Nursing Assignment: Case Analysis of Mr Z’s Pre-Operative Care
This nursing assignment is based on the case scenario of patient, Mr Z.
Mr Z has been admitted to your ward following an unwitnessed fall at home earlier this morning; he has sustained a (R) # NOF and is scheduled for theatre tomorrow morning for a (R) ORIF. And you are the nurse allocated to provide pre-operative person-centred care. Based on the subjective and objective data provided, identify three (3) actual or potential nursing problem statements relating to Mr Z’s pre-operative care. Nursing problem statements should be 3-part statements e.g. Problem related to aetiology (cause) as evidenced by signs & symptoms. Each of these nursing problem statements must be supported by the cues and data from the case scenario and supported with credible, current and relevant literature.
1. Identify three (3) actual or potential nursing problem statements based on the subjective and objective data provided pertaining to Mr Z’s current admission.
Each of these nursing problem statements must be supported by the cues and data from the scenario and justified (referenced) using current and relevant nursing literature. Nursing problem statements should be 3- part statements e.g. Problem related to aetiology (cause) as evidenced by signs & symptoms.
2. Using evidence-based practice, discuss how literature supports each nursing problem statement pertaining to Mr Z’s pre-operative care. The literature needs to be credible, current and relevant.
Introduction to the case of nursing assignment:
Preoperative nursing has relied on the skills and understanding of nursing facilitiesto assess and evaluate the best care and treatment necessary before proceeding with the surgical procedure. In order to provide preoperative care, nurses need to focus on delivering high-quality care, involving a multidisciplinary team, therapeutic communication as well a patient-centred approach along with the surgical team and family (Turunen et al., 2017). The assessment focuses on the case study of MrZ who has been admitted to the surgical ward as he witnessed a fall at home in the morning which led to a fractured neck of the femur. Thus, focusing on the injury, he has been scheduled for Open Reduction Internal Fixation or ORIF the next morning.
Three (3) actual nursing problem: after going through the case scenario of Mr Z and the injury sustained, three actual nursing problems related to the pre-operative nursing acre have been identified which needs to be addressed to ensure better care and management before surgical procedure.
1. Pain:One of the actual nursing problems in the case of Mr Z that is associated with his fractured neck of femur is severe pain. Pain in the groin is considered as one of the most common problems related to fracture neck of the femur which disrupts the movement of the hip. In the case of a femoral neck fracture, the intracapsular region within the hip joint where the lubricating fluid is present sustains fracture. Thus, as the regions sustain a fracture, the blood vessels and tissue witnesses damage which often leads to minimal or no supply of blood within the femoral head (Moore et al., 2021). The conditionled to witnessingsevere pain within the affected regions. As the region gets injured, inflammation within the regions is found to be an active reason behind the development of severe pain. Pain has been accounted as one of the common signs and symptoms of fractured neck of the femur which makes it difficult for an individual to sustain comfort and thus explains the need for nursing care in the phase of pre-operative care (Rowlands et al., 2018). Pre-operative nursing care thus highlights the delivery of significant pain management care to minimize the pain and discomfort of the patient and prepare for surgical procedures.
2. Risk of fall:Another actual nursing problem related to the condition of Mr Z has been identified to be the risk of fall. Mr Z possesses an increased risk of fall and associated injury which might develop a further complication in his health condition. The risk is associated with the issue of immobility related to the fractured neck of the femur which thus explains the need for significant pre-operative nursing care (Basava Alekhya, Harikrishna & Chincholi, 2020). In the case of a femoral neck fracture, the hip sustains fracture due to which the movement of the hip becomes limited and painful. In such a condition the patient witnesses the condition of immobility, and thus the risk of fall and related injury becomes higher.According toLiu, Chan & Irwin, (2020), immobility and deprived quality of life with the associated risk of fall is considered to be one of the major issues or problems in the case of a patient with a fractured neck or femur. Thus, it is necessary for nursing facilities to ensure better care and assistance to patients before surgery in assisting them with mobility.
3. Coxa Vara: One of the last actual nursing issues in the case of Mr Z is Coxa Vara focusing on his condition of hip fracture as the condition occurs as the hip sustains deformity as the angles in between theshaft of the femur and the head gets reducedup to 120 degrees. It leads to develops of a limp along with the shortening of the length of the leg. Coxa Vira occurs as the hip sustains major fractures such as the fractured neck of the femur which if not treated develops into a severe bone disorder.It is known to develop major complication is mobility as fractured neck of femur cause severe pain and immobility, and as the hip sustain deformity causing Coxa Vara, the length of the leg become shorter which thus led to major issues of immobility and risk of fall in the suffering individual Tomar, Govil & Dhawan, 2020).
Three (3) potentialnursing problems: with consideration to the actualrisk associated with the condition of fractured neck of the femur of Mr Z there are three potential nursing problems that have been identified. Theserisk factors are actively identified incaseof a pre-operative acre in surgical settings.
1. Avascular necrosis:Focusing on the actualnursingproblems and the fractured neck of the femur, it has been found that avascular necrosis is one of the potential risk or nursing issues that might take place in the case of Mr Z.As the blood vessels and tissueswithin the fracture region of the hip sustain injury and tear, often blood supply gets disrupted within these regions. In such conditions where appropriate blood is not delivered to the femoral head, the tissues of the bine sustain immediate death which is known as avascular necrosis. It has been found that Avascular necrosis leads to tissue damage and weakening of the bone which causes sudden collapse of the bone (Milenkovic, Mitkovic & Mitkovic, 2020). Thus, it is necessary for the nursing facilities in case of pre-operative care to ensure that the condition of blood supply disruption is managed and treated to avoid the development of a state of avascular necrosis.
2. Fluid imbalance: It has been found that fluid imbalance is one of the potential nursing problems that is found in the case of Mr Z post-fracture which might develop complications within the health of the patient. It has been found that fluid imbalance is occurred within an individual due to reasons such as hypervolemia, hypovolemia as well as normovolemia. Also, trauma has a major role in developing a state of hypovolemia that leads to the risk of fluid imbalance. Post fracture the body sustain pain and injury and thus promotes a state of trauma, in which the patient often suffers from vomiting, dehydration and nausea. It is necessary to focus on maintaining fluid balance in the body to ensure that the fluid is circulated throughout the body in normal concertation (Pollmann et al., 2021). It has often been observed that fluid imbalance leads to a major complication during and post-surgery inpatient with fracture and injury.
3. Deep Vein Thrombosis:Focusing on the state of immobility, it has been found thatMr Z has a potential nursing problem of deep vein thrombosis that might develop and impact his injury. Deep vein thrombosis is known to be one of the majorrisksassociated with the hip replacement or fracture risk of the femur. As the tissue sustain injury and damage of blood vessels, the pressure within the region due to immobility and pressuremightlead to blood clot development. It has a potential risk of travelling to the lungs of the sufferingindividual as breaking out which often causes pulmonary embolism. Focusing on the risksassociated with deep vein thrombosis, it is necessary for focuses on providing nursing care in the pre-operativecondition of patients with fractured neck of femur. It is necessary to routinely monitor the injured region and assess the risks of the development of cloth within the region of injury.
From the assessment, a wider range of understanding and knowledge about pre-operative nursing care has been identified and evaluated. It has been found that nurses play a significant role in providing effective care and treatment to the patient before and after surgical procedures. The different types of actual and potential nursing issues related to the fractured neck of the femur have been evaluated according to the case study of Mr Z which has explained the aetiology as well as signs and symptoms of the illness. The assessment helps in understanding the need for preoperative care focusing on the health issues as well as the issues that might take place in future post-surgery if the signs and symptoms of the current injury are not addressed with proper care.
Basava Alekhya, D., Harikrishna, C., & Chincholi, S. (2020).
Functional outcome of uncemented vs cemented prosthesis in management of fracture neck of femur by hemiarthroplasty: A prospective study. International Journal of Orthopaedics, 6(1), 672-676. Retrieved from: https://www.orthopaper.com/archives/2020/vol6issue1/PartL/6-1-110-238.pdf
Liu, K., Chan, T. C., & Irwin, M. G. (2020). Anaesthesia for fractured neck of femur. Anaesthesia & Intensive Care Medicine. https://doi.org/10.1016/j.mpaic.2020.11.005
Milenkovic, S., Mitkovic, M., & Mitkovic, M. (2020). Avascular necrosis of the femoral head after traumatic posterior hip dislocation with and without acetabular fracture. European Journal of Trauma and Emergency Surgery, 1-7. https://doi.org/10.1007/s00068-020-01495-x
Moore, E., Obst, S., Heales, L., Clift, K., & Stanton, R. (2021). Pre-hospital immobilisation for neck of femur fractures in Australia-a break in the evidence. Nursing assignmentAustralasian Journal of Paramedicine, 18. https://doi.org/10.33151/ajp.18.919
Pollmann, C. T., Mellingsæter, M. R., Neerland, B. E., Straume-Næsheim, T., Årøen, A., & Watne, L. O. (2021). Orthogeriatric co-management reduces incidence of delirium in hip fracture patients. Osteoporosis International, 1-9. https://doi.org/10.1007/s00198-021-05974-8
Rowlands, M., van de Walt, G., Bradley, J., Mannings, A., Armstrong, S., Bedforth, N., ... & Sahota, O. (2018). Femoral nerve block intervention in neck of femur fracture (FINOF): a randomised controlled trial. BMJ open, 8(4), e019650. http://dx.doi.org/10.1136/bmjopen-2017-019650
Tomar, L., Govil, G., & Dhawan, P. (2020). Bilateral Femoral Neck Stress Fracture in an Obese Middle-Aged Female With Osteomalacia and Coxa-Vara Managed by Simultaneous Bilateral Total Hip Arthroplasty. Cureus, 12(11). doi: 10.7759/cureus.11478
Turunen, E., Miettinen, M., Setälä, L., & VehviläinenJulkunen, K. (2017). An integrative review of a preoperative nursing care structure. Journal of clinical nursing, 26(7-8), 915-930. https://doi.org/10.1111/jocn.13448