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Discussion

Help in a case study

hello to all! Please help me with my case study. Here is the scenario: A patient has injured his hand at work, went to the ED with a co-worker. You examine his left hand and find a piece of a drill bit sticking out of the skin between the third and 4th knuckles. there is another puncture site about an inch below and toward the center of the hand. Bleeding is minimal. Pt is 41 years old, no significant medical history, and NKDA. His last tetorifice booster was 3 years ago. he is able to flex and extend the distal joints but not the proximal joints of the third and fourth fingers. provide the initial care for the pt's injury.

1. you examine pt. hand. what should you include in your initial assessment? and why?

2. you notice pt's wedding band and promptly ask him to remove it. why is this important?

3. pt ask you why he can't just pull the bit out and go home. how should you respond to his question.

THESE ARE THE 3 QUESTIONS THAT I REALLY NEED HELP ON..THANKS!

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I am not doing your homework for you, these questions are pretty basic. I don't know where you are in school, first semester or senior student but a hugh part of nursing is using your resources. In your case, that means your books and notes.

  • Experts

1. you examine pt. hand. what should you include in your initial assessment? and why?

assess skin, neurovascular, rom. you are assessing to determine what is normal and abnormal. what is abnormal gives you hints as to what kind of damage the patient has sustained.

2. you notice pt's wedding band and promptly ask him to remove it. why is this important?

when cells and tissues are injured (this goes back to what you learned in physiology), the inflammatory response is called into action. the 4 cardinal signs of the inflammatory response that you will see with your eyes (but you should look up the pathophysiology of what is actually going on) in this order is (1) redness, (2) heat, (3)
swelling
and (4) pain. you should be able to recite these off the top of your head and they should roll off your tongue because the inflammatory response occurs with all injuries, bites, cuts into the skin, incisions, and every single infection and infectious process. in short order this man's hand is going to start swelling as a result of the inflammation response by his body to this injury and his fingers are going to swell. his wedding band is going to become a tourniquet that will end up literally impeding the circulation to his ring finger if it is not removed
now
.

3. pt ask you why he can't just pull the bit out and go home. how should you respond to his question.

the bit is threaded and pretty much locked in place. attempting to remove it is likely to injure more tissues. who knows what veins, arteries or nerves are in its path? the bit was also contaminated with bacteria and who knows what foreign material it was drilled into before it went and got drilled into the guy's hand. the patient will need antibiotic treatment as well as tetorifice prophylaxis. x-rays will be ordered to make sure that no bones were broken. since there is some compromised rom that will need to be assessed as well.

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