Which of the following actions should the nurse prioritize during the initial assessment of a patient with a femur fracture?

A) Assess the patient's pain level

B) Measure the patient's blood pressure

C) Check the patient's capillary refill time

D) Evaluate the patient's range of motion in the affected limb

Which of the following is the most appropriate initial nursing action for managing the patient's reported pain level of 7 out of 10?

A) Administer prescribed pain medication as ordered.

B) Apply a warm compress to the affected area.

C) Encourage the patient to perform deep breathing exercises.

D) Reassess the patient's pain level in 30 minutes.

What is the primary reason for monitoring the patient's neurovascular status closely following the initiation of pain management interventions?

B) To ensure adequate blood flow and nerve function

A) To assess for signs of infection

B) To ensure adequate blood flow and nerve function

C) To evaluate for potential allergic reactions

D) To monitor for changes in vital signs

Which nursing intervention was primarily used to manage the patient's pain in this scenario?

B) Increased mobility exercises to reduce stiffness

C) Administration of antibiotics to prevent infection

D) Use of diuretics to reduce swelling

What is the primary reason for monitoring the patient's hemoglobin level before surgery?

A) To ensure adequate oxygen carrying capacity.

B) To assess the risk of infection.

C) To determine the patient's hydration status.

D) To evaluate electrolyte balance.

What is the primary reason for monitoring the patient's hemoglobin level in the pre-operative period?

C) To determine the patient's oxygen-carrying capacity.

A) To assess the patient's hydration status.

B) To evaluate the patient's risk for infection.

C) To determine the patient's oxygen-carrying capacity.

D) To monitor the patient's electrolyte balance.

While preparing a patient for surgery, the nursing team observes mild swelling and redness around the area of a fracture. What initial action should the nurse take?

D) Notify the surgical team to assess for possible infection

A) Apply a warm compress to the affected area

B) Document the findings and continue to monitor

C) Elevate the affected limb to reduce swelling

D) Notify the surgical team to assess for possible infection

Which nursing intervention is most appropriate to address the patient's reported pain level of 4 out of 10 before surgery?

A) Administer a mild analgesic as ordered

B) Apply a cold compress to the surgical site

C) Increase the patient's fluid intake

D) Withhold any pain medication to ensure alertness

What is the primary reason for monitoring the patient's white blood cell count in the context of her condition?

C) To identify signs of possible infection

A) To assess the effectiveness of pain management

B) To evaluate the patient's hydration status

C) To identify signs of possible infection

A nurse is assessing a patient with a fracture who has shown signs of infection. Which of the following interventions is a priority for the nurse to implement?

B) Reinforce infection control practices.

A) Encourage the patient to increase fluid intake.

B) Reinforce infection control practices.

C) Educate the patient on pain management techniques.

D) Prepare the patient for immediate surgery.

67 YEAROLD FEMALE, OSTEOPOROSIS, FALL SUFFERED FRACTURED FEMUR - Nursing Case Study

Pathophysiology

• Primary mechanism: Osteoporosis leads to decreased bone density and strength, making bones more fragile and susceptible to fractures. In older adults, this is often due to hormonal changes, such as reduced estrogen, that affect bone remodeling.

• Secondary mechanism: With aging, there is a natural decline in bone formation and an increase in bone resorption. This imbalance results in weakened bones, particularly affecting weight-bearing bones like the femur.

• Key complication: A fall in someone with osteoporosis can easily result in a fracture, such as a fractured femur, due to the diminished bone strength and increased fragility, highlighting the importance of fall prevention strategies in managing osteoporosis.

Patient Profile

Demographics:

67-year-old female, retired teacher

History:

• Key past medical history: Osteoporosis, hypertension

• Current medications: Alendronate, Amlodipine

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Right femur fracture due to fall

• Key symptoms: Pain in the right thigh, limited mobility

• Vital signs: Blood pressure 130/80 mmHg, heart rate 72 bpm, respiratory rate 18 breaths/min, temperature 98.6°F, oxygen saturation 98% on room air

Section 1

Initial Assessment Findings:

Upon admission to the orthopedic unit, the patient's initial assessment focused on evaluating the severity of the femur fracture and her overall condition. The patient was visibly uncomfortable, reporting a pain level of 7 out of 10 in her right thigh despite having received initial pain management in the emergency department. Her right leg was immobilized with a temporary splint, and there was noticeable swelling and bruising around the fracture site. The skin was intact, with no signs of open wounds or abrasions.

The neurovascular assessment of the affected limb was crucial. Capillary refill time was slightly prolonged at 3 seconds, and the patient described a tingling sensation in her right foot, although she was able to wiggle her toes and had palpable pulses. Sensation to light touch was intact, but there was mild weakness noted when compared to the left leg. These findings suggested that while there was no immediate vascular compromise, close monitoring would be necessary. Vital signs remained stable, and laboratory results showed a normal complete blood count and electrolyte panel, with a serum calcium level slightly below normal at 8.4 mg/dL, consistent with her osteoporosis.

Overall, the initial assessment highlighted the need for effective pain management, careful monitoring of neurovascular status, and the planning of surgical intervention to repair the fracture. This stage set the foundation for the patient's treatment plan, emphasizing the importance of addressing her osteoporosis management to prevent future falls and fractures. The next steps would involve collaborating with the orthopedic team to determine the appropriate surgical approach while ensuring the patient's comfort and safety.

Section 2

Response to Interventions

Following the initial assessment, the patient was started on a scheduled regimen of acetaminophen and low-dose opioid analgesics to better manage her pain, while anti-inflammatory medication was administered to address the swelling. Over the next 24 hours, the patient's pain level decreased to a more tolerable 4 out of 10, allowing her to rest more comfortably. The nursing team continued to monitor her neurovascular status closely. The capillary refill time in her right foot improved to 2 seconds, and the tingling sensation began to diminish, suggesting a positive response to the interventions and the absence of any worsening neurovascular compromise.

In preparation for the surgical intervention, the patient underwent a repeat set of laboratory tests. Her serum calcium level showed a slight improvement to 8.6 mg/dL after the initiation of calcium and vitamin D supplementation. Her vital signs remained stable, with a blood pressure of 126/74 mmHg, heart rate of 78 bpm, respiratory rate of 16 breaths per minute, and oxygen saturation at 98% on room air. The interdisciplinary team, including the orthopedic surgeon and the primary care physician, discussed the surgical plan, focusing on the patient's overall stability and readiness for the procedure. The plan was to proceed with an open reduction and internal fixation (ORIF) to stabilize the fractured femur, scheduled for the following day.

These developments provided the patient and her family with reassurance, as the nursing team emphasized the importance of continued pain management, mobility support, and osteoporosis treatment post-surgery. The patient's journey was progressing as expected, with all preparations in place to ensure a smooth transition to the surgical phase, highlighting the importance of comprehensive and coordinated care.

Section 3

The morning of the scheduled surgery, the nursing team conducted a thorough pre-operative assessment to ensure the patient remained stable and prepared for the upcoming procedure. Her vital signs continued to be within normal limits, with a slight decrease in heart rate to 72 bpm, indicating a calm and stable condition. Her blood pressure was steady at 124/76 mmHg, and her respiratory rate remained at 16 breaths per minute with an oxygen saturation of 97% on room air. The patient's pain was well-managed with a consistent rating of 3 out of 10, allowing her to participate in early mobility exercises with assistance, as advised by the physical therapy team.

A new set of laboratory results revealed that her hemoglobin level was slightly lower at 11.8 g/dL, prompting the healthcare team to increase her dietary iron intake and monitor for any signs of anemia. Her serum calcium level remained stable at 8.5 mg/dL, maintaining adequate bone health support alongside the ongoing calcium and vitamin D supplementation. There was a mild increase in her white blood cell count to 10,800/mm³, slightly above normal, which was attributed to the body's natural response to the fracture and the healing process.

The interdisciplinary team reviewed these findings and maintained a cautious approach, ensuring all potential risks were addressed before proceeding with surgery. The patient expressed mild apprehension about the procedure, but the nursing staff provided reassurance and education about the surgical process, reinforcing the importance of post-operative care and the role of each team member in her recovery. These proactive measures and close monitoring underscored the importance of comprehensive care and communication, setting the stage for a successful surgical outcome and further rehabilitation.

Section 4

As the patient was prepared for surgery, the nursing team continued to monitor her status closely. During the final pre-operative assessment, it was noted that her vital signs remained stable: her heart rate was steady at 70 bpm, blood pressure consistent at 122/74 mmHg, and respiratory rate at 16 breaths per minute with an oxygen saturation of 98% on room air. However, the patient reported a slight increase in her pain level, now a 4 out of 10, which prompted the nursing team to adjust her pain management plan. This involved administering a mild analgesic to ensure her comfort without affecting her alertness before surgery.

In addition to managing her pain, the nurses paid attention to her nutritional status, following the recent findings of a slightly lower hemoglobin level. A quick review of her dietary intake confirmed that she was consuming adequate iron-rich foods, and the team reinforced the importance of continuing this nutritional regimen post-surgery to support her recovery. The patient was encouraged to maintain her mobility exercises as tolerated, with the assistance of the physical therapy team, to prevent complications such as blood clots and to promote circulation.

Amidst these preparations, a new concern arose when the patient exhibited mild swelling and redness around the area of the fracture. The interdisciplinary team promptly evaluated the site to rule out any signs of infection, given her slightly elevated white blood cell count. To address this potential complication, the nursing staff implemented standard infection control measures and communicated closely with the surgical team to ensure that all necessary precautions were in place. This proactive approach not only addressed the immediate concern but also reinforced the importance of vigilance and responsive care, ensuring the patient was in optimal condition for her upcoming surgery.

Section 5

The nursing team, continuing their vigilant monitoring, observed a change in the patient's status the following morning. Her previously stable vital signs showed a slight increase in temperature to 99.5°F, accompanied by the persistence of swelling and redness around the fracture site. Her pain level also rose to a 5 out of 10, despite the analgesic regimen. These changes prompted a reassessment of her condition and a review of the most recent lab results, which showed a further slight increase in her white blood cell count, now at 11,000/mm³, suggesting ongoing inflammation or possible infection.

In response to these findings, the nursing team collaborated with the interdisciplinary team to initiate a specific plan of care. They prioritized enhancing the patient's comfort and addressing the potential infection risk. The attending physician ordered a targeted antibiotic therapy while maintaining the patient's pain management plan. Additionally, the nurses reinforced infection control practices, ensuring the fracture site was clean and properly dressed. They also educated the patient and her family on signs of infection to monitor and report promptly.

These interventions aimed to stabilize the patient's condition, mitigate any further complications, and prepare her adequately for surgery. The team remained focused on maintaining open communication with the patient, providing reassurance, and ensuring she felt supported during this critical phase of her care. With these proactive measures, the patient was positioned for a successful surgical outcome, setting the stage for her ongoing recovery and rehabilitation journey.