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05/20/2012

Case Study Assessment


Case Study Assessment

Introduction

A child (4/12; female) has a fracture in the shaft of her femur. She was placed in Gallows traction. The legs with a fractured femur are suspended from a bar with adhesive strapping and it is held in a place and secured with several turns.

1.0 Nursing Care Plan

Nursing Problems

Causes

Ischemia or an insufficient supply of blood to an injured part

due to a blocked artery of a child

Inappropriate intervention

Older/ heavier infants with leg traction

Appositional growth of the bones the leads to misalignment

Unsuccessful Gallows traction

Other vascular problems, including severe compartment syndrome

Due to the elevated position of the legs, straightness of the knees and tightness of bandages

 

2.0 Signs and Symptoms

2.1 Subjective and Objective Data

The following information is extracted from the Functional Health Patterns assessment form the patient/child:

Subjective

Objective

She use to cry to express the pain

There is a sign of discomfort

 

Irritated when she is surrounded by people and strangers

 

3.0 Nursing Intervention and Expected Outcomes

The following information contains the information regarding the implemented nursing interventions and the anticipated results and improvements.

Nursing Intervention

Expected Outcomes

Securing the strapping is highly important and checking the circulation in her toes is requested, especially during the first 3 days. It is advised to keep the traction for 3 weeks

Avoid the main cause of ischemia that impairs circulation

Treatment should consider not only traction but with spica cast, or combination of both

There is an improvement especially on older/ heavier infants

Examine the skin daily release bandages but not disturbing the adhesive traction.

Maintain the health progress of the child

Apply the traction carefully, use adhesive skin traction, allow some knee flexion and don't bandage too tight

To move the leg and improve the circulation of the blood without hurting the child

 

4.0 Nursing Documentation

*Following DAP format

Data: Child’s Health Assessment: Gordon’s Functional Health Patterns

Functional Health Pattern

Pattern Description

Health Perception/Management

Taking analgesic, regular exercise and check-ups

Nutritional-Metabolic

There is a change in the build of the child and affects the weight

Elimination

There is a slight difficulty in attending the needs in excretion

Activity - Exercise

Light mobility and plays

Cognitive-Perceptual

May cried loudly especially at night

Sleep-Rest

Disturbing sleep because of the traction

Self-Perception/Self Concept

Noticed discomfort and accompanied with limitations in movements

Role-Relationship

Little anxiety and discomfort with nurses

Sexuality-Reproductive

NA

Coping/Stress Tolerance

During examination, the child is given with familiar toys

Value - Belief

NA

 

Analysis

The Functional Health Patterns are based on the child assessment. The table shows the functions of the child and the phase of her recovery. The descriptions are based on the observation on the child and the actions taken during her stay with the medical professionals.  The nursing intervention applied for the patient can achieve the expected outcomes. However, a child/infant is more vulnerable and a little discomfort and pain is expected from them. The knowledge that the nurses can gain should be applied in the next coming cases of children.

Plan: Genogram  

The Genogram represents the familial relationships and patterns of behavior. Its main purpose is to orient and engage the family in pictorial summarizing and illustrating the familial relationships and patterns of behavior of the child within the family system. This aims to support the family in the assessment and intervention planning for the recovery of the child. Rounded Rectangle: After learning the outcome of the child care, the family are expected to participate in the fully recovery of their child. Through the guidance of the nurse/s, the parents can gather the right method in the examination and recovering exercise of the child. Each member of the family will help in the prevention of the increase in fracture on the child and promote the well being.

Rounded Rectangle: Parent
Rounded Rectangle: Parent
 
Oval: Child
 
 
Oval: Son
 
 
Text Box: Grandfather
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


 

SOAP

Subjective

Objective

Cries loudly to catch the attention of the nurses and her family

There is a grimace of her face during the exercise

 

She always reach for the straps as a sign of discomfort

 

There is an active physical function

 

Analysis

The implemented nursing intervention might be foreign to the infant that is why she often refuses to take the examination. However, the light exercises performed are made by the parents who are actually guided by the nurses. With the help of her toys and the playful faces of her family members, the attention of the child towards the exercise and medication is temporarily parted. 

Plan: Ecomap

The Ecomap represent s the family’s connection to the child and the system in their environment. It illustrates the three separate dimensions – strength, impact, and quality. Through the illustration it will classify the needs of the family and the decision making about the potential interventions. Furthermore, it creates a shared awareness in between the family and their nurses that will give a significant connection and influence that can be the basis for the decisions.

 

Through the contribution of the nurses, the family will gain the idea in the promotion of the recovery of the child. In addition, the economic condition, and social and environmental factors can affect the continuous promotion and recovery of the child. The external support received by the family is good indications that the family has the opportunity in the promotion of child’s health.

Discharge Plan

An infant of walking age, with isolated femoral fracture is more likely to be accidental than non-accidental injury. The Gallows traction is used to make nursing easier and does not need plaster. For small children, there is an immediate monitoring action. It is better if the treatment will be held in the health care settings because many families will find it difficult to nurse the child with fractures and as much as possible, to avoid additional risks. Furthermore, this will help the early detection of ischemia. Therefore, the discharge date should be moved to 4/9. This is because by the second week, the strapping will shows the signs of strains and by 3 weeks it will be wearing out, then the child will be set free for advanced observation of recovery, and she can go home.

Work Cited:

Calnan, M., Gabe, J. & Williams, S.J. (2000) “Health, Medicine, and Society: Key   Theories”, Future Agendas. Routledge.

Ostrum, R.F., (2006) “Femoral Shaft Fractures”, Cooper Hospital, Accessed 26 August 2010, from <http://www.ota.org/res_slide/L04_Femur_Shaft_ST_Fx.ppt>

Pearson, A., Wiechula, R., Court, A., & Lockwood, C., (2007) “A Re-Consideration of What Constitutes ‘Evidence’ in the Healthcare Professions”, Nursing Science Quarterly, Vol. 20, No. 1. 

Wieting, J. M., (2005) "Massage, Traction, and Manipulation." Medscape, Accessed 17 August 2010, from <http://emedicine.com/pmr/topic200.htm>

 

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