Nursing Assessment: Physical Health Status in Pelvic Injury Case

This presentation outlines the assessment of a 15-year-old patient, Diana Prince, who sustained a pelvic injury due to a bicycle accident, resulting in an open book fracture and hypovolemia-induced acute kidney injury. The presentation details how a nurse should obtain accurate information about the patient's physical health status through observation, including assessing bleeding sources and pelvic stability; taking patient history, focusing on previous fractures and family history of osteoporosis; and checking case files for bone mineral density scores, vitamin D levels, and medication uptake. Key questions to ask the patient regarding pain location, intensity, and past injury history are also highlighted. The multidisciplinary team approach involving nephrologists, orthopedic, and trauma surgeons in managing the patient is also emphasized.

Pelvic injury

Introduction
 Hip fractures can cause significant mortality and morbidity in
women. Most of the hip fractures and kidney injuries are
associated to falls due to accidents or decreased bone mineral
density (Magee, 2014).
 A proper physical assessment is necessary take up proper
treatment regimen for the patient.

Scenario
Diana Prince, who is 15 years old has met with an accident while
riding her bicycle yesterday. She has suffered from blunt trauma to
the pelvis. Due to her falling Blood pressure she was shifted to the
ICU where she was being transfused with 3 units of Packed RBS.
Her BP is 110/70 mm of Hg now. According to the CT scan reports
she has suffered from an open book fracture of the pelvis. Blood
reports from this morning has indicated an augmented Serum
Creatinine level of about 5.2mg/dl. She was diagnosed with
Hypovolemia induced Acute Kidney Injury with fracture pelvis. She
is now under the surveillance of a multidisciplinary team of
Nephrologists, Orthopaedic and Trauma surgeons.

Physical health status of the
patient
 By observation- It is necessary to understand the source of the bleeding.
 Normally the bleeding takes place from the cancellous bone, iliac vessels or
presacral venous plexus.
 Examination of the pelvis may show deformity, tenderness and gross motion.
 Pelvic ring fractures can be recognized by the use of the magnetic resonance
imaging (MRI).
 Patient should be assessed with haematuria, hypotension, history of a rapid
deceleration injury (Halawi, 2015).
 Pelvic stability has to be assessed by the application of rotational, super-inferior
and anterior-posterior stress to the pelvis.
 Physical findings includes deformity in the pelvic region or pelvic instability,
abnormal position of the lower limb, pain (Magee, 2014).
 The initial parameter is to assess the hemodynamic status of the patient.

Patient history
 Previous hip fracture
 or a family history of hip fractures.
 Family history of osteoporosis.

Checking of the case files
 It is necessary to review the patient's factors and complete
imaging studies such as the anterior-posterior, inlet and outlet
radiographs and computed tomography before a definitive
treatment (Halawi, 2015).
 Checking the bone mineral density T-score.
 Checking the vitamin D levels.
 Checking the uptake of any medications.

Questions asked to the
patient
 In which part of are you feeling the pain?
 Are you feeling pain? How would you rate your pain?
 Have you had any past history of pelvic injury?

References
 Halawi, M. J. (2015). Pelvic ring injuries: Emergency assessment
and management. Journal of clinical orthopedics and trauma,
6(4), 252-258.
 Magee, D. J. (2014). Orthopedic physical assessment-E-Book.
Elsevier Health Sciences.