N.E. is a 32-year-old manwho sustained a closed, complete, oblique fracture of the left femur in a single vehicle motor vehicle accident. He is being admitted to the orthopedic floor from the emergency department(ED) and is scheduled to have surgery tomorrow afternoon. He states he had asthma as a child and denies any other health problems. Muscular System
- Rates pain in left leg as 4 on a 0 to 10 pain scale after receiving 4 mg of intravenous (IV) morphine in the ED 30 minutes before arrival on the orthopedic unit
- States his parents and girlfriend saw him in the ED and have gone home for the night and will come back tomorrow before his surgery Muscular System
- Temperature98.9°F, pulse 88, respirations 18, blood pressure 132/70
- Alert and oriented x 3
- Abrasion to forehead and multiple abrasions to arms and legs
- Left leg to 10 lb of Buck’s traction
- Bilateral feet and toes warm and pink with movement and sensation equal and within normal limits
- Dorsalis pedis and posterior tibial pulses palpable at 3+
- 10 lb of Buck’s traction to left lower extremity
- IV Lactated Ringer’s @ 125 mL/hr
- Morphine sulfate 4 mg IV every 2 hours PRN for pain
- Cefazolin 1 mg IV on call to the operating room
- What does N.E.’s diagnosis of a closed, complete, oblique fracture of the left femur mean?
- What is the primary purpose of applying Buck’s traction? What interventions do you employ to maintain the traction system?
- What specific assessments do you need to be perform?
- What potential complications is N.E. at risk for because of his reduced mobility? Describe interventions to include in his plan of care to prevent each complication.
Case Study Progress
Two hours after admission, N.E. requests pain medication for pain of a 5 in his left upper leg and you administer 4 mg IV morphine. Fifteen minutes later, he states that his pain level is now a 2. Two hours later, N.E. states he has pain in his lower left leg and rates it a 10. Youask the doctor for an additional pain medication order and administer another 4 mg morphine IV.After reassessingthe patient’s pain 15 minutes later,he states that his pain is unchanged and is still a 10 in the left lower leg.
- What additional assessments do you need to make at this time?
- E. states that he has some numbness and tingling in his left foot. What do you suspect and what should you do?
- Using SBAR, outline the information you would provide the surgeon when you call.