A 45-year-old patient with a left femur fracture exhibits signs of worsening vascular compromise and escalating pain despite maximal non-opioid analgesia. Which nursing action is the most appropriate to prioritize in this scenario?

C) Prepare the patient for potential surgical intervention and notify the healthcare provider immediately.

A) Elevate the affected limb above heart level to reduce swelling.

B) Apply a warm compress to the affected limb to improve circulation.

C) Prepare the patient for potential surgical intervention and notify the healthcare provider immediately.

D) Administer additional non-opioid analgesics to manage the patient's pain.

A 45-year-old patient with a left femur fracture is showing signs of compartment syndrome, including worsening pain and decreased perfusion in the affected limb. Which of the following nursing interventions should be prioritized to prevent further complications?

C) Notify the healthcare provider immediately to discuss the need for surgical intervention.

A) Elevate the affected limb above heart level to reduce swelling.

B) Apply a warm compress to the affected limb to promote circulation.

C) Notify the healthcare provider immediately to discuss the need for surgical intervention.

D) Administer additional non-opioid analgesics as prescribed to manage pain.

A patient is exhibiting signs of systemic inflammatory response syndrome (SIRS) with a confirmed Staphylococcus aureus infection. The medical team has initiated broad-spectrum intravenous antibiotics. As a nurse, what is the priority action to prevent further complications?

C) Assess for changes in the patient's mental status and report promptly.

A) Administer antipyretics as prescribed to manage fever.

B) Monitor the antibiotic administration for signs of an allergic reaction.

C) Assess for changes in the patient's mental status and report promptly.

D) Ensure the patient remains NPO to prepare for possible surgery.

A patient is showing signs of systemic inflammatory response syndrome (SIRS) and blood cultures indicate a Staphylococcus aureus infection. Which nursing intervention is the highest priority to prevent further complications?

A) Administering prescribed broad-spectrum intravenous antibiotics

B) Monitoring vital signs every 4 hours

C) Encouraging oral fluid intake to maintain hydration

D) Educating the patient about infection control measures

A patient with a post-surgical wound infection is being managed with antibiotics and is scheduled for an urgent debridement. As the nurse, which intervention should be prioritized to facilitate the patient's recovery and prevent further complications?

D) Monitor the patient's vital signs every 4 hours to detect signs of systemic infection.

A) Administer prescribed analgesics prior to the debridement procedure to manage pain.

B) Educate the patient on the importance of completing the entire course of antibiotics.

C) Ensure the patient's surgical site is kept clean and dry to prevent additional infection.

D) Monitor the patient's vital signs every 4 hours to detect signs of systemic infection.

A patient is being monitored for a potential wound infection following surgery. Despite initial improvement with antibiotic therapy, the patient now presents with localized swelling, redness, and purulent drainage at the surgical site. What is the most appropriate nursing action to prioritize in this situation?

B) Notify the healthcare provider about the possible wound infection

A) Increase the frequency of vital signs monitoring

B) Notify the healthcare provider about the possible wound infection

C) Administer prescribed analgesics to manage pain

D) Educate the patient on the importance of adhering to antibiotic therapy

A patient post-debridement is showing signs of acute respiratory distress with hypoxemia and respiratory acidosis. What is the most appropriate initial nursing intervention to improve the patient's oxygenation?

D) Administer supplemental oxygen via nasal cannula

A) Increase the patient's fluid intake to thin secretions

B) Position the patient in a high Fowler's position

C) Encourage the patient to perform deep breathing exercises

D) Administer supplemental oxygen via nasal cannula

A patient recovering from a surgical debridement is now exhibiting signs of acute respiratory distress with a recent diagnosis of hospital-acquired pneumonia. Which nursing intervention is most critical to prioritize for this patient to address the current respiratory compromise?

C) Start supplemental oxygen therapy and monitor the patient's respiratory status closely.

A) Initiate deep vein thrombosis prophylaxis to prevent further complications.

B) Administer broad-spectrum antibiotics as prescribed to treat the suspected infection.

C) Start supplemental oxygen therapy and monitor the patient's respiratory status closely.

D) Encourage early mobilization to improve pulmonary function and overall recovery.

A patient with respiratory distress shows partial improvement in arterial blood gases following oxygen therapy and antibiotic administration. Despite these interventions, the patient's respiratory rate remains elevated, and there is a concern for fluid overload. What is the most appropriate next step in the nursing management of this patient?

D) Encourage frequent use of incentive spirometry and monitor closely.

A) Increase the flow rate of supplemental oxygen to 6 liters per minute.

B) Administer a diuretic to manage potential fluid overload.

C) Initiate non-invasive positive pressure ventilation.

D) Encourage frequent use of incentive spirometry and monitor closely.

A patient has been placed on supplemental oxygen at 4 liters per minute via nasal cannula and shows a slight improvement in oxygen saturation to 92%. Despite broad-spectrum antibiotics and respiratory interventions, the patient remains febrile with a temperature of 101.5°F and has a respiratory rate of 26 breaths per minute. Given the clinical findings, what is the nurse's priority action?

B) Encourage the patient to use the incentive spirometer every hour

A) Increase the supplemental oxygen flow rate to 6 liters per minute

B) Encourage the patient to use the incentive spirometer every hour

C) Notify the healthcare provider about the persistent fever

D) Initiate prophylactic anticoagulation therapy immediately

Left femur fracture - Nursing Case Study

Pathophysiology

• Primary mechanism: Disruption of bone integrity occurs due to a direct impact or excessive force, causing the femur to fracture. This results in displacement or angulation of bone fragments, impairing normal limb function and stability.

• Secondary mechanism: Vascular injury may accompany the fracture, leading to potential bleeding and hematoma formation. This can compromise blood supply to surrounding tissues, increasing the risk of avascular necrosis if not promptly managed.

• Key complication: Improper or delayed treatment can lead to malunion or nonunion of the fracture, potentially causing chronic pain, reduced mobility, and long-term disability. Early intervention and stabilization are crucial to prevent these outcomes.

Patient Profile

Demographics:

45-year-old male, construction worker

History:

• Key past medical history: Hypertension, Type 2 Diabetes

• Current medications: Lisinopril, Metformin

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Severe pain and swelling in the left thigh

• Key symptoms: Inability to bear weight on the left leg, bruising and deformity around the left thigh, increasing pain despite pain medication

• Vital signs: Blood pressure 150/95 mmHg, heart rate 110 bpm, respiratory rate 22 breaths per minute, temperature 38.2°C (100.8°F), oxygen saturation 95% on room air

Section 1

As the clinical team continues to monitor the 45-year-old construction worker with a left femur fracture, new complications begin to emerge. Despite initial stabilization efforts, the patient exhibits signs of worsening vascular compromise in the affected limb. Upon further assessment, the left leg appears increasingly pale and cool to the touch, with capillary refill time extending beyond 3 seconds, indicating potential impaired perfusion. The patient's pain also escalates to an excruciating level despite maximal non-opioid analgesia, raising concerns about compartment syndrome, a serious condition that can result from increased pressure within the muscle compartments of the leg.

New diagnostic results, including a Doppler ultrasound, reveal diminished arterial flow distal to the fracture site, confirming significant vascular involvement. Additionally, laboratory tests show an elevated white blood cell count of 14,500/mm³, suggesting an inflammatory response, possibly due to tissue injury or an emerging infection. These findings prompt the medical team to consider urgent surgical intervention to relieve pressure and restore adequate blood flow to the limb, thus preventing further tissue damage and potential loss of limb function.

The patient's status necessitates a multidisciplinary approach, with input from orthopedic surgeons, vascular specialists, and the nursing team to optimize care. The priority is to address both the fracture and the vascular compromise, recognizing that timely intervention is critical to prevent irreversible muscle and nerve damage. This evolving scenario underscores the importance of vigilant monitoring and proactive management to mitigate the risk of long-term complications such as chronic pain or disability, guiding the next steps in the patient's treatment journey.

Section 2

As the clinical team proceeds with the plan for surgical intervention, they prioritize the patient's stabilization and closely monitor for any further complications. The patient's vital signs reveal a heart rate of 110 beats per minute, a blood pressure of 98/68 mmHg, and a respiratory rate of 22 breaths per minute, indicating a compensatory response likely due to pain and stress. Despite these measures, the patient begins to exhibit signs of systemic involvement. Notably, there is an onset of mild tachypnea and intermittent confusion, suggesting the possibility of systemic inflammatory response syndrome (SIRS) secondary to either the trauma or a developing infection.

In response to these changes, the medical team orders additional laboratory tests, including a complete blood count and blood cultures, to assess for potential bacteremia. The blood cultures return positive for Staphylococcus aureus, raising the concern of a possible osteomyelitis or wound infection, which could further complicate the patient's condition. The elevated white blood cell count, now at 16,200/mm³, corroborates the suspicion of an infectious process. Immediate initiation of broad-spectrum intravenous antibiotics is undertaken, tailored to the suspected pathogen, to prevent further systemic spread and complications.

These developments necessitate a reevaluation of the surgical plan to incorporate debridement and possible drainage alongside fracture stabilization and vascular repair. The interdisciplinary team discusses the need to adjust the patient's care plan accordingly, emphasizing the importance of addressing both the infectious and vascular components swiftly. This coordinated approach aims to reduce the risk of sepsis, preserve limb function, and promote optimal recovery, highlighting the critical role of timely and comprehensive management in mitigating the potential for long-term disability.

Section 3

As the medical team continues to manage the patient's condition, they closely monitor the response to the initiated antibiotic therapy. Within 48 hours, the patient's vital signs show slight improvement, with a heart rate of 102 beats per minute, a blood pressure of 104/70 mmHg, and a respiratory rate of 20 breaths per minute, indicating a potential stabilization of the systemic inflammatory response. However, the patient still experiences intermittent confusion, and new laboratory results reveal a persistent elevation in inflammatory markers, including a C-reactive protein level of 12 mg/L and an erythrocyte sedimentation rate of 45 mm/hr. These findings underscore the need for vigilant monitoring and evaluation of the underlying infection and inflammatory state.

Despite the initial positive response to antibiotics, further assessment reveals localized swelling and redness around the surgical site, with purulent drainage noted upon inspection. This development suggests a possible wound infection, potentially complicating the recovery process and necessitating immediate intervention to prevent further deterioration. The surgical team decides to perform an urgent debridement to remove necrotic tissue and drain any accumulated pus, which is essential to control the spread of infection and promote healing.

In light of these findings, the clinical team emphasizes the importance of a multidisciplinary approach, incorporating infectious disease specialists and wound care nurses to optimize treatment strategies. They also adjust the patient's antibiotic regimen based on culture sensitivities to ensure targeted microbial eradication. This comprehensive approach is critical to addressing both the infectious complications and ensuring successful fracture stabilization, ultimately aiming to preserve limb function and enhance the patient's overall recovery trajectory. As the patient progresses through this critical phase, the team remains vigilant for any signs of new complications, prepared to adapt the care plan to meet evolving clinical needs.

Section 4

A few days post-debridement, the patient's condition takes a concerning turn, illustrating a new complication in the recovery process. Despite the initial improvement in systemic signs, the patient now shows signs of acute respiratory distress. Upon assessment, the patient exhibits increased respiratory rate at 28 breaths per minute, oxygen saturation levels have dropped to 88% on room air, and lung auscultation reveals diminished breath sounds with crackles in the lower lobes bilaterally. The patient's confusion has worsened, and she is intermittently disoriented, which raises suspicion for potential hypoxia or other systemic involvement.

New diagnostic results are prioritized to identify the underlying cause of these respiratory changes. A chest X-ray reveals bilateral infiltrates, suggesting the development of hospital-acquired pneumonia, possibly secondary to prolonged immobilization and compromised respiratory function. Blood cultures are drawn again to rule out secondary bacteremia, and arterial blood gases indicate a pH of 7.31, PaCO2 of 48 mmHg, and PaO2 of 60 mmHg, confirming respiratory acidosis with hypoxemia. These findings necessitate a re-evaluation of the current therapeutic plan and highlight the importance of respiratory support and infection control.

In response to these developments, the clinical team implements an immediate intervention plan. The patient is started on supplemental oxygen via nasal cannula, with plans to escalate to non-invasive ventilation if her respiratory status does not improve. Empiric broad-spectrum antibiotics are initiated while awaiting culture results to address the potential pneumonia, and the respiratory therapy team is engaged to optimize pulmonary hygiene and facilitate secretion clearance. The multidisciplinary team remains focused on addressing this new complication, with an eye toward preventing further escalation of the patient's respiratory compromise and ensuring comprehensive care that supports her recovery from both the fracture and the infectious challenges.

Section 5

Response to interventions:

Following the initiation of supplemental oxygen therapy via nasal cannula at 4 liters per minute, the patient's oxygen saturation improves slightly to 92%, but her respiratory rate remains elevated at 26 breaths per minute. Despite the introduction of empiric broad-spectrum antibiotics, the patient's fever spikes to 101.5°F, suggesting ongoing infectious processes. The patient's mental status, however, shows modest improvement; she is now more alert and oriented to person and place, although she still struggles with recall of recent events.

The respiratory therapy team implements chest physiotherapy and instructs the patient in incentive spirometry usage to enhance lung expansion and secretion clearance. With these interventions, the patient demonstrates increased expectoration of purulent sputum. Repeat arterial blood gases show a slight improvement in pH to 7.35, PaCO2 reduced to 45 mmHg, and a PaO2 of 64 mmHg, indicating partial improvement in respiratory acidosis and hypoxemia. These changes suggest a positive response to the combined respiratory and antibiotic therapies, though careful monitoring remains essential.

However, the team remains vigilant for further complications. Given the patient's prolonged immobility and recent surgical history, there is a heightened risk for thromboembolic events. Prophylactic anticoagulation is considered to mitigate this risk, and the patient's fluid balance is closely monitored to prevent fluid overload, which could exacerbate respiratory compromise. The clinical team continues to assess the need for escalating respiratory support, particularly if the patient's respiratory parameters do not stabilize or if her oxygen requirements increase. This ongoing assessment underscores the need for a dynamic and responsive care plan tailored to address the evolving complexity of her condition.