Reference no: EM133565611
Joanne is a 23-year-old female who was involved in a motor vehicle crash. She was wearing a seatbelt and was hit on the driver's side by an SUV. The Paramedics at the scene extricated her from the car. After being treated in the local emergency room Joanne was transported by air ambulance to the University of Alberta Hospital for further treatment. Joanne has no known allergies and does not take any prescription medications. She is single but has a serious relationship with a 20-year-old-male Tom. Joanne has recently moved out of her parent's home into a third-floor apartment. The apartment does not have an elevator. CASE STUDY You are the LPN receiving Joanne into care from the transferring paramedics. Joanne is being repatriated to your Acute Care unit from the University of Alberta hospital 3 days Post MVC. Joanne's had an ORIF (Open Reduction Internal Fixation) of Left Tibia/Fibula fractures, a chest tube inserted to the left chest for a hemothorax. Her chest tube is connected to a pleur evac that is connected to low constant suction draining small amounts of serous fluid, and 6 fractured ribs in the left ribcage. Nursing Foundations III: Medical/Surgical Nursing The orthopedic surgeon's order states Joanne should be ready for crutch walking in 7 days. She states she has pain in her left leg and chest. She rates her pain as 6/10. She has an indwelling Foley catheter attached to straight drainage that is draining clear urine. Joanne states she is glad to be back home, as she was lonely in Edmonton. VS= T-36.8, HR-76, RR-16, BP-108/66, and SPO2 92% on room air. DOCTORS ORDERS Morphine 5 mg IV Q2h PRN Ketorolac 30 mg IM BID PRN No weight bearing on left leg. Crutch walking trial after 7 days Physiotherapy to assess. keep SPO2 greater than 92% DAT VS Q4h Incentive spirometer Q1h while awake
QUESTIONS
1. What are your immediate priorities for Joanne's nursing care?
2. Describe what assessments are required to assess the adequacy of circulation and sensation to her legs.
3. Why is a chest tube an effective treatment for a hemothorax? What assessments and care are required for a patient with a chest tube?
4. Joanne's chest tube suddenly stops draining. What do you suspect has happened and what nursing interventions should the nurse take? What symptoms do you anticipate Joanne to display?
5. What is the purpose of using the incentive spirometer directly related to Joanne's symptoms and condition?
6. Joanne has constant 6/10 pain to her left leg and ribs; she requires dressing changes and a sponge bath today. What pain medication would you administer and prioritize your nursing interventions, provide rationale for both.
7. Develop a care plan for Joanne using 1 PRIORITY nursing diagnosis and 3 goals using SMART criteria and 2 interventions for each goal with evidence-based ration.