Medical Case: Marilyn Hughes. Lower leg fracture-Guided Reflection Questions Medical Case: Marilyn Hughes. Lower leg fracture

Medical Case: Marilyn Hughes. Lower leg fracture-Guided Reflection Questions Medical Case: Marilyn Hughes. Lower leg fractureMedical Case: Marilyn Hughes. Lower leg fracture Guided Reflection Questions 1. How did the scenario make you feel? I didn’t really like this simulation because I didn’t feel helpful to this patient. She was complaining of pain of 8 even after I had loosened the restrictive dressing. I didn’t know what to do next for her since the doctor was notified but didn’t give any new order. I wish this simulation could go further and allow more nursing interventions to care for patients with compartment syndrome. 2. How would you recognize that Marilyn Hughes’ condition was deteriorating? Patients complaints of increasing pain even after loosening the dressing. She reports “my left foot feels really numb.”The lower left leg looks cyanotic. The pulse is absent on the left side and there is prolonged capillary refill in the toes on the left side. 3. What interventions exist to alleviate compartment syndrome, and what assessments indicate improved perfusion to the extremity? Interventions: Loosening the dressing. Elevate left leg to heart level but not above This study source was downloaded by from CourseH on :33:53 GMT -05:00 This study resource was shared via CourseH Improvement assessment: Capillary refill less than 3 seconds. Strong pedal pulses of 2+ . Skin of left leg is warm to touch and not cool or sweaty. Patient is able to move the left leg distal to the site of injury 4. Why is it important to maintain the limb at heart level versus elevating it above heart level? Elevation above heart level is contraindicated because it decreases arterial flow and narrows the arterial-venous pressure gradient. Keep the extremity at heart level helps maintain arterial pressure, which is very important because the muscle compartment is experiencing ischemia. 5. What could have happened in this scenario if Marilyn Hughes’ condition was not treated expediently? If not treated expediently, patient would have to resort for a fasciotomy. 6. What key elements would you include in the handoff report for this patient? Consider the SBAR (situation, background, assessment, recommendation) format Patient is a 45 year old female reporting “my left foot feels really numb,”with pain of 8/10 in severity and is unable to move her left leg. She is status post op for an open reduction with internal fixation with a below the knee ace/splint dressing on her left foot after slipping on icy stairs this morning. She is unable to move or feel her toes and pulse is absent on the left side. The lower left leg looks cyanotic. There is prolonged capillary refill in the toes on the left side. I think patient is having compartment syndrome and I recommend to elevate her left leg to heart level and start a new dressing so that it’s not too loose and contact provider. 7. What would you do differently if you were to repeat this scenario? How would your patient care change? If I were to repeat this simulation, I would assess the patient’s foot sooner. I would immediately loosen her dressing and elevate her leg to heart level. I think her pain would have been lower and then lastly I would administer morphine. Documentation Assignments 1. Document a comprehensive pain assessment for Marilyn Hughes. This study source was downloaded by from CourseH on :33:53 GMT -05:00 This study resource was shared via CourseH During the initial assessment, patient described the pain “it's killing me, 9 out of 10. It feels like the bandage is too tight” and “it's in my left leg.”After when I had loosen the dressing and administered morphine, her pain is reduced. Patient reports pain as “not too bad, it's about a 2 2. Document Marilyn Hughes’ neurovascular assessment.  Patient reports numbness on left leg  Patient is unable to move or feel her left toes  The pulse is absent on the left side.  The lower left leg looks cyanotic.  There is prolonged capillary refill in the toes on the left side 3. Document the changes in Marilyn Hughes vital signs. Initial assessment: ECG: Sinus tachycardia. Heart rate: 100. Pulse: Present. Blood pressure: 151/91 mm Hg. Respiration: 21. Conscious state: Appropriate. SpO2: 97%. Temp: 99 F (37 C) Assessment after interventions: ECG: Sinus rhythm. Heart rate: 89. Pulse: Present. Blood pressure: 139/83 mm Hg. Respiration: 16. Conscious state: Appropriate. SpO2: 97%. Temp: 99 F (37 C) 4. Identify and document key nursing diagnoses for Marilyn Hughes. Ineffective peripheral tissue perfusion related to arterial blood flow as evidenced by patient reporting 9/10, prolonged capillary refill on left toes, pulse is absent on left leg, numbness, and patient is unable to move or feel her left toes. Acute pain related to surgical incision and disruption of skin and muscle integrity as evidenced by patient reporting pain of 9/10, increased vital signs HR 100, RR 21, BP 151/91, and tight dressing. Impaired skin integrity related to altered sensation and circulation evidenced by patient reporting numbness, tight dressing on surgical site, cyanotic left leg, and rated pain of 9/10 in severity. 5. Referring to your feedback log, document the nursing care you provided and Marilyn Hughes’ response to this care.  Took vitals and assessed for pain  Performed neurovascular assessments and patient reports her left foot feels numb. She has reduced circulation evidenced by cyanotic left foot and prolonged capillary refill time.  Performed Glasgow Coma Scale and her score is 15  Loosened dressing and gave morphine 4mg and patient reports pain has reduced to a 2/10. This study source was downloaded by from CourseH on :33:53 GMT -05:00 This study resource was shared via CourseH This study source was downloaded by from CourseH on :33:53 GMT -05:00 This study resource was shared via CourseH Powered by TCPDF ()