Open Reduction Internal Fixation Worksheet

Open Reduction Internal Fixation Worksheet

You are working evenings on an orthopedic floor. One of your patients, J.O., is a 25-year-old man who was a new admission on day shift. He was involved in a motor vehicle accident (MVA) during a highspeed police chase on the previous night. His admitting diagnosis is status post (S/P) open reduction internal fixation (ORIF) of the right femur, multiple rib fractures, sternal bruises, and multiple abrasions. He speaks some English but is more comfortable with his native language. He is under arrest for narcotics trafficking, so one wrist is shackled to the bed and a guard is stationed outside his room continuously. Another drug dealer told him he is “coming to get him.” Hospital security is aware of the situation. Your initial assessment reveals stable vital signs (VS) of 116/78, 84, 16, 98.6 ° F. His only complaint is pain, for which he has a patient-controlled analgesia (PCA) pump. Lungs are clear to auscultation. His abdomen is soft and non-tender. He has a nasogastric tube connected to intermittent low wall suction. His IV of D5LR is infusing in the proximal port of a left subclavian triplelumen catheter at 75 mL/hr; the remaining two ports are heparin-locked. His right femur is connected to skeletal traction. The dressing is dry and intact over the incision site. J.O.’s right leg is connected to 10 pounds of skeletal traction. 1. J.O. has not had a cigarette since the accident. He is irate because the day nurse would not let him smoke. What is your major concern about J.O.’s smoking? 2. Do you think J.O. would be a good candidate for a nicotine patch? Why or why not? State your rationale. 3. J.O. has an antiembolism stocking ordered for his left leg. What is the rationale for putting stockings on this leg only? 4. J.O. has a Foley catheter inserted to drain his urine. What would you assess for in relation to the Foley catheter? 5. In view of the threat made on J.O.’s life and his vulnerable situation, what precautions should the nursing unit take to protect him? CASE STUDY PROGRESS The nurse in the emergency department phones to tell you that J.O.’s immunization status could not be determined when he arrived, so no tetanus immunization was given. When you ask J.O. the date of his last tetanus shot, you find out that he was born and raised in Colombia and immigrated to the United States 5 years ago. He does not know whether he has ever had a tetanus shot. You inform the physician, and he orders diphtheria/tetanus toxoid 0.5 mL IM and tetanus immune globulin (HyperTET) 250 units deep IM. 6. Why is J.O. getting two injections? 7. When you give J.O. the tetanus injections, you find J.O. in the position illustrated below. Are any of these findings of concern to you? If so, how would you fix it? 8. While assessing distal to the fractured femur, you note that his toes are slightly cool to the touch. What other assessment findings should be gathered? CASE STUDY PROGRESS At 2100, J.O.’s guard summons you to his room. J.O. is pale, slightly confused, and complaining of chest pain and dyspnea. VS are 90/60, 120, 28, 100.0 ° F (37.8 ° C), and Sa O 2 of 84%. His pulse is weak and thready, and there are petechiae on his chest. You immediately suspect a fat embolism. 9. Explain the pathophysiology of a fat embolism. 10. List the priority actions you should take next and the rationale for each. Arterial Blood Gases on 2 L Nasal Cannula pH 7.32 Pa CO 2 53 mm Hg HCO 3 22 mmol/L Pa O 2 84 mm Hg 11. Interpret J.O.’s ABG results. The physician comes and examines J.O. He writes the following orders, then leaves, stating he will be back in 1 hour to check on J.O. 12. Describe a plan for implementing these orders in order of priority. 13. What is the expected outcome associated with each of the medications ordered for J.O.? Physician’s Orders Bed rest Oxygen (O 2 ) to maintain Sa O 2 of 90% Change D5LR IV rate to 125 mL/hr ECG monitoring Repeat arterial blood gases (ABGs) in 1 hour CBC with differential and serum lipase now STAT CXR Methylprednisolone (Solu-Medrol) 12 mg IVP now Furosemide (Lasix) 60 mg IV push now Digoxin 0.25 mg IV push now ■ Chart View Arterial Blood Gases on 10 L Face Mask pH 7.29 Pa CO 2 56 mm Hg HCO 3 22 mmol/L Pa O 2 74 mm Hg 14. J.O. is placed on oxygen at 10 L via face mask. ABGS are redrawn after 1 hour. Interpret the results. 15. What intervention do you anticipate, based on your interpretation of these values? CASE STUDY PROGRESS The physician returns to reexamine J.O. Because J.O.’s status is deteriorating, despite the application of oxygen and the administration of the IV medications, the physician writes to transfer J.O. to the ICU for ventilator support. 16. You accompany J.O. on the transfer to the ICU. Why would you do this, and what information would you provide to the ICU nurse? CASE STUDY OUTCOME J.O. recovered for several weeks in the hospital before being sent to jail to await trial. Shortly before his trial date, he was found stabbed to death in his cell. …

Homework Market
Calculate your paper price
Pages (550 words)
Approximate price: -

Why Homework Market

HomeworkMarket

Quality Researched Papers

We always make sure that writers follow all your instructions precisely. You can choose your academic level: high school, college/university or professional, and we will assign a writer who has a respective degree.

Homework Market

Qualified Writers

We have hired a team of professional writers experienced in academic and business writing. Most of them are native speakers and PhD holders able to take care of any assignment you need help with.

HomeworkMarket

Unlimited Revision

If you think we missed something, send your order for a free revision. You have 10 days to submit the order for review after you have received the final document. You can do this yourself after logging into your personal account.

HomeworkMarket

Timely Delivery

All papers are always delivered on time. In case we need more time to master your paper, we may contact you regarding the deadline extension. We will always strive to deliver on time.

HomeworkMarket

Original & Confidential

We use several writing tools checks to ensure that all documents you receive are free from plagiarism. Our editors carefully review all quotations in the text.

HomeworkMarket

Customer Support 24/7

Our support agents are available 24 hours a day 7 days a week and committed to providing you with the best customer experience. Get in touch whenever you need any assistance.

Try it now!

Calculate the price of your order

Total price:
$0.00

How it works?

Follow these simple steps to get your paper done

Homework Market

Place your order

Fill in the order form and provide all details of your assignment.

Homework Market

Proceed with the payment

Choose the payment system that suits you most.

Homework Market

Receive the final file

Once your paper is ready, we will email it to you.

Homework Market Writing Services

No need to work on essay at night. Sleep tight, we will cover your back. We offer all kinds of essay writing services.

HomeworkMarket HomeworkMrket

Essays

Essay Writing Services

No matter what kind of academic paper you need and how urgent you need it, you are welcome to choose your academic level and the type of your paper at an affordable price. We take care of all your paper needs and give a 24/7 customer care support system.

HomeworkMarket HomeworkMarket

Admissions

Admission Essays

An admission essay is an essay or other written statement by a candidate, often a potential student enrolling in a college, university, or graduate school. You can be rest assurred that through our service we will write the best admission essay for you.

HomeworkMarket HomeworkMarket

Editing

Essay Editing

Our academic writers and editors make the necessary changes to your paper so that it is polished. We also format your document by correctly quoting the sources and creating reference lists in the formats APA, Harvard, MLA, Chicago / Turabian.

HomeworkMarket HomeworkMarket

Research Paper

Research Paper

If you think your paper could be improved, you can request a review. In this case, your paper will be checked by the writer or assigned to an editor. You can use this option as many times as you see fit. This is free because we want you to be completely satisfied.