Orthopedic Surgery and Bone Fracture Pain †MyAssignmenthelp.com

Question: Discuss about the Orthopedic Surgery and Bone Fracture Pain. Answer: Introduction: Mr Ben Casey is a 38 years old man, who was admitted to the Emergency Department after a motor vehicle accident. Ben is an electrician and lives in a two bedroom unit with his partner and a two years old son. Ben had an accident, while he was driving back to home from his mates place. He also self-reported that he had lots of drinks at a friends party. While coming back to home he was hit by an unidentified object on the road, due to which he lost control on the bike and skidded into a metal fence. Due to this accident Ben had to suffer from the fractures in the left tibia and left femoral bones. The wounds were open and the tibial bone could be seen. X-Ray informed about the oblique fracture in the left femur and open displaced fracture in left tibia. The surgery was conducted that included insertion of intramedullary rod in left femoral canal and use of nails and plates to fixate the tibial fracture. Assessment of the patient after the surgery was carried out in order to identify the significant and potential risks that are affecting or could affect patient after the surgery. The observations documented on the first assessment of patient on ward include the self reported pain score that is 7/10 in the left leg. The pain score of the patient can inform about the severity of pain. The underlying pathophysiology associated with Pain on the wound site could be associated with infection or could be due to the sympathetic nervous systems response and the potential tissue damage at the surgical wound site (Carli, 2015). The main patho-physiological reason behind this is the inflammatory response of the body that is directed by the sympathetic nervous system and severity of this inflammatory response results in acute pain (Christiano et al, 2016). However, the assessment of wound site, and psychological alertness of the patient informs about the pain being a response process after surgery. Skin assessment of the patient was also carried out that informed that skin of the foot is pink and warm and no signs of swelling were identified. Patient was also assessed to inform, if he is experiencing cramping pain in calf, foot or ankle. Heart rate and respiratory rate of the patient were also assessed that informed that HR is 120bpm and respiratory rate is 24 bpm. Therefore, HR and RR are found to be within normal ranges and no signs of complications were identified. This assessment is also focused on early identification of Deep Vein Thrombosis (DVT). Though, it did not occur in this case, risk of this complication is very high in the patients experiencing trauma and surgery in Lower extremities (Auer Riehl, 2017). The first identified health problem associated with the case of Ben is problem of acute pain. Pain after the surgery is common, but acute pain can result delayed wound healing. Pain is a sensory and emotional experience that can result in the development of stress and anxiety. Wound related pain can result in negatively affecting the patient and threatening their quality of life (Upton, Solowiej, 2010). Also the experience of stressful event can negatively affect the patient and can compromise with the patients recovery and wound healing. Pain can also affect functionality and mobility of the patient and can cause activity intolerance (Mann, Carr, 2018). Intervention Type Example Required Information Pain management is the first strategy that would be applied in the case of Ben Vital sign assessment will be carried out to analyze the physical effects of pain. Assessment of the pain characteristics will be done such, quality, severity, location and onset of pain. Assessment of pain is very significant for planning the pain management strategies (Whiteing, 2008). Correct assessment of the pain is also significant to ensure that correct analgesic is prescribed or administered. Administration of Analgesia Administering Nonsteroidalanti-inflammatory drugs (NSAIDs) (Majuta, et al, 2015) NSAIDs are considered to be very effective in managing moderate to severe pain and do not cause sedating effect (Mann, Carr, 2018) Non-Pharmacological Pain Control Patient will be encouraged to change position. Foot massage can be given to the patient. Positioning helps in enhancing comfort and reducing pain. Massage helping providing comfort to the patient and also distract patient from sensation of pain (Buckenmaier, et al, 2016) Deep Vein Thrombosis (DVT) DVT is mainly associated with the fractures, surgeries or trauma in the lower extremities that increase the rate of morbidity and mortality. DVT is characterized with the formation of the blood clot in the major deep vein of the leg, thighs or pelvis. The surgical procedure can result in affecting the deep vein of leg and result in formation of blood clot (Van Gent et al, 2017). Some of the common signs and symptoms of DVT are pain, swelling, edema in foot and ankle, warm and discolored skin, rapid breathing and shortness of breath and leg cramps. The pathophysiology of DVt associated with trauma in lower extremities includes the proximal vein and valves. Damage in the proximal vein caused due to trauma results in Hypercoagulability that increases the risk of formation of clot (Kapoor et al, 2016). In the given cases scenario, Ben has experienced the traumatic injury in the lower extremity and fractures that increases the risk of occurrence of deep vein thrombosis in his case. Theref ore, nursing intervention will focus on preventing the condition. Nursing Priority Interventions Required Information Preventing Deep Vein Thrombosis (DVT) Intervention will include regular monitoring of the heart rate, respiratory rate, skin integrity and also blood pressure and temperature of the patient. Pulmonary embolism is also a significant Complication associated with deep vein thrombosis that requires vital signs monitoring (Piazza, Hohlfelder, Goldhaber, 2015). Monitoring and documenting vital signs is very significant because vital signs can help in early identification of development of Deep Vein Thrombosis (DVT). Therefore, respiratory assessment of the patient will be regularly conducted to identify the signs of respiratory distress or obstruction caused due to pulmonary embolism (Piazza, Hohlfelder, Goldhaber, 2015).. Keeping Blood Flow Patient will be encouraged to wear Sequential compression devices (SCDs), for example compression stockings. SCDs help in squeezing the leg and keep the blood moving and prevent blood clotting (Kreutzer, Minami, Yang, 2016). Educating Patient Providing patient with the information about post-operative exercises and Early Ambulation Patient will be informed about light weight bearing exercises to improve blood flow and prevent DVT (Kreutzer, Minami, Yang, 2016). Early ambulation increases mobility and prevents DVT. References Auer, R., Riehl, J (2017). The incidence of deep vein thrombosis and pulmonary embolism after fracture of the tibia: An analysis of the National Trauma Databank.Journal of Clinical Orthopaedics Trauma,8(1), 38-44. Available from: https://www.journal-cot.com/article/S0976-5662(16)30060-1/abstract Brown,D, Edwards, H,Seaton ,L Buckley,T.,(eds) (2015). Lewis medical-surgical nursing: assessment and management of clinical problems. 4th edn, Elservier Australia, Chatswood, NSW. Buckenmaier, C., Cambron, J., Werner, R., Buckenmaier, P., Deery, C., Schwartz, J., Whitridge, P (2016). Massage therapy for paincall to action.Pain Medicine: The Official Journal of the American Academy of Pain Medicine,17(7), 1211. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4925169/ Carli, F (2015). Physiologic considerations of Enhanced Recovery After Surgery (ERAS) programs: implications of the stress response.Canadian Journal of Anesthesia/Journal canadien d'anesthsie,62(2), 110-119. Available from: https://link.springer.com/article/10.1007/s12630-014-0264-0 Christiano, A. V., Pean, C. A., Konda, S. R., Egol, K. A (2016). Predictors of patient reported pain after lower extremity nonunion surgery: the nicotine effect.The Iowa orthopaedic journal,36, 53. Available From: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4910799/ Kapoor, C. S., Mehta, A. K., Patel, K., Golwala, P. P (2016). Prevalence of deep vein thrombosis in patients with lower limb trauma.Journal of Clinical Orthopaedics Trauma,7, 220-224. Available from: https://www.journal-cot.com/article/S0976-5662(16)30143-6/abstract Kreutzer, L., Minami, C., Yang, A. (2016). Preventing venous thromboembolism after surgery.Jama,315(19), 2136-2136. Available from: https://jamanetwork.com/journals/jama/fullarticle/2521971 Majuta, L. A., Longo, G., Fealk, M. N., McCaffrey, G., Mantyh, P. W (2015). Orthopedic surgery and bone fracture pain are both significantly attenuated by sustained blockade of nerve growth factor.Pain,156(1), 157. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4495732/ Mann, E., Carr, E. (2018). Pain management.Foundation Studies for Caring: Using Student-Centred Learning, 259. Available from: https://books.google.co.in/books?hl=enlr=id=riFHDwAAQBAJoi=fndpg=PA259dq=Mann,+E.,+%26+Carr,+E.+(2018).+Pain+management.+Foundation+Studies+for+Caring:+Using+Student-Centred+Learning,+259.ots=9kE6b6SbOQsig=S5m9PLay1sTH6u0gjzM7fgw-wKE#v=onepageqf=false [Accessed 4th April, 2018] Piazza, G., Hohlfelder, B., Goldhaber, S. Z. (2015) Pathophysiology of Deep Vein Thrombosis and Pulmonary Embolism: Beyond Virchows Triad. InHandbook for Venous Thromboembolism(pp. 15-20). Springer, Cham. Available from: https://link.springer.com/chapter/10.1007/978-3-319-20843-5_3 Upton, D., Solowiej, K (2010). Pain and stress as contributors to delayed wound healing.Wound Practice Research: Journal of the Australian Wound Management Association,18(3), 114. Available from: https://search.informit.com.au/documentSummary;dn=364536431309445;res=IELHEA Van Gent, J. M., Calvo, R. Y., Zander, A. L., Olson, E. J., Sise, C. B., Sise, M. J., Shackford, S. R. (2017). Risk factors for deep vein thrombosis and pulmonary embolism after traumatic injury: A competing risks analysis.Journal of trauma and acute care surgery,83(6), 1154-1160. Available from: https://journals.lww.com/jtrauma/Abstract/2017/12000/Risk_factors_for_deep_vein_thrombosis_and.23.aspx Whiteing, N. L. (2008). Fractures: pathophysiology, treatment and nursing care.Nursing Standard (through 2013),23(2), 49. Available from: https://search.proquest.com/openview/7132041950e359f4182fdefbda4cf169/1?pq-origsite=gscholarcbl=30130