Manage Care Simon: A Case

Manage Care

Simon: A Case Study

What preparations should you make for Simon's return to the ward post-operatively?

Simon must be well-situated in a bed where he is able to have the necessary pain and antibiotic medication administered intravenously through a cannula and can be closely monitored by hospital staff. It is essential that a member of the staff monitor Simon immediately after the surgery for any complications or changes in his condition. Also, as much as possible, Simon and his mother must be made cognizant of what has occurred. His mother must be made aware of the need to take notes to prepare her for the treatment of Simon's postoperative condition upon discharge, such as monitoring his pain threshold. The usual prescription for nursing care is to elevate and immobilize the affected leg to prevent swelling, as well as to dress the other areas treated by the surgery with antibiotic-treated dressing. The dressings must be changed daily on the exposed wounds motion ("Fractures of the tibia and fibula," 2008, Chapter 21: Practical Plastic Surgery).

Question 2: Based on Simon's story what observations are you going to perform on Simon in the first 8 hours after his return from theatre?

Swelling in his leg and around his open wounds, loss of sensation in the affected leg, headache from a possible concussion that may be the as-yet undiscovered result from his fall, examining him for possible stress fractures or other fractures that were not immediately obvious upon his entry into the hospital should all be part of his continuing evaluation.

Question 3: Simon complains of increasing pain and tingling in his lower left leg. You notice swelling of his toes. What could be happening and what interventions need to be performed?

It is possible that Simon's circulation is affected from the immobilization of his leg. It is also possible that his vascular status is affected by the injury, or that he may have an arterial injury. To screen for arterial injuries it is advised to check if Simon's capillary refill and the circulation on the top of the foot and behind the posterior tibia's artery. If signs of circulation are not present, a serious arterial injury might be suspected. Simon should also be evaluated for evidence of nerve dysfunction or injury, and he should be checked for sensation in the deep nerve of the first web space on between the big toe and the second toe, the plantar surface of the foot or posterior tibial nerve and the lateral aspect of the foot or sural nerve. He should also be checked as much as possible for active ankle motion and toe motion within the confines of his injury and immobilization ("Fractures of the tibia and fibula," 2008, Chapter 21: Practical Plastic Surgery).

Question 4: Simon's IV cannula has become red and swollen since he had a dose of antibiotics. What may be occurring at the site and what should be done?

Simon is an asthmatic, and asthmatics are often more prone to other allergies. The red and swollen appearance could be an on-site reaction to the administered medication. A change of type of antibiotic medication may be necessary.

Question 5: Simon begins to complain of chest tightness he is beginning to get distressed what may be occurring and what interventions need to be undertaken.

An asthma attack partially brought on by the psychological stress of the surgery and being in the hospital, combined with the physical trauma is likely. Simon, physician permitting, should be allowed with assistance to treat his asthma in the usual fashion, after screening for potentially more serious conditions that can manifest in chest tightness, such as a cardiac condition.

Question 6: You notice that Simon has become disoriented and is complaining of a headache what may be occurring and what interventions need to be undertaken?

Signs and symptoms of a concussion, the result of head trauma, are not always immediately apparent. While rest, which Simon should be receiving in ample amounts, is the best treatment for a concussion, he should be formally evaluated for the condition, to see if he also feels nausea or has ringing in his ears, for example, to see if he has such a trauma, or a more serious injury to his head.

Question 7: What additional nursing considerations should you have when caring for a pediatric patient such as Simon?

Ensuring that Simon knows how to evaluate his state of pain, is not administered too much (or too little) pain medication, that his medications are correctly supervised by a parent, and do not conflict with his other necessary medication, such as his allergy medication, are essential.