NUR2206 Integrated Nursing Practice
Added on 2020-02-23
11 Pages3140 Words52 Views
Running head: INTEGRATED NURSING PRACTICEIntegrated nursing practiceName of the StudentName of the UniversityAuthor note
1INTEGRATED NURSING PRACTICESurgical treatment optionsThe surgery for mid-shaft fractured femur depends on time. Mid-shaft femur fractures aretreated depending upon pattern of fracture. Femoral neck fractures, percutaneous pinning orsliding of hip screw and anthroplasty is done for the elderly patients like in the given case studyof Mr.Brown. If the skin around the fracture is still not broken, then it is advisable to wait tomake it stable before surgery. If the fracture is open, it might be exposed to environment and soneed to be cleaned urgently to prevent infection before immediate surgery. The leg is placed inskeletal fraction or long-leg splint between the period of initial emergency care and surgery. Thishelps to keep the broken bones aligned and maintain length of leg. There are three surgicaltreatment options available for the mid-shaft fractured femur. External fixation is a type of operation where screws or metal pins are placed in bonesabove and below the site of fracture. The screws and pins are attached to bar outside skin that actas stabilizing frame for the holding bones in proper position for fast healing. It is a temporarytreatment where external fixators are applied which provide temporary and good stability untilthe femur is healed [ CITATION Kul11 \l 1033 ]. Intramedullary nailing is another surgical option where and currently in use for the mid-shaft femoral fractures opted commonly by most surgeons. In this procedure, a speciallydesigned metal rod is inserted in femur marrow canal. The rod then passes across fracture thathelps to it in position. The intramedullary nail is inserted in the canal at the knee or hip in smallincision. There is crewing at the bones at both ends. This keeps the bone and nail in properposition at the time of healing [ CITATION Gel12 \l 1033 ].
2INTEGRATED NURSING PRACTICEScrews and plates are also done as a surgical operation when the bone segments arereduced or first repositioned in their normal alignment. Metal plates and special screws areattached to the bone outer surface. These screws and plates are often used during intramedulalrynailing which is not possible for the fractures that are extended to knee or hip joints [ CITATIONSmi11 \l 1033 ]. Complications Patients who sustain mid-line femur fracture after a traumatic accident like tractoraccident of Mr. Brown, encounter complications depending upon the severity of break or fracturelocation. The complications include infection, bone healing problems, nerve damage,compartment syndrome or surgical complications [ CITATION Kon14 \l 1033 ]. In fracturedfemur, there can be bone breaking the skin and that increases the risk for infection. If there iswrong alignment of bones or infection that causes irritation, the healing process is delayed andthere is requirement of further surgery. Nerve damage can also occur where there might beweakness or numbness that is a rare complication. Compartment syndrome is also a rarecomplication of femoral mid-shaft fractures where there is compression of blood vessels, nerves,muscles inside compartment or closed space within the body. This generally occurs within thethigh with bleeding or inflammation because of trauma that is associated with the fracture. Incase of this syndrome, immediate operation is required. Surgical complications can also occurdue to hardware failure that is required to stabilize bone or hardware piece that causes pain orirritation. Nerve damage is the possible surgical complication in mid-shaft femoral fracture[ CITATION Par13 \l 1033 ].
3INTEGRATED NURSING PRACTICEMajor complications, nursing interventions and monitoring Depending on the femoral fracture, the major complications in mid shaft femoral fractureaffects the knee, however, in a different way. Femur movement when it breaks, there is ligamentdamage in knee that demand immediate operation for repairing the damage. Heterotopicossification, pudendal nerve injury and Acute compartment syndrome are major complicationsthat might occur post-operation of fractured femur [ CITATION Kai11 \l 1033 ]. Heterotopic ossification occurs with an incidence of 25% as a post-operativecomplication after femur fracture surgery. In this, there is varying severity where bone debrisfrom endosteal canal reaming is deposited in soft tissues that surround the site of nail insertion inIntramedullary nailing surgery [ CITATION Bot13 \l 1033 ]. These debris are stimulate theheterotopic bone formation that decreases debris amount left in tissues after the nailing leading toheterotopic ossification. This complication occurs at the proximal end of reamed intramedullaryfemoral nail posing a complication after the procedure. The nursing intervention is the physicaltherapy where the nurse keeps the patient with involved joint at rest to maintain a functionalposition and perform Passive Range of Motion (PROM) where the body parts are moved withinthe available range without muscle activation [ CITATION Mar11 \l 1033 ]. It is monitored bykeeping into account the movement range of the patient and pain management. Pudendal nerve injury is another main complication that is associated with the fracturesurgery where there is static interlocking in the femur nailing. This neurologic injury is acombination of direct compression and localized ischaemia of perineum against post fracturecountertraction. In this, there is branching of sensory terminals of pudendal nerve that appearsusceptible to injury causing complications after the surgery. It is an important and common
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