Nursing Assessment and Care Planning for Lower Leg Fracture Patient

Miss Jane Green, a 30-year-old female, suffered a lower leg fracture after being hit by a car. The patient is experiencing tingling sensations and paleness of the left leg. The nursing assessment and care planning process involves managing these two conditions, along with chronic pain. The goal is to reduce tingling sensation, pallor, and pain in the patient. The effectiveness of the nursing action can be evaluated by monitoring the color of the skin, capillary refill rate, and pain score of the patient. The nursing encounter has informed the practice of the importance of non-pharmacological techniques for pain relief. Subject: Nursing, Course Code: NURS101, College/University: Not mentioned

Scenario 1: Miss Jane Green
Consider the patient
situation
Miss Jane Green is a 30 year old female who was hit by a car that ran a red light whilst she was crossing at a pedestrian crossing. The impact
caused Jane to been thrown into the kerb resulting in an obvious left lower leg fracture. She has just arrived on your ward from the
emergency department. You introduce yourself to the patient and ask how she is going. She winces visibly but answers that she is worried
about her mother who is in the early stages of dementia and for whom she is the sole carer. You also notice that she has a bad graze on her
left shoulder. The time is 0800.
Collect Cues Review:
Examine existing documentation provided.
From the review of progress note for Miss Green, it has been found that the patient is currently in severe pain. However, review of past medical
or family history is not available except the facts that patient’s was given morphine for good effect. As part of the nursing assessment and care
planning process, the review of patient’s medical chart and patient history is important to collect all patient information and get guidance
regarding other cause behind certain symptoms observed in patient.
Gather new information (patient assessment):
Upon undertaking a further assessment of Miss Green you obtain the following new information:
Vital signs
BP: 155/90
Pulse: 107bpm
RR: 22
Sa02: 97%
Temp: 36.6
Other data
GCS: 15
Pain score: 9/10 on movement. 8/10 on rest
Patient becoming anxious in regards to her mother’s welfare.
Neurovascular assessment
Capillary refill rate of >3 seconds.
Complaining of tingling in the toes of left leg
Increased pain at rest and upon passive movement of affected limb
Left leg appears more pale than right leg

Recall:
Recall and apply your existing knowledge to the above situation to ensure you have a broad understanding of what is/may be occurring
before proceeding with the rest of the cycle (self-directed)
Process Information Interpret:
List the data that you consider to be normal/abnormal below (not included in word count)
Normal Abnormal
<<insert text here>>
RR
SpO2
Temp
Capillary refill rate
<<insert text here>>
BP
Pulse
Pain
Neurovascular parameters
Relate & Infer:
 Relate the two most significant abnormal findings to the underlying physiology/pathophysiology to justify why it is considered abnormal
in this context.
 Based on your interpretation of all the information/cues presented, form an overall opinion on what may be happening and justify your
answer (400 words).
<<insert text here>>
Miss Jane had suffered lower leg fracture after being hit by a car and a backslab was applied after the admission to the hospital.
After the review of vital sign assessment record and neurovascular assessment record, it can be said that paleness of the left leg and
tingling sensations of the left leg are two abnormal findings for patient.
The patient was having tingling sensation on the left leg or suffering from parasthesia due to the effect of trauma related injury. The peripheral
sensory nerves are responsible for carrying sensation from different parts of the body to the brain, however problem in the pathway between
trigeminal nerve and brain stem result in parasthesia. Such pathway was affected in case of Miss Jane because of leg injury or pressure on the
nerve of the leg. This condition is mostly seen in patient because of infection, inflammation or trauma (Sharif-Alhoseini, Rahimi-Movaghar and
Vaccaro 2012). Hence, this condition needs to be managed in patient as it may result in neurological disease or traumatic nerve damage in the
future.
Palor or discoloration of the skin of the leg might be seen in patient is seen due to the body response to injury. When patients like Miss Jane
fracture any part of the body due to a car accident, they experience physical trauma. Due to the effect of such trauma, the nerve and muscles of
the leg was affected and this resulted in cessation of blood supply to the leg muscle. Because of these physiological changes, symptom of
paleness of the left leg was observed in patient. Blood flows to the superficial vessels of legs are responsible for color of skin and paleness is
seen due to little blood flow to the affected area of low oxygen level in the blood (Stephen, Sen and Lees 2016). Both these abnormal signs are
indication of neurovascular complication in patient.

After collecting cues and review of overall assessment data for Miss Jane, it can be said that the patient is suffering from the
immediate effect of physical trauma caused by injury and lower leg fracture. Due to the damage to the nerve muscles of the leg and
blood flow restriction, tingling sensation and paleness of skin are major concern for patient. Due to the effect of injury, the vital signs
of patient like respiratory rate, blood pressure and pulse rate of patient was also affected. This might be happening because of
damage to the nerve muscles of the leg which has affected the sensory response system and the blood flow to the leg. This has
resulted in discoloration of the leg and tingling sensation in patient (Sharif-Alhoseini, Rahimi-Movaghar and Vaccaro 2012).Hence, for
Miss Jane, management of these two conditions are necessary.
Predict:
What may happen to your patient if you take NO action and why? (100 words)
<<insert text here>>
If no action is taken to treat symptom of parasthesia, then it may increase the risk of permanent neurological damage or traumatic nerve
damage in the future. The sensation of pain in patient will be altered too. Due to peripheral neuropathy, the patient is likely to fall too due to
poor balance and coordination (Finnerup et al. 2015).
If to no action is taken to address paleness of skin and pain, then patient may suffer severe complications like born deformity, swelling in the
legs, permanent nerve damage and muscle and ligament damage. Hence, management of pain and paleness of skin should be a major nursing
priority for recovery of Miss Jane (Frink et al. 2010).
Identify the
Problem/s
List in order of priority at least three key nursing problems (not included in word count)
<<insert text here>>
The three important nursing problem in order of priority are as follows:
1. Management of parasthesia in patient due to peripheral neuropathy
2. Management of chronic pain
3. Management of paleness of left leg of Jane Green
Establish Goals &
Take Action
From the above (identify problems), use the top 2 nursing problems identified and for each of these establish one goal and then list related
actions you would undertake, including detailing any relevant nursing considerations (350 words)
Problem 1 Goal Related actions Rationale
Complain of tingling sensation in
the left leg of Jane Green
(symptom of parasthesia )
 To reduce tingling
sensation in the left leg,
reduce muscle weakness
and promote mobility
 To provide elastic
stockings or warm packs
to patient
 To provide cool water
 This is essential to
control tingling sensation
 High temperature and
heavily covered feet

soaks to the leg and
control temperature
 Check the pulse of the
lower leg (Karroum et al.
2012)
prevent air circulation
and decreases level of
discomfort for patient
 This is necessary to
understand that to get
baseline data for
comparison. Normal
pulse rate may indicate
good blood circulation to
the affected area
(Karroum et al. 2012).
Problem 2 Goal Related actions Rationale
Presence of paleness of the left
leg and chronic pain in patient
 To reduce pallor and
control chronic pain in
patient
 To monitor the colour of
the skin of the left leg
 To monitor capillary refill
rate of patient (Fahey
2016).
 To provide passive
exercise to patient
 To teach breathing
technique to patient
(Streckmann et al. 2016)
 This is necessary to
assess level of vascular
damage and implement
appropriate intervention
for patient
 Pallor is associated with
decreased skin turgor
and delayed capillary
refill. Hence, monitor the
rate of capillary refill
important to identify
severity of the condition
(Khanna 2016).
 Passive exercise is a form
of rehabilitative care for
patient which can reduce
muscle stiffness aand
weakness
 This is necessary to
control anxiety
(Streckmann et al. 2016)
Evaluate outcomes &
Reflect on new
Briefly describe how you would evaluate the effectiveness of the care provided (i.e. what do you want to happen?) and reflect on how this
encounter has informed your nursing practice if you were to encounter a similar situation in the future (150 words).

learning
<<insert text here>>
The main purpose of the above nursing action is to provide pain relief to patient and increased the level of discomfort that the patient was
facing due to leg fracture. The effectiveness of the nursing action can be understood when the patient the patient has no tinglinging sensation
and changes in color of the skin. Improvement in symptom will also be understood by low pain score and improvement in mobility of patient.
Hence, by implementing pharmacological and non-pharmacological intervention for pain relief and peripheral neuropathy related compliacation,
wound healing will be promoted and patient will be able to mobilize very soon. By the experience of preparing care plan for Miss Jane, I have
learned that the technique involved for pain relief is also essential to promote quick mobilization of patient. In the future, I aim to learn more
about non-pharmacological technique of pain relief so that I can effectively handle emergency case of patient with fracture.

References:
Fahey, V.A., 2016. Clinical assessment of the vascular system. Vascular Nursing-E-Book, p.49.
Finnerup, N.B., Attal, N., Haroutounian, S., McNicol, E., Baron, R., Dworkin, R.H., Gilron, I., Haanpää, M., Hansson, P., Jensen, T.S. and Kamerman, P.R., 2015.
Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis. The Lancet Neurology, 14(2), pp.162-173.
Frink, M., Hildebrand, F., Krettek, C., Brand, J. and Hankemeier, S., 2010. Compartment syndrome of the lower leg and foot. Clinical Orthopaedics and Related
Research®, 468(4), pp.940-950.
Karroum, E.G., Golmard, J.L., Leu-Semenescu, S. and Arnulf, I., 2012. Sensations in restless legs syndrome. Sleep medicine, 13(4), pp.402-408.
Khanna, A.K., 2016. Approach to a Case of Ulcer of Lower Extremity. In Ulcers of the Lower Extremity (pp. 79-91). Springer, New Delhi.
Shadgan, B., Pereira, G., Menon, M., Jafari, S., Reid, W.D. and O’Brien, P.J., 2015. Risk factors for acute compartment syndrome of the leg associated with tibial diaphyseal
fractures in adults. Journal of Orthopaedics and Traumatology, 16(3), pp.185-192.
Sharif-Alhoseini, M., Rahimi-Movaghar, V. and Vaccaro, A.R., 2012. Underlying causes of paresthesia. In Paresthesia. InTech.
Stephen, E., Sen, I. and Lees, T., 2016. The swollen leg. Gynecologic and Obstetric Surgery: Challenges and Management Options, p.174.
Streckmann, F., Zopf, E.M., Lehmann, H.C., May, K., Rizza, J., Zimmer, P., Gollhofer, A., Bloch, W. and Baumann, F.T., 2014. Exercise intervention studies in patients with
peripheral neuropathy: a systematic review. Sports Medicine, 44(9), pp.1289-1304.