dislocated elbow - Nursing Case Study

Pathophysiology

• Primary mechanism: A dislocated elbow occurs due to a sudden and intense force applied to the arm, often in a fall or a direct blow. The force causes the bone to move out of its normal position in the elbow joint, leading to a dislocation.

• Secondary mechanism: After the initial dislocation, surrounding tissues such as ligaments, tendons, and muscles may also be damaged. This can cause additional pain, swelling, and limit the movement of the joint.

• Key complication: If not properly treated, a dislocated elbow can lead to chronic instability and recurrent dislocations. Moreover, the damage to nerves and blood vessels around the elbow can cause numbness, weakness, or even tissue death.

Patient Profile

Demographics:

45-year-old male, construction worker

History:

• Key past medical history: No significant past medical history

• Current medications: None

• Allergies: No known allergies

Current Presentation:

• Chief complaint: Pain in the left elbow following a fall at work

• Key symptoms: Severe pain, inability to move the left elbow, visible deformity of the elbow

• Vital signs: Blood Pressure - 120/80 mmHg, Pulse - 78 bpm, Temperature - 98.6°F, Respiratory rate - 16 breaths per minute

Section 1

Initial Assessment Findings:

On physical examination, the client's left elbow was visibly swollen and deformed, and he exhibited a marked reduction in range of motion. He rated his pain as 8 on a scale of 0 to 10. The skin around the elbow was intact with no signs of open wounds or abrasions. Capillary refill was less than 2 seconds and there was no cyanosis, indicating good peripheral perfusion. However, the patient reported a tingling sensation in the forearm and fingers, suggesting possible nerve involvement.

Upon palpation, crepitus was not felt, ruling out any possibility of a fracture. Neurovascular assessment was performed which indicated normal sensation and motor function in the distal part of the injured arm. The radial pulse was palpable and strong. No signs of compartment syndrome such as pain on passive stretching, paresthesia, pallor, and pulselessness were noted. This initial assessment suggests that while the dislocation appears severe, it has not resulted in any major vascular or neurological complications at this point. The priority now is to manage the patient's pain and prepare for possible reduction of the dislocation.

Section 2

Upon administration of intravenous analgesics, the patient reported a decrease in pain to a 4 out of 10. The nursing team then initiated cold compress therapy on the affected area to further alleviate pain and reduce swelling. The patient was placed in a comfortable position with the injured arm elevated to promote venous return and minimize edema.

In preparation for possible reduction of the dislocation, a repeat neurovascular assessment was performed. The patient's tingling sensation had subsided, and he reported normal sensation and motor function in the distal part of the injured arm. The radial pulse was still palpable and strong. Vital signs were stable: blood pressure was 120/80 mmHg, heart rate was 72 beats per minute, respiratory rate was 18 breaths per minute, and body temperature was 98.6°F. The patient's response to the interventions appeared to be positive and no new complications were noted.

This updated assessment suggests that the patient is responding well to pain management interventions. The nursing team must now communicate these findings to the physician, who will decide the next step in the patient's care, possibly including the reduction of the dislocation. This calls for continued monitoring of the patient's pain levels, as well as maintaining vigilance for any changes in neurovascular status following the reduction procedure.

Section 3

The physician, after reviewing the patient's current status and findings, decided to proceed with a closed reduction procedure for the dislocated elbow. The nursing team prepared the patient for the procedure, providing emotional support and explaining the procedure to alleviate the patient's anxiety.

After the successful reduction, the patient's arm was immobilized in a sling. A post-reduction neurovascular assessment was conducted, with the patient reporting no pain and normal sensation in the affected arm. The radial pulse remained strong and the patient's vital signs were stable: blood pressure was 120/80 mmHg, heart rate was 70 beats per minute, respiratory rate was 18 breaths per minute, and body temperature was 98.6°F. The patient's positive response to the intervention suggests effective pain management and successful reduction of the dislocation.

The nursing team will continue to monitor the patient's neurovascular status and pain levels, and observe for any potential complications such as limited mobility or infection. The team will also provide post-procedure care education to the patient including the importance of maintaining the arm immobilization, signs of complications to watch for, and follow-up care.

Section 4

On the following day, the nursing team conducted a follow-up assessment of the patient. Upon inspection, the team observed slight swelling around the elbow joint, but no visible signs of infection such as redness or pus discharge. The patient reported a pain level of 2 on a scale of 0-10, which was manageable with over-the-counter pain medication. Upon palpation, the elbow was tender but the patient's radial pulse remained strong and their vital signs were stable: blood pressure was 122/78 mmHg, heart rate was 68 beats per minute, respiratory rate was 18 breaths per minute, and body temperature was 98.4°F.

However, the patient reported difficulty in performing basic tasks such as eating and dressing due to the immobilization of the arm. The nursing team provided education on how to use assistive devices and techniques to manage daily activities while keeping the arm immobilized. The team also reassured the patient that the difficulty is temporary and will improve as the elbow heals. This situation emphasized the importance of patient education and the need for adaptive strategies in managing the impact of health changes on daily living. The nursing team will continue to monitor the healing process and provide necessary support to the patient.

Section 5

Three days after the initial assessment, the patient reported a slight increase in pain, rating it as a 4 on a scale of 0-10. The patient also noted a feeling of stiffness and mild discomfort when attempting to move the fingers of the immobilized arm. On physical examination, the nursing team observed no significant increase in swelling or any signs of infection. The patient's vital signs remained stable: blood pressure was 124/79 mmHg, heart rate was 70 beats per minute, respiratory rate was 18 breaths per minute, and body temperature was 98.6°F.

In response to the increased discomfort, the nursing team encouraged the patient to continue taking the over-the-counter pain medication as directed and to gently exercise the fingers and wrist of the immobilized arm to maintain flexibility and prevent stiffness. The team also suggested the use of a cold pack on the elbow to help reduce discomfort. The patient was reminded that these symptoms are a normal part of the healing process and should improve over time. The nursing team will continue to monitor the patient's pain levels and the healing progress of the elbow, adjusting interventions as necessary. This situation underscores the importance of pain management and the need for regular reassessment and adjustment of care plans based on patient feedback and observed changes in status.