BNURS20 Nursing

Answer

This assignment is about Mr. X who is a 65-year-old farmer. He was involved in a tractor accident and suffered from a mid-shaft fractured femur. There are several surgical options for Mr. X such as intra medullary nailing and it can be performed by two methods such as antegrade or retrograde. In this method, a special metal rod is inserted in the canal of femur. The rod provides support to the leg and keeps it intact. An intramedullary nail is inserted inside the canal in the knee or in the hip region by making a small incision. It helps in maintaining the position of both the nail and the bone during the healing process. There are other treatment methods such as fixation of plate and screw and external fixation. The method of fixation depends on the type of fracture as well as injuries associated with it. During the fixation of plates and screws, the fragments of bone are initially brought in their normal alignment. External fixation involves fixing of metal pins or screws in the bone above and below the site of fracture.

The potential post-operative complications which may lead to a negative impact on the mortality and morbidity of patients following surgical repair of a fractured femur are potential risk of infection to the surgical wound, blood clot and fat embolism leads to the risk of DVT and improper positioning of the  bone fragments due to fracture. The infection at the site of fracture can be controlled by keeping the wound clean and taking antibiotics as prescribed by the doctor. Nurses should also follow ANTT technique (Aseptic non-touch technique for wound care) which involves a few steps to prevent infection. The surface of wound should be cleaned with clean hands and the materials required should be collected beforehand. The wound is cleaned by taking proper precautions such as disposal of waste. Nurses should be alert at all times and protect Mr. X from all the risks of dangers and harmful situations. If they come across any adverse situations they should inform the management team and ask for professional health services (Swiontkowski & Resnick, 2015).

Since, Mr. X has a past history of deep vein thrombosis (DVT) and hypertension he has been prescribed nifedipine (CR) 60mg and warfarin 10 mg on a daily basis Nifedipine is used to cure the patient suffering from high blood pressure and warfarin is an anticoagulant which is used in thinning of blood. Hence, she should take his medicines regularly to prevent blood clot and fat embolism which increases the risk of DVT.

The doctors and the nursing staff have to be careful while performing the surgery so that the bone fragments are placed in a correct position to avoid to chances of surgery in the future. There are various tools for the assessment of pain that can be used if he is feeling discomfort. The nurses and other healthcare professionals should help him and provide psychosocial care along with palliative care so that he gets well soon.

It is very crucial for the nurses and other health care professional to keep a track on the health parameters such as blood pressure, pulse rate and oxygen saturation to prevent any risk in future and provide proper care. They should follow six rights of medication which involves giving him proper drug by considering his allergic reactions to drugs and expiry date, proper route of administration such as oral, mouth, buccal, sublingual, gastric tube, and nasogastric tube, correct timing, right client or patient, proper dosage as prescribed by the doctor and documenting about the drug given to the patient (Murray et al., 2015).

There should be monitoring in appropriate manner and clinical assessments should be repeated in order to keep a track on the signs and symptoms so that surgical complications are recognized in an adequate manner. Monitoring of infection at the site of injury can be done by regular checking of the wound and by making sure that there is no pus formation and foul smell after the surgery has been performed. The doctors should make sure that there is no swelling or redness at the site of incision in Mr. X (Giannoudis, & Harwood, 2017).

Monitoring of blood clot formation and fat embolism after the surgery of mid-shaft fracture femur can be done by keeping the risk factors in mind such as having a previous history of deep vein thrombosis and hence he has been prescribed warfarin. The doctors should check for fever and swelling in Mr. X which is a sign of developing a clot. Fat embolism syndrome can be monitored by checking for various symptoms such as fever, anemia, respiratory issues, and visual problems. Fat embolism syndrome involves clinical symptoms of tachypnea, tachycardia, pyrexia and thromocytopnea. Hypoxea and pulmonary dysfunction  also occurs in around 75% of the patients undergoing mid shaft fracture femur. The patient should be taken for Head computed tomography and magnetic resonance imaging of brain. Sublinical hypoxia should be monitored along with pulse oximetry in a continuous manner to detect if Mr. X is suffering from fat embolism. Nurses and other staff in the OT should provide proper post operative care so that he does not suffer from any kind of infection. There should be proper follow-ups to keep a track on any other symptoms   developed after the surgery. Prioritizing patients can prevent further complications, increased hospitalization and unnecessary deaths (Parameswaran et al., 2016).

Monitoring of improper positioning of the bone fragments can be done by a physical therapist who designs a specialized treatment plan for the patient to monitor the progress of recovery. He helps the patient in improving the balance of standing and the ability of walking after the surgery has been done (Ozkan et al., 2015). He also monitors the motion of hip, leg and back and the level of pain suffered by the patient. Self-management of disease such as having well balanced diet, proper sleep and physical exercise should be taught. Maintenance of personal hygiene and regular medication should be monitored (Ball et al. 2013).Psychosocial care will provide him emotional support. He should be provided proper physiotherapy sessions and rehabilitation services if required. Information on prevention strategies should also be given to him. 

References

Ball, J. E., Murrells, T., Rafferty, A. M., Morrow, E., & Griffiths, P. (2013). ‘Care left undone’during nursing shifts: associations with workload and perceived quality of care. Quality and Safety in Health Care, bmjqs-2012.

Detering, K.M., Hancock, A.D., Reade, M.C. and Silvester, W., 2015. The impact of advance care planning on end of life care in elderly patients: randomised controlled trial. Bmj, 340, p.c1345.

Murray, S. A., Kendall, M., Boyd, K., & Sheikh, A. (2015). Illness trajectories and palliative care. BMJ: British Medical Journal, 330(7498), 1007

Giannoudis, P. V., & Harwood, P. (2017). Complications After Damage Control Surgery: Pin-Tract Infection. In Damage Control Management in the Polytrauma Patient (pp. 297-307). Springer International Publishing.

Swiontkowski, M., & Resnick, L. (2015). Treating Atypical Femoral Fractures Related to Bisphosphonates. JBJS Case Connector, 5(1), e5.

Parameswaran, A., Krishnamoorthy, V. P., Oommen, A. T., Jasper, A., Korula, R. J., Nair, S. C., & Poonnoose, P. M. (2016). Is pre-operative assessment of coagulation profile with Thrombelastography (TEG) useful in predicting venous thromboembolism (VTE) following orthopaedic surgery?. Journal of clinical orthopaedics and trauma, 7, 225-229.

Akoh, C. C., Schick, C., Otero, J., & Karam, M. (2014). Fat embolism syndrome after femur fracture fixation: a case report. The Iowa orthopaedic journal, 34, 55.

Ozkan, K., Türkmen, I., Sahin, A., Yildiz, Y., Erturk, S., & Soylemez, M. S. (2015). A biomechanical comparison of proximal femoral nails and locking proximal anatomic femoral plates in femoral fracture fixation: a study on synthetic bones. Indian journal of orthopaedics, 49(3), 347.