Jack Buun, 69, Femoral Neck Fracture Post a Fall
Instructions:-
NRSG370 Assessment Task 2: Case Study – Medical/Surgical #2
Jack Buun, 69, femoral neck fracture post a fall
Jack Buun presented to the emergency department (ED) via ambulance after a fall in his backyard, which lead him to twist and fall directly on the lateral aspect of his right hip. On examination the paramedics reported his right leg to be shortened and externally rotated, and Jack was unable to get up and in a significant amount of pain. His wife Ethel found him and called the Ambulance. Jack has a past history of hypertension that is well controlled.
Jack required emergency surgery under general anaesthetic for his femoral neck fracture, and underwent a hemiarthroplasty. You are called to the post anaesthetic recovery unit (PACU) to receive handover, and are happy that he meets the discharge criteria of the hospital. You are told that Jack received the following intravenous medications for pain during and after his surgery:
- 20mg Morphine
- 100mg Tramadol
- 40mg Paracoxib
- 1g Paracetamol
Jack also received 0.625mg of droperidol in the PACU for nausea. On arrival to the orthopaedic ward you conduct further assessment as follows:
- Vital Signs: BP 145/80, HR 120, SpO2 96% on 2L via nasal prongs, Temp 37.1° Celsius, RR 10;
- Drowsy but rousable to voice commands;
- Pinpoint pupils;
- Neurovascular observations (Right Lower Limb): Cool, pale, touch present, movement present, capillary refill sluggish, dorsalis pedis present but thready;
- Pain 3/10.
You are the RN caring for Jack on the surgical ward.
Solution
Jack Buun, 69, Femoral Neck Fracture Post a Fall
Introduction
In Australia, the code of ethics for nurses has the purpose of identifying the vital ethical standards and values that the entire nursing profession is dedicated and offers nurses with a point of reference upon which they can reflect in their behavior as well as others (Nursing and Midwifery Board of Australia, 2013). It also guides nurses in practice and decision-making including presenting ethical values and human rights standards expected in nursing. On the other hand, the practice of a Registered nurse (RN) is evidence-based and person-centered with elements that are supportive, preventive, recuperative, palliative and curative. As a profession, the work of a RN demands an endless thinking and analysis in the framework of considerate development and upkeep of positive relationships, which are contained in the standards of practice (Nursing and Midwifery Board of Australia, 2013).
This paper will use the case study of Jack Buun, 69, femoral neck structure post fall to analyze and evaluate person-centered and evidence based care that will be offered to the condition of the patient. In the first place, the paper will present the background health information of the patient. The paper will then identify and prioritize problems based on the assessment and analyze the provision of ethical, legal, evidence-based, holistic person centered care as well as establishing the relevant and realistic goals to his condition. Further, the paper will present strategies to justify the nursing care offered and a reflection on the outcomes. Finally, the paper will summarize the entire ideas presented in the discussion.
Background
In the case study, Jack Buun is a patient who has been presented to the emergency department by an ambulance after a fall at the back of his house. This resulted into a twist and a direct fall on the lateral aspect of his right hip. After an examination was conducted by paramedics, it was reported that Jack was unable to get up and was under great pain, and his right leg was to be shortened and rotated externally. He was found by his wife Ethel who called the ambulance. The history of Jack is associated with hypertension that is well managed.
The type of condition affected Jack is characterized by a break in the neck of the thigh bone (femur) and is known as femoral neck fracture (Colón-Emeric, 2012). Femur can be defined as the long bone found on the thigh. It is the strongest and the largest bone in the human body (Colón-Emeric, 2012). The part of the bone that connects the round headed ball of the hip joint near the elongated shaft of the femur is represented by the neck of the thigh bone. As a result of a fall or a direct blow to the thigh or the hip, the femur is stressed. A break in the neck bone may happen if an excessive force that the femur cannot withstand is applied. If such a condition happens to an individual, it is referred to as a femoral neck fracture. The condition may vary from minimal displaced fracture to a serious displaced fracture with apparent deformity.
Clinical Reasoning Process
In considering the situation of the patient, Jack required an emergency surgery under general anesthetic for his femoral neck fracture and underwent a hemiarthroplasty (Julkunen, Honkonen, & Tarkkanen, 2009).
Collection and processing of information
During and after the surgery, Jack received 20mg Morphine, 1g Paracetamol, 40mg Paracoxib, and 100mg Tramadol as intravenous medications so as to prevent pain. In addition, Jack received 0.625mg of droperidol to prevent nausea while he was at the post anesthetic recovery unit (PACU). At his arrival at the orthopedic ward, the following assessments were done to Jack:
- Vital Signs: BP 145/80, HR 120, SpO2 96% on 2L via nasal prongs, Temp 37.1° Celsius, RR 10;
- Drowsy but rousable to voice commands;
- Pinpoint pupils;
- Neurovascular observations (Right Lower Limb): Cool, pale, touch present, movement present, capillary refill sluggish, dorsalis pedis present but thready;
- Pain 3/1
The above considerations were done to Jack before he was handed over to me in order to initiate the process of managing his condition.
Under person-centered practice, the patient is offered treatment in the manner that he or she requires (Snaedal, 2011). This may include considering concepts such as respect and dignity of the patient (Gillies, Levett-Jones, & Sullivan, 2013). Under the ethical code of conduct, valuing respect and kindness is highly expected in the context of healthcare. Having respect for oneself as well as the patient is also expected. Respect for Jack will help in achieving his capacity of informed and active participation during his personal health care (“Nursing and Midwifery Board of Australia,” 2013).
Ethical management of information will be valued during the healthcare process of Jack. Professionalism and integrity will be performed during the generation and management of documents and healthcare records of the patient. This will ensure that all the information is recorded about Jack is accurate, non-judgmental, and relevant to his health, treatment, as well as care. Besides this, ethical management of information will consist of respecting the privacy and confidentiality of Jack without bargaining his health. This will apply to the entire clinical and research data regardless of the medium in which the information about Jack is stored. According to the professional code of conduct in nursing, nurses are responsible for the provision of competent and safe healthcare personally.
The kind of person-centered care that Jack will receive should include the following: In the first place, I will focus on knowing Jack personally. This will include building a personal relationship with him and understanding more about his family (Gillies, Levett-Jones, & Sullivan, 2013). Second, emphasis will be sharing responsibility and power through respecting preferences of the patient. This may include handling Jack as a partner during the setting of goals, making decisions about his health care, planning over his care, and treatment. Third, focus will consider achieving the needs of the patient through being sensitive to expression of needs, preferences, and values (Gillies, Levett-Jones, & Sullivan, 2013). Besides this, focus will be on offering Jack accurate and timely information in a way that he can understand and make decisions over the kind of care he wishes to receive.
Goals
The main goal will be to ensure that Jack is comfortable in terms of controlling nausea and pain management (Chikae Yamaguchi, 2013). I will ensure that Jack’s temperature, blood pressure, respiratory rate, levels of oxygen and heart rate are well monitored since they are the most vital signs in the condition of the patient. Another goal that I will consider is to recognize and quickly correct any obstruction of the airway, troughs or peaks in the pressure of blood, and changes in oxygenation of blood. In addition, I will temper with any sudden changes in physiology and prevent pain, vomiting or nausea. I will also ensure that any specialized equipment that may be of importance is ordered by the doctor (Hommel, Kock, Persson, & Werntoft, 2012).I will ensure that the surgical site, tubes, dressing and drains are well monitored and medicated accordingly. If possible, I will ensure that I meet with members of the family and friends to discuss the condition of the patient as well as any changes at the waiting room. Also, I will consider improving the femoral neck fracture condition that Jack is under so that he gets back to normal (Hommel, Kock, Persson, & Werntoft, 2012).
The nursing care of Jack as a patient with a femoral neck fracture post a fall is based upon the prevention of complications at the time of the healing process (Wilkinson, & Treas, 2011). Through accurate of performance of nursing assessment on a regular basis, the patient’s pain can be managed and prevented by a nurse (Chikae Yamaguchi, 2013).
Strategies to manage the condition
Pain management.Nearly all patients that suffer from hip fracture are faced with lots of pain (Beaudoin, & Leytin, 2011). Therefore, aggressive control of pain is an important strategy in managing the condition of the patient. Regular assessment of pain especially for patients like Jack who has a history of hypertension will be important. The use of intravenous medications after his surgery as well as frequent pain assessments will be important for Jack.
Besides pain management, the patient should undergo a long-term improvement plan for the outcomes through rehabilitation (Beaudoin, & Leytin, 2011). Despite the lack of specific kind or place that offers rehabilitation after the femoral neck fracture, an approach that may be sensible should be offered in a most intensive way accepted by the patient (Wilkinson, & Treas, 2011). On the other hand, fall prevention may also be important strategy to Jack since the femoral neck fracture condition increases the risk of fall. Thus, more attention is required to prevent fall after the care of the patient (Viberg, 2013). Occupational therapy visits to the patient at home may be important to assist his safety back at home.
Conclusion
The paper has utilized the cycle of clinical reasoning to plan and evaluate the person centered care of Jack, a patient who had a femoral neck fracture post a fall on the back of his house. The patient successfully underwent an emergency surgery under a general anesthetic for his femoral neck fracture and was handed to me at the post anesthetic recovery unit (PACU). Through application of ethical, legal, evidence-based, holistic person centered care, as well as the establishment of relevant and realistic care, the paper has discussed Jack’s situation. Goals that will be used to handle Jack’s situation have been analyzed as well as strategies to be considered.
References
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