HLT54115 Diploma Of Nursing
Questions:
Q I. What observations does Emma need on admission and Why?
Q2. Apart from the mild swelling noted in the emergency department handover, all Emma’s admission vital signs are unremarkable. Where would you document them?
Q3. When you checked Emma’s wrist and hand, you noticed that her wedding ring was tight because of the swelling. How do you action this and why?
Q4. When you check on Emma at 1400 she tells you the pain is increasing. Are there any special precautions you should take when giving Emma pain relief? Is there anything else you should do?
At 1455 Emma’s husband comes up to you at the nurses’ station to tell you that she is experiencing worsening pain.
05. When you assess Emma you notice that the swelling is much worse. What other assessments should you do? What are you assessing for?
Emma tells you her pain is increasing from her elbow down to her finger tips and gradually getting worse over the last half hour, and is now severe, from her mid-forearm down. She says her skin feels tight, and her hand is now pale, cool, too swollen for her to wriggle her fingers, she has pins and needles in her fingertips and reduced sensation; when you press on her fingertips, it takes several seconds for the colour to return.
Q6. What is most likely causing Emma’s increased pain and these new signs?
Q7. How should you action this?
Emma returns from theatre at 1745, following an open reduction and internal fixation (ORIF) of her fractured wrist, and a fasciotomy (a surgical incision into the fascia tissue to release pressure). Any surgery, however well performed, is an insult to the body and results in trauma and, potential complications.
Answers:
1.
Emma requires neurovascular observations on admission to determine her intensity of Colle’s fracture after fall. Firstly, it is essential to perform admission assessment that involves observing general appearance, patient history, the physical and mental condition of the patient. As the attending nurse, it is essential to observe the level of pain in the injury region by using a pain assessment tool. Further, the sensation and motor function should be observed in Emma’s fractured left distal radius region. Lastly, vital signs parameters should be observed that involves colour, temperature, swelling, pulse and capillary refill (LeMone et al. 2015).
2.
The unremarkable vital signs shall be documented in “Adult vital sign chart” for proper care treatment of Emma (Dains, Baumann & Scheibel, 2015).
3.
To reduce or manage the swelling observed in fingers and hands of Emma two actions shall be performed that are cold therapy and rest at this stage. The action of providing cold therapy will work to reduce swelling by restricting the blood flow and slowing metabolism in cells. Further, rest is followed to irritate the damaged cells helping in recovery (LeMone et al. 2015).
4.
As Emma is complaining about increasing pain, a possible solution is pain relief. In the case of Emma, any pain relief except morphine is suitable for her pain treatment because she is allergic to morphine. Further, it is required to ensure her time of contraceptive pill before implementing pain relief because the action of pain relief can counter with contraceptive creating complications (Dains, Baumann & Scheibel, 2015).
5.
In the provided situation where Emma is facing worsening pain even after implementation of pain relief it is critically essential to perform a detailed Neurovascular assessment of her affected body region. This detailed neurovascular assessment shall help to detect the damage in a specific region or nerve that is creating an increase in swelling symptom.
Through neurological assessment, the pain, sensation and function of radial, median and ulnar nerve shall be assessed to determine their functionality. This shall help to detect the proper region of defect leading to increased swelling in the wrist (LeMone et al. 2015).
6.
Complex regional pain syndrome is one of the most common complications of Colle’s fracture. The provided signs in Emma’s case matches the symptoms of regional pain syndrome where swelling followed by loss of sensation, change in skin colour and texture are the most common symptoms. Basically, this can be the shoulder-hand syndrome in case of Emma, which is a category of complex regional pain syndrome (Moyce, Lash & de Leon Siantz, 2016).
7.
The Complex pain syndrome is a critical situation that requires professional treatment, therefore, as an attendant nurse, a proper communication shall be transferred to doctor for providing further assistance to handle Emma’s case (Dains, Baumann & Scheibel, 2015).
8.
In the case of Emma as she was a victim of fall that caused Colle’s fracture, the two potential complications in her case are malposition-malunion and wrist osteoarthritis. The malposition-malunion generally occurs after bone trauma. The deformed position (malposition) of healing fracture leads to limb shortening termed as malunion. This can be identified as a shortened limb. Another complication is wrist osteoarthritis, which is the most common complication after Colle’s fracture. This is considered as post-traumatic condition after surgery identified by joint instability, licking, stiffness and swelling on the wrist (Bruyneel et al. 2015).
References
Ackley, B. J., Ladwig, G. B., & Makic, M. B. F. (2016). Nursing Diagnosis Handbook-E-Book: An Evidence-Based Guide to Planning Care. Elsevier Health Sciences.
Dains, J. E., Baumann, L. C., & Scheibel, P. (2015). Advanced Health Assessment & Clinical Diagnosis in Primary Care-E-Book. Elsevier Health Sciences.
LeMone, P., Burke, K., Dwyer, T., Levett-Jones, T., Moxham, L., & Reid-Searl, K. (2015). Medical-surgical nursing. Pearson Higher Education AU.
Urden, L. D., Stacy, K. M., & Lough, M. E. (2017). Critical Care Nursing-E-Book: Diagnosis and Management. Elsevier Health Sciences.
Bruyneel, L., Li, B., Ausserhofer, D., Lesaffre, E., Dumitrescu, I., Smith, H. L., … & Sermeus, W. (2015). Organization of hospital nursing, provision of nursing care, and patient experiences with care in Europe. Medical Care Research and Review, 72(6), 643-664.
Kelly, M. P., & Field, D. (2016). Medical sociology, chronic illness and the body. Sociology of Health & Illness, 18(2), 241-257.
Moyce, S., Lash, R., & de Leon Siantz, M. L. (2016). Migration experiences of foreign educated nurses: a systematic review of the literature. Journal of Transcultural Nursing, 27(2), 181-188.
Zolnierek, C. D. (2014). An integrative review of knowing the patient. Journal of nursing scholarship, 46(1), 3-10.
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