Fractured Femur

Patient Profile
N.E. is a 32-year-old male who sustained a closed, complete, oblique fracture of the left femur in a single vehicle motor vehicle accident.  He is being admitted to the orthopedic floor from the ED and is scheduled to have surgery tomorrow afternoon. He states he had asthma as a child and denies any other health problems.

Subjective Data

• Rates pain in left leg as 4 on a 0 to 10 pain scale after receiving 4 mg morphine IV in the ED 30 minutes prior to arrival on the orthopedic unit
• States his parents and girlfriend saw him in the ED and have gone home for the night and will come back tomorrow before his surgery

Objective Data

• Temperature  98.9° F, pulse 88, respirations 18, blood pressure 132/70
• Alert and oriented x 3
• Abrasion to forehead and multiple abrasions to arms and legs
• Left leg to 10 lbs. of Buck’s traction
• Bilateral feet/toes warm and pink with movement and sensation equal and within normal limits
• Dorsalis pedis  and posterior tibial pulses palpable at 3+

Collaborative Care
Admitting orders

• Bedrest
• 10 lb Buck’s traction to left lower extremity
• NPO
• IV Lactated Ringer’s @ 125 mL/hour
• Morphine sulfate 2 mg IV every 2 hours PRN for pain
• Cefazolin (Ancef) 1 mg IV on call to OR

Discussion Questions

1. What does N.E.’s diagnosis of a closed, complete, oblique fracture of the left femur mean?

2. What is the purpose of applying Buck’s traction and what interventions do you employ to  maintain the traction system?

3. What specific assessments need to be performed for N.E.?

4. What potential complications is N.E. at risk for due to his reduced mobility? Describe interventions to include in his plan of care to prevent each complication.

Case Study Progress
Two hours after admission, N.E. requests pain medication for pain of a 5 in his left upper leg and you administer 2 mg IV morphine. Fifteen minutes later, he states that his pain level is reduced to a 2.  Two hours later, N.E. states he has pain in his lower left leg and rates it a 10.  You administer another 2 mg morphine IV and reassess his pain 15 minutes later. He states that his pain is unchanged and is still a 10 in the left lower leg.

5. What additional assessments do you need to make at this time?

6. N.E. states that he has some numbness and tingling in his left foot.  What do you suspect and what should you do?

7. Using SBAR, what information would you provide the surgeon when you call?

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