nursing care plan for multiple fractures.. help!

[ksurette]

I am a first year student.. working on the below assignment. I would think in this scenarios i would first focus on pain and secondary on the fact this person will not have much movement with a fracture on both sides. What are your thoughts on this assignment..what would be the first two critical things you would address.

You have been assigned to care for Mr. J, who fell from the first story of his home while shoveling snow off his porch roof to prevent collapse. He landed on his feet and fractured his left ankle and right femur. He is currently on bed rest. Vital signs are T- 37, P- 78, R-20, and B/P 112/74. He is ordered diet as tolerated. Medications ordered for Mr. J include, morphine sulfate for pain. His order reads morphine sulfate 10 mg IM q 6-7 hours for pain.

• Develop a nursing care plan for Mr. J.
  
• Critically think
  
• Include 2 nursing diagnosis relevant to Mr. J's situation
  
• For each nursing diagnosis develop at least 2 goals/interventions/ rationale
  
• Evaluate the nursing actions/State weather the goals/outcomes were met
  

[smf0903]

What do you have so far in terms of pain and immobility/limited mobility? I think you're headed in the right direction. I would suggest looking at medication order. Also think about things like side effects of pain medications, immobility, etc.

[ksurette]

Here is my first attempt at the first one.. thoughts what have i missed?

Nursing Diagnosis Acute pain related to fractures his left ankle and right femur

Planning(goal) The client will experience diminished pain as evidenced by:1. verbalization of a reduction in pain 2. relaxed facial expression and body positioning 3. stable vital signs

Intervention(Nursing) Conduct pain management interview. Document location, quality, onset, duration, intensity, aggravating and alleviating factors. Use self-report tool to understand intensity level. Access patient for pain routinely both when vitals are assessed, during activity and rest and with interventions or procedures likely to cause pain. Ask patient to discuss changes in pain to understand medication effectiveness. Implement measures to reduce pain: perform actions to reduce fear and anxiety about the pain experience (e.g. assure client that his/her need for pain relief is understood). perform actions to reduce fear and anxiety in order to promote relaxation and subsequently increase the client's threshold and tolerance for pain. perform actions to promote rest (e.g. minimize environmental activity and noise, limit the number of visitors and their length of stay) in order to reduce fatigue and subsequently increase the client's threshold and tolerance for pain

Rationale- Pain is expected after fracture; pain is subjective and is best evaluated on a pain scale of 0 to 10 and through. description of characteristics and location, which are important for identifying cause of discomfort and for proposing interventions. Continuing pain may indicate development of neurovascular problems. Pain must be assessed periodically to gauge effectiveness of continuing analgesic therapy.

Evaluation Client reports increased comfort, decreased pain. Client expresses comfort when leg is positioned and immobilized. Clients vitals are stabilized. Client expresses they are rested and relaxed and this is further demonstrated in clients face and body movement.

[teesquared]

the first thing that comes to my mind is risk for bed sore formation and pain management. good luck!

[jj224]

DVT / PE would probably be the worst outcome.

[Nurse Leigh]

The femur is a rather large bone. Any idea what a complication *might* result from a fracture in a bone like that?

[jm_emt]

I agree that prolonged bed rest is dangerous. Pressure ulcers, hypostatic pneumonia, blood clots, and UTIs can all result from staying in bed for days at a time. There are mobility devices that allow patients with fractures to be mobilized and moved into sitting (or partially inclined) positions but they are not that common in hospitals and nursing homes. Being in a sitting position reduces most of the above medical complications (especially pressure ulcers).

Two of the better known devices (usually called stretcher or mechanical chairs) which allow for "supine transfer" are the Barton Chair (model H250) and Wy'East TotaLlift II Chair. You can see how they work in the Youtubes listed below.

However most LTC, hospital, and rehab facilities will not spend the money to buy these devices in spite of their being useful for patients such as the one you mention above. But it is good to be aware that they exist should the facility come up with some money and ask nurses what equipment they might want to buy to make their jobs easier by patient transfer and improve patient outcomes.

Barton transfer chair:

Wy'East Chair:

[NICUismylife, ADN, BSN, RN]

Are you allowed to use "risk for" or "risk for complication of" diagnoses yet? Pain would maybe be in the top 5, but not anywhere near a top 2, especially with his normal vitals. Thinking like a nurse means asking yourself, "what could kill him first?" Think worst case scenario and then go from there. Have you learned about compartment syndrome yet? DVT/PE? I know you've learned about skin integrity and risks of immobility.

[BuckyBadgerRN, ASN, RN]

Is your 16 years experience in engineering? This post kind of sounds like an ad for a transfer chair that you may have designed, LOL

I agree that prolonged bed rest is dangerous. Pressure ulcers, hypostatic pneumonia, blood clots, and UTIs can all result from staying in bed for days at a time. There are mobility devices that allow patients with fractures to be mobilized and moved into sitting (or partially inclined) positions but they are not that common in hospitals and nursing homes. Being in a sitting position reduces most of the above medical complications (especially pressure ulcers).

Two of the better known devices (usually called stretcher or mechanical chairs) which allow for "supine transfer" are the Barton Chair (model H250) and Wy'East TotaLlift II Chair. You can see how they work in the Youtubes listed below.

However most LTC, hospital, and rehab facilities will not spend the money to buy these devices in spite of their being useful for patients such as the one you mention above. But it is good to be aware that they exist should the facility come up with some money and ask nurses what equipment they might want to buy to make their jobs easier by patient transfer and improve patient outcomes.

Barton transfer chair:

Wy'East Chair:

[jm_emt]

I have no connection with either company or product I mentioned. But I do think transfer chairs are the answer to some of the problems nurses confront, especially when mobilizing patients who cannot tolerate lifts. As a former aide and Hospice volunteer, I have watched patients struggle with being bedfast for weeks and months on end. It is a very serious situation and the nurses and caretakers I worked with found it difficult to watch also.

I do not see it as "advertising" to recommend a generic type of medical device (transfer chair) that solves a difficult challenge for nurses.

[BuckyBadgerRN, ASN, RN]

You didn't answer my question? Is your 16 years experience as a NURSE?

I have no connection with either company or product I mentioned. But I do think transfer chairs are the answer to some of the problems nurses confront, especially when mobilizing patients who cannot tolerate lifts. As a former aide and Hospice volunteer, I have watched patients struggle with being bedfast for weeks and months on end. It is a very serious situation and the nurses and caretakers I worked with found it difficult to watch also.

I do not see it as "advertising" to recommend a generic type of medical device (transfer chair) that solves a difficult challenge for nurses.

[jm_emt]

4 years as an aide. 15 years as a hospice volunteer. 20+ as an engineer. Hope this helps.