Case Study B: Patient with Fractured Tibia (Unit IV) Due by April 26th Mr. West, 26…

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Case Study B: Patient with Fractured Tibia (Unit IV) Due by April 26th Mr. West, 26…

Case Study B: Patient with Fractured Tibia (Unit IV) Due by April 26th

Mr. West, 26 years old, was admitted with left fractured tibia. He was taken to surgery and is now being transferred to the orthopedic unit. He has a long leg cast on the left leg. His post-op orders are transcribed to the nursing care plan:

VS q4h                     I&O

Neurovascular checks (cric,. Movement, sensation, temp) q4h

Elevate left leg on (1) pillow

1liter D5W q10h-discontinue when taking fluids well

Teach crutch walking in AM

Diet Clear Liquids to Regular


   PCA-Dilaudid 0.2mg/hr

You are assigned to Mr. West as he is taken into his room. You noted that he is alert, left leg cast is damp and clean, and an IV is infusing into his right hand.

Prioritize the five nursing interventions as you would do them to take care of Mr. West. Write in the number in the box to identify the order of your interventions (#1=first intervention, #2=second intervention, etc.) and state an evidence-based rational for each intervention (cite your source)

                INTERVENTIONS           PRIORITY #                           RATIONALE_____     

Take vital signs

Neurovascular assessment of both extremities

Assess cast for dryness, signs, of drainage, and sharp edges

Use palms of hands to elevate cast on pillow

Teach isometric exercises

Check neuro status of right leg (CMST)

On the morning of the first post-op day, you noted that Mr. West is:

  1. Requesting pain med
  2. Left pedal pulses present, edema 2+
  3. Capillary refill >2 sec, moves left toes
  4. Taking fluids and voiding quantity sufficient
  5. MD orders CPK, LDH, and SGOT

All of the following nursing diagnosis may apply to Mr. Jackson

Risk for injury, Deficient knowledge, Risk for infection, Risk for impaired skin integrity, Ineffective tissue perfusion, Impaired physical mobility, Fear, Pain, Activity intolerance, Impaired tissue integrity, Anxiety, risk for peripheral neurovascular dysfunction

  1. Select the ONE nursing diagnosis above that is of priority at this time
  2. Provide a rationale for your selection
  3. List three nursing interventions that meet the needs of Mr. West

Mr. West refuses lunch and you assess:

c/o increased pain, especially with elevation of the leg, numbness and tingling, left pedal pulse weak, cool

Based on this new information, identify and write the priority problem in the box below. Then, starting with the small box labeled #1, prioritize the nursing intervention for this situation and identify your follow-up action plan for Mr. West.

Priority Problem # 1 # 2 # 3 # 4 # 5 # 6 New Action Plan

Nursing Intervention:

A Take the vital signs

B .Inform MD stat

C. Prepare to have cast bivalved

D. Ensure left extremity is at heart level

E. Monitor left pedal pulse

F. Stay with patient

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Reference no: EM132069492



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