Clinical Scenario Assignment – ZANE

Clinical Scenario – ZANE CASE SECARIO

Brief statement identifying and succinctly summarising your chosen scenario and what you
will address in the body of your report.
Zane is a 15 year old boy who has been admitted to the emergency ward as he flipped from
a bike and the motorbike landed on his leg which results in swollen and deformed thigh. Zane is in
6/10 pain which has been increased to 9/10 on the movement. Zane has no medical history and has
been updated with the immunisation. He has been diagnosed with proximal femoral shaft
comminuted fracture. Doctor has written for IV opioids which will help him in some relief for pain
management. Zane will require pain medication which helps in faster recovery and results. This
study will highlight, specific aspect of the nursing care and principles of child centred care.
Furthermore, it will also highlight issues related with communication in a specific clinical scenario.
This study will also integrate principles of family centred care while communicating with family
and patient.
Identify one specific aspect of nursing care currently required by the child based on the
information presented in the scenario.
Based on the case scenario, the specific nursing care must be provided to zane is with pain
management in order to recover fast from proximal femoral shaft comminuted fracture. Any injury
in the body tissue near fracture results in pain ( Kacha et al. 2018). There are three stages of pain
due to fracture which includes acute pain, sub- scute pain and chronic pain (Kacha et al. 2018).
Acute pain is occurred when bone is broken immediately after the fracture. Sub acute pain occurs
in the weeks when soft tissues and bones start to heal after the fracture (Chiu et al. 2019). Chronic
pain tends to last for a longer period of time after the fracture (Chiu et al. 2019). In chronic pain
soft tissues of the body have finished healing ( Chou et al. 2015). For jane in the case study the
femoral shaft comminuted fracture is due to high energy collision which is happened because of
motorbike landed on his leg.
Rationale: the nursing care should ensure free motion of weights in order to avoid excess force on
fracture. In relation to this, patient should avoid lifting and releasing weights. Avoidance of
unnecessary movement helps ion preventing pressure deformities (Stainton 2019). In relation to
this, fracture site is supported with folded blankets, trochanter roll, footboard, sandbags, splints and
pillows (Stainton 2019). This will helps in enhancing the healing process (Comfort Devices Used
for Patient in Hospital, 2019). Like wise, patient care is one of the most important care in order to

treat patients. Controlling of pain helps in improving behavioural, psychological and hormonal
outcomes (Ganesan et al. 2016). Conjunction with pharmological therapies helps in lowering level
of pain, anxiety and distress in patients (Gosselin et al. 2017). Relaxation techniques and physical
intervention such as heat and cold compress, massage repositioning are useful strategies in
managing pain to zane (Gosselin et al. 2017). Furthermore, psychological therapies such as
meditation and cognitive behaviour therapy are useful strategy in pain management of zane
(Pennock et al. 2017).
Discuss how the child’s developmental age and stage may impact the way you approach the
child and provide the required nursing care.
(Khow and et.al., 2017) sought to determine the fact that, Child's development age and
stage is critical as it influences the recovery process among individual (Tanner & Arnett 2016).
Child development can be categorized into infancy, childhood, adolescence and adulthood (Tanner
and Arnett, 2016). In accordance with the current case scenario, Zane is of 15 years of age and is at
the stage of early adolescence. This is one of the most crucial period of life where there is a
specific need for health and development. This is a stage where individual goes through various
physical changes like rapid growth, facial hair, development of sexual organs, etc. The femoral
shaft comminuted fracture causes severe pain. The major complications associated with this injury
is leg length difference which can grow up to 2 centimetres in the next 2 years after fracture
(Ganesan et al.2016). This fracture may also result in malunion. This is a situation where the bone
has not healed properly which results in permanent damage to the individual (Ganesan et.al.,
2016).
Child's development leads to psychological, emotional and biological changes which occurs
in human from birth till adolescence. Zane is at its adolescent stage where it goes through various
psychological and physical changes at this stage. In the specific case of Zane, he is suffering from
pain which in turn largely influences the development of child. He is suffering from 9/10 pain
which results in anxiety, depression, lack of normalcy in child's life, physical limitation often leads
to frustration, etc (King et al.2019). Child develops muscles and bones which helps in faster
recovery of pediatric patient. At the early stage, bones of the child is flexible. With the ageing
process, bones tend to get stiff and it in turn results in increasing the frequency of pain in child.
Pain may also affect the growth and development stage of Zane. Nurses should focus on assessing

pain of the child, proper medication and cognitive behaviour therapy. Zane's tissue growth is
affected due to proximal femoral shaft commuted fracture which in turn affects the Endochondral
growth of the bones.
Discuss how you will incorporate the principles of child centred care while providing the
required nursing care.
Child centred care is a practice where young people and children actively participate in the care
program in order to recover from the pain (Shields 2015). Child centred care helps in protecting
and safeguarding the interest of the children (Shields 2015). Bsed on the case study, Zane thigh is
deformed and swollen which made it difficult for him in the movement of leg and results in
significant pain. The key principles of child centred care are:
 Principle of child centered care focuses on cognitive, physical, social and emotional
development. It is very crucial that health care practitioners should create safe and
comfortable environment for the children. This will help nurses to give effective treatment
to Zane for faster recovery process (Coyne, et al 2016). Parents and health care
practitioners must focus on developing physical, social, emotional and cognitive support to
an individual.
 Participation of children in the care process. This helps in independently taking care of
oneself in order to get better results and outcomes (Hill et al. 2018). This in turn helps in
strategic decision making. Zane should freely express his viewpoints in order to effectively
participate in health care decision making.
 Recognizing and being sensitive to the child's unique experience and perspective. In the
given case, Zane is suffering from severe pain and the proper medical treatment should be
given to the child. It helps in finding out the relationship of Zane with family members.
 Family members and health care practitioners should come together in order to provide
better health care services to the Zane. It helps in faster recovery and health outcomes.
Mick and Kelly must work together as a team in order to provide emotional support to the
Zane for better recovery and results. They should be responsible in order to actively
participate in decision making related with Zane health condition.

Communication
(Hoskins et al. 2017) said that, Femoral shaft comminuted fracture can be treated among
adolescents with the help of intramedullary nailing. Knee mobilizer can be used to prevent
movement which helps in keeping the child comfortable (Pennock et al 2017). More rigid nails are
used which is inserted near the hip, at the top of the femur. This is done to interrupt blood flow to
the ball of hip joint (Gosselin et al. 2018). Sub-muscular plating is another way to treat femoral
shaft comminuted fracture (Gosselin et al 2018). Stainless steel plate is inserted under the muscle
of the leg near fracture. Screws are placed across the bone and plate to hold it intact on place. This
in turn will help Zane to recover effectively from femoral shaft comminuted fracture by managing
pain (King et.al., 2019). Mick has surgical team has consented Zane for the surgery, as he will
require metal plates, wires, screws, etc. Traction can be used in Zane to realign and stabilise the
bone fracture in order to reduce pain of fracture before surgery.
The major communication problem in the particular case scenario is that Zane is suffering
from severe pain and is not able to effectively communicate with the parents and nurses. His
parents are arguing about the decision to admit him to surgery and also nervous to discuss anything
with them in his severe pain condition. There is a conflict between Zane parents which results in
agitated argument. Zane was not able to communicate with the parents and make them understand
the pain which he was going through. Likewise, there is no direct communication of parents with
the nurses which in turn affects the decision making and recovery process of Zane. Physical
discomfort and patients anxious behaviour is one of the most important barriers to the
communication in nursing care (Wani et al.2016). This may lead to difficulty in pain management
of the patient which adversely hamper the recovery of the patient (Wani et al.2016). Stress,
anxiety, distress, depression, fear avoidance behaviour, etc. have a positive relationship on chronic
and acute pain describe an issue with communication arising from this scenario.
Discuss how will you address this issue when communicating with this patient and family.
Communication issues in healthcare is very detrimental to the patient care and results in
various medical errors. Zane's parents were arguing which led to increase anxiousness in patients
nad led to major communication problem. Creation of effective patient channel results in effective
care and results. Effective communication helps in better care results and outcomes for Zane.

Health care practitioners should understand the viewpoints of family members and patient for
better treatment. Miscommunication leads to adverse care results and affect the health outcomes of
the patient. Corporation of effective communication in healthcare company requires effective
training programs.
The nursing care focuses on addressing the severe pain caused by Zane due to proximal
femoral shaft comminuted fracture by making parents understand the pain through which Zane is
going in order to give him mental and emotional support. Nursing care will also focus on applying
cognitive behaviour therapy which will help patient on changing the thought patterns in order to
improve the overall functioning of the patient (Dobson and Dozois 2019). Cognitive behaviour
therapy is also very useful in reducing the post surgical pain of the patient due to treatment of
femoral shaft comminuted fracture (Dobson and Dozois 2019). This in turn helps in better recovery
and improves quality of life. Cognitive behaviour therapy helps in increasing the physical
functioning of the individual. This therapy helps in reducing the pain severity and it further helps
in lower intake of IV opioid medication. Nursing care should involve parents in decision making
process to provide better care and support to the patients (Cognitive behavioral therapy to reduce
persistent postsurgical pain following internal fixation of extremity fractures (COPE): Rationale
for a randomized controlled trial, 2019). Effective communication between care takers and patient
helps nursing care to provide customized care according to the need and preference of the Zane for
faster recovery. It helps in better understanding of the needs and want of the patient. Healthy and
positive environment will be maintained for faster recovery and healing of patients (Titov et al.
2015). Nurses focus on providing patients with individualized care and support for better recovery
and health outcomes.
Discuss how will you incorporate the principles of family centred care when communicating
with this patient and family.
Patient and family centered care is important as it helps nursing care in gaining important
information of the patient which in turn helps in decision making (Almasri et al.2018). The core
concepts of family centred care are dignity and respect, information sharing, collaboration and
participation. Dignity and respect: Nursing care practitioners honor family and patient choices,
perspective, values, cultural background, knowledge for better delivery of care. In case of

Zane, it will help in understanding the care values and belief of patients and family
members to attain better care results. Nurses will collaborate with Mick and Kelly in
nursing care in order to gain knowledge related to the patient's culture and belief. It helps in
better health care results to the Zane. Information sharing: It helps in sharing unbiased information which in turn results in
effective decision-making. Nurses will help family to communicate with patients using
various technology and direct communication with the patient in order to gain correct
information. According to this case, the nurses will share information related to the pain
Zane is suffering in order to provide emotional and mental support of parents. Participation : Families and patients participate in decision making and delivery of care. As
per the case, participation principle helps nurses in providing better care by involving
parents in decision making and child care support. Participating patients in family-centred
care helps in better care results ad outcomes. Mick and Kelly must work together as a team
in order to provide emotional and psychological support to the Zane for better health care
outcomes.
 Collaboration: Collaboration of heath care practitioners, family and patients helps in
development of program and best quality care to the patient for higher recovery. This will
help nurses to find best care solution for Zane to provide effective care and treatment. Mick
and Kelly collaborate with health care practitioners in order to manage pain and provide
proper treatment for better care results.
These principles of Patient and family centred care in turn helps in pain management of
Zane by reducing conflicts among parents and care takers. This in turn helps in better
communication and improves the care of the patient by finding best evidence based solution to the
problem (Almasri, An and Palisano, 2018). Taking viewpoints and family centred participating in
decision making process helps in providing the best care to the patient.
CONCLUSION
From the above conducted study it has been summarized that, nursing care should focus on child
centred care and family centred care in order to provide effective care to the patients. This study
helps in highlighting the child development age and stage which influences the recovery process.

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