Nursing Dx for 7 mo.old fractured femur

[ladybugpie]

Hi all, I need help with providing 5 diagnosies for a 7 month old baby with a fractured femur (in a SPICCA cast). DYFS has custody and mother was allowed to stay with child. Mother claims baby tried to climb on dining chair and chair fell over. I need 5 dx and I must prioritize. I came up with:

1. Pain R/T recent trauma as evidenced by irritability manifested by leg injury

2. Risk for impaired skin integrity R/T acidic excritions on perneal tissue manifested by SPICCA cast intrusion

3. Risk for peripheral neuovascular dysfunction R/T Immobilization

4. Risk for ineffective tissue perfusion R/T presence of cast

5. Deficient diversional activity R/T physical limitations from cast.

I would appreciate any help. I'm learning to prioritze this semester, and must work the most important to completion.

[Daytonite, BSN, RN]

1. pain r/t recent trauma as evidenced by irritability manifested by leg injury (actual physiological need for comfort)
   • the evidence of pain is pain, or whatever body language indicates pain (such as irritability is a baby) - "manifested by leg injury" makes no sense, so you need to eliminate it
     
   • just say pain r/t recent trauma aeb irritability

[*]deficient diversional activity r/t physical limitations from cast (actual need for self-esteem)

• the reason (r/t) for decreased stimulation is that there is nothing to do where the patient is
  
• say something like deficient diversional activity r/t lack of available activities aeb patient acting bored

[*]risk for ineffective tissue perfusion r/t presence of cast (anticipated physiological need for oxygenation)

• the site of the tissue perfusion needs to be specified - since the patient is in a spicca cast the concern would be for the circulation to the lower extremity, so risk for ineffective tissue perfusion, peripheral r/t presence of cast

[*]risk for impaired skin integrity r/t acidic excretions on perineal tissue manifested by spicca cast intrusion (anticipated safety need from physiological threat)

• i'm pretty sure urine isn't acidic - skin breakdown occurs because urine sits on the skin and the skin macerates and rubs off with friction. that is risk for impaired skin integrity r/t sitting in wet urine. there are no aeb items with "risk for" diagnoses because these problems do not exist so there cannot be evidence of them yet. a spicca cast intrusion wouldn't be evidence of skin breakdown anyway.

[*]risk for peripheral neurovascular dysfunction r/t immobilization (anticipated safety need for protection)

• this is actually the same as what you mean by risk for ineffective tissue perfusion r/t presence of cast. so, you really only have 4 diagnoses.

you might consider using risk for disproportionate growth r/t trauma.

[C. Thinking]

As it is a greater bone fracture, I would be most concerned with "Fluid volume deficit". Greater bones are very vascular and the risk for hemorrhage is high.