Nursing Anatomy Essay 2022

Running head: NURSING
NURSING
Name of the Student
Name of University
Author’s note

NURSING
With an increase in age, there occur inevitable biological modifications in the
human body that increase the likelihood of suffering from disability and illness ( Taneja
et al., 2016). The case studies to be discussed here involved a septuagenarian John
and 7 year old Jacob Murray, who had been admitted to the emergency department for
the treatment of a fractured tibia. The fracture occurred when they encountered an
accidental fall The priority problem selected is potential for impaired skin integrity
related to altered circulation. The essay will elaborate on the anatomy, physiology, and
pathophysiology of the condition presented by the patients, in order to support evidence
based interventions. It will also apply decision making and chemical resetting framework
that are in accordance to the standards of practice.
The tibia is generally found on the medial portion of the leg, adjacent to the fibula
and is situated close to the central line or the median plane. It is also associated by the
interosseous membrane to the fibula, and leads to the formation of the syndesmosis,
which is a special kind of fibrous tissue joint that shows restricted movement (Schenk et
al., 2018). In addition, it is a component of four joints namely, the ankle, the knee, the
inferior and superior tibiofibular joints, and when present in the knee, it results in the
formation of one of the two major articulations in relation to the femur that is often
known as the tibiofemoral component. According to Smith et al. (2016) this tibiofemoral
component is considered as the weight-bearing region of the nature, and therefore
fracture in the tibia (right or left) will prevent the patients from bearing weight. This is the
reason why both John and Jacob are experiencing problem while walking.
In case of Jacob it is undisplaced spiral fracture and for John it is undisplaced
transverse fracture. In both cases the bone cracks either in parts or all of the way
1

NURSING
through, however it does move and maintains the proper alignment. Since the bone is in
proper alignment, both John and Jacob are able to wiggle their toes. Although there are
no nociceptors present in the bone tissue, this bone fracture resulted in painful
sensation due to oedema of the soft tissues that are located nearby (Hurtgen et al.,
2016). This in turn occurred as a result of fracture of the bone marrow that evoked
pressure pain. In addition, it might also have resulted in a breakage in the continuity of
periosteum that comprises of pain receptors. Furthermore, skin integrity refers to skin
health and impairment in skin integrity in the patient suggests that the fall resulted in
damage to the skin, which made it vulnerable to injury, thus preventing normal healing
process. The breakage in the skin integrity is the reason why both John and Jacob is
experiencing inflammation in the breakage area. Breakage in the bone hampers the
disruption of the blood vessels in the bone that are important for maintaining the skeletal
functioning along with the development of homeostasis and repair (Tomlinson & Silva,
2013).
This disruption of the blood vessel flowing to the bone leads hampers the
vascularisation or the circulation. This disruption in the blood flow hampers the
underlying skin integrity beneath the subcutaneous layer of the skin. This might be the
reason why Jacob and John is experiencing pain at the site of fracture (8/10 and 7/10 in
pain score respectively) along with warm temperature over the affected area of the skin.
John is also having bruise 7cm x 4cm anterior mid shaft. Since he is 72 years old,
Jacob might be suffering from poor skin integrity due to loss of the connective tissue of
the skin and this might lead to delay in wound healing. Jacob is 7 years old and thus
2

NURSING
has firm skin integrity unlike John. He also does not have osteoporosis and thus his
inflamed area of anterior mid-shaft is 5cm x 3cm (Marenzana & Arnett, 2013).
On analysing the case studies it can be suggested that sheer force, friction, and
pressure from immobility have put the patients at a risk for impaired skin integrity. On
conducting a health assessment it was found that John weighed 85 kg, hence signifying
that he was overweight, which in turn put him at a risk (Potes et al., 2017). In addition,
since the patient was aged 72 years, old age resulted in slowing the process of skin
breakdown that lead to normal loss of skin elasticity and vascular insufficiency
(Coleman et al., 2013). The fall from the ladder resulted in mechanical trauma. In
addition, osteoporosis also weakened the bones and increased his risk of suffering from
altered skin integrity. Jacob is much young to John; he is 7 years old and has ideal
weight (26 kgs). Thus his bone and skin healthy is comparatively healthy to John.
However, main risk factor is, since he is child, he might experience problem with the
effective management of pain resulting from bone displacement and breakage of skin
integrity.
Assessment of the level of pain using numeric pain rating scale will be important
in order to determine the intervention that must be given in order to improve the
wellbeing for both John and Jacob. Taking into consideration the age of John, the
overall condition of the skin will be assessed, which will provide baseline data for the
proposed intervention. A healthy skin is expected to have good turgor, which indicates
the presence of moisture, and it must feel dry and warm and be free from any kind of
impairment. In addition the capillary refill time will also be assessed (Foster, Fix &
Bergerhofer, 2018). The bony prominences such as, the sacrum, heels and inner and
3