HLT54115 Diploma Of Nursing


At 1315, Emma Jones, 32, is admitted to your ward from home (via the emergency department) with a left CoIle’s fracture, (fractured left distal radius) following a fall; she has a past history of childhood measles, wisdom teeth extraction, and morphine allergy; she is on the oral contraceptive pill, and no other medications. Her left arm is being elevated with a sling and supported by a pillow to reduce swelling, but her fingers and hand are puffy. On arrival to the ward she has manageable pain; she is fasting prior to the surgery on her wrist, with her scheduled theatre time for 1600. Her husband is present. 

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.

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