I need some Assistance!!!!!!!!!!!!!

[zwoman80]

Scenerio:

J.L. is a 30 y/o man who tried to light a cigarette while driving and lost control of his car.The car flipped and landed on the pasenger side. J.L was transported to the ED with edamatous right leg and a deep puncture wound approximately 5cm long over the deformity. Blood continues to ooze from the wound.

1. What Further assessment should the nurse make of the leg injury and what precautions should she take in making this assessment?

2. What would be the most appropriate method for controlling bleeding at this wound site?

3. List 3 issues r/t his smoking that can complicate his care and recovery?

We were thrown this curveball @ school d/t a professor's sudden illness. We were given 2 wks to complete (This could mean a pass or fail from my LPN program d/t depleted hours). I'm just drawing a blank . Any help and/or advice will be greatly appreciated.

[suebird3]

moved your post to a more appropriate forum. good luck!

suebird :)

[Tweety, BSN, RN]

That doesn't sound like questions in an LPN program, more like an ER Trauma Core.

I don't know a lot off the top of my head, but one thing about #1 you should immediately consider is compartment syndrome. Which if you're worried about, I'm not sure too much pressure to the oozing blood (notice it doesn't say profuse bleeding) is appropriate. In other words I don't know the answer to #2. http://orthoinfo.aaos.org/fact/thr_report.cfm?Thread_ID=287&topcategory=About%20Orthopaedics

Remember in these kinds of injuries your "CMS" Circulation/Sensation/Movement distal to the injury. i.e. what is the color of his feet - is there brisk cap refill, can he feel without numbness and tingline, can he wiggle his toes.

Ciggarate smoking causes vasoconstriction which will complicate healing and recovery

[emtb2rn, BSN, RN, EMT-B]

With respect to compartment syndrome, doesn't that require an intact skin surface? I would think the puncture provides the same relief that a surgical incision would (per Tweety's ortho reference).

Every puncture wound I've received needed to be thoroughly cleaned so I imagine this pt is going down that road as well. I would hazard that a couple of 4bys with light pressure would suffice to control an oozing wound.

How's that CMS? Good pedal pulse, toe wiggling and sensation?

How about poor driving skills r/t smoking that could delay his recovery due to a potential follow-up crash?

[zwoman80]

Thank you all for the advice. Everything made great sense. It's very comforting to know [as a student] that when you are faced with a problem that you are unsure how to approach there's always wonderful peers on this website, ready and willing to help and offer their years of expertise and knowledge with us newcomers!!!!!THANXS:bow:

[Race Mom, ASN, RN]

Smoking reduces the amount of functional hemoglobin in blood, thus decreasing tissue oxygenation (poor wound healing).

Smoking may increase platelet aggregation and cause hypercoagulaility.

Smoking interferes with normal cellular mechanisms that promote release of oxygen to tissues.

The client who smokes is at greater risk for postoperative pulmonary complications. The chronic smoker already has an increased amount and thickness of mucous secretions in the lungs. General anesthetics increase airway irritation and stimulate pulmonary secretions, which are retained as a result of reduction in ciliary activity during anesthesia. After surgery the client who smokes has greater difficulty clearing the airways of mucous secretions and needs emphasis on the importance of post-op deep breathing and coughing.

Fundamentals of Nursing, Perry/Potter.

[boomerfriend]

But what do you do for the poor guy that's probably going through serious withdrawal from his smoking habit? I've always wondered what they do for patients that are 2/pack/day smokers and they're hospitalized for an extended period.