would have been effectively done.

Referrals

According to Ignatavicius & Workman (2015), any condition that the nurse might find difficult to handle or new as they have never encountered before needs to refer to the professional doctors for assistance. However, the interdisciplinary team is made of a team of professionals who are well experienced and have enough knowledge to handle the situation. Thus, the nurse only needs to refer to the interdisciplinary team members for further assistance. Mark’s condition only needs a strong nursing management, and therefore, they only have to refer him to the doctor to perform the surgery if any difficulties arise.

However, the nurse has to refer everything to the interdisciplinary team as it is made of professionals who will help in solving the condition effectively. Therefore, Konstantinides et al. (2014) say that the interdisciplinary team needs to collectively work together with the nurse and overlap accordingly to ensure that effectiveness and efficiency in the assessment is met. They also have to use a favourable communication strategy that would apply to everyone effectively thereby ensuring that Mark’s left limb heals successfully.

Discussion

Mark has to always remain at the centre of every decision that the nurse and the interdisciplinary team makes. Therefore, effective teamwork and good communication could lead to a reduction of the potential risks on Mark’s wound that might hinder it from healing normally. Within a short span of time that Mark was wounded and the time he was awaiting to undergo an operation, type III open fracture had affected his emotions and psychology. It shows that his social, cultural, and economic environments are playing a bigger role in this condition. According to Macario et al. (2015), every step in the assessment of the wound needs to be keenly done by the right people in the team. Thereafter, Mark needs to be updated on what is being done and also given some encouragements to ensure that he restores his psychological and emotional conditions back to normal.

Conclusion

In summary, the nurse together with the interdisciplinary committee has to ensure that the Roper-Logan-Tierney Framework model has been well applied in the nursing management practices for Mark before he undergoes the operation. They also have to ensure that the condition is well taken care of and that his emotional and psychological effects are well addressed to restore his blood pressure and pulse rate to normal average. Furthermore, Mark needs to be given encouragement in order to boost his hopes of successful healing. He also needs to be warned effectively of the physical movements he makes and the extreme to which he has to carry out any activities to avoid any other problem that might make the operation hard or fail. Thus, effective adherence to the model will lead to successful healing of the wound.