Nursing Case Study: Mr. Kim Lui's Pathophysiology and Treatment

This case study focuses on Mr. Kim Liu, a 28-year-old man involved in a motor vehicle accident, presenting with an open fracture of the left tibia and fibula, and a head laceration. The study meticulously outlines the pathophysiology of these injuries, including the mechanism of fracture, potential complications like bleeding and infection, and the nature of head lacerations. It details the diagnostic assessments, such as vital signs, chest x-rays, leg x-rays, and abdominal CT scans, used to diagnose the conditions. Furthermore, the study explores the pharmacological management, including the use of analgesics, antibiotics, and tetanus prophylaxis, along with the importance of ice packs and over-the-counter pain relievers. The study concludes by summarizing the key aspects of the injuries and their management, emphasizing the importance of effective pharmacological treatment and nursing care.

Mr. Kim Lui

TABLE OF CONTENTS
INTRODUCTION...........................................................................................................................1
MAIN BODY...................................................................................................................................1
Pathophysiology..........................................................................................................................1
Diagnostic assessments to diagnose the condition......................................................................2
Pharmacological management related with the condition..........................................................2
CONCLUSION................................................................................................................................3
REFERENCES................................................................................................................................4

INTRODUCTION
Nursing is referred to as the significant degree of knowledge which helps in improving the
health conditions of the patient (Byard, Herbst & Langlois, (2016)). This study will highlight on
the Pathophysiology, Diagnostic assessments and pharmacological management linked with the
Mr Kim Liu case scenario.
MAIN BODY
Case scenario
Mr Kim Liu is a 28 year old Korea man who has been brought in after the motor vehicle
accident. He has suffered an open fracture on the left tibia and fibula. Moreover, he has also
suffered head injury laceration with the left temporal area. Furthermore, Mr Kim Liu has pain in
the left upper quadrant and also a mark of the seatbelt along the neck, left shoulder and chest of
Mr Kim Liu. He also has a laceration within the left temporal area. It has been examined that, Mr
Kim Liu is muddled up with specific place and time but remembers his name. It has been
examined that, there are no known allergies and Mr Kim Liu suffers a pain of 9 out of 10 in spite
of the intravenous morphine which has been given by the healthcare professional on site.
Pathophysiology
The lower leg fracture tends to comprise of the fractures related with the fibula and tibia.
However, tibia is considered to be as the only weight bearing bone. The tibia fracture is mainly
linked with the fibula fracture because the force in directly transmit to the interosseous
membrane of the fibula (Bonato & et.al. (2017)). This is mainly cause because of the motor
vehicle accident in this specific case scenario. The skin and sub- cutaneous tissue are very thin
within the medial and anterior tibia which leads to significant degree of fractures within the
lower leg and is known as open fractures.
The fibula is prominent in effectively supporting the tibia and helps in stabilizing the lower
leg muscles and the ankle (Tibial Shaft Fractures, 2020). The key risks and complications which
are mainly linked with the tibia and fibula fracture is mainly includes bleeding, infection, fat
embolism, bone misalignment, blood clots, nerve damage, irritation on overlying tissue, etc.
Head injury laceration are considered to be as a common head injury which results in the
laceration of the bony defect or galea of the skull. Once hemostasis has been achieved then the
wound is irrigated and the scalp lacerations are closed with the surgical staples with proper local
anesthesia (Pasco & et.al (2015)). The head injury laceration are caused by the motor vehicle
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accident as per the specific case scenario of Mr. Kim Liu. Moreover, Lacerations tends to occur
because of the sharp objects which leads to underlying structures within the nerves, muscles of
facial expression and arteries (Ekegren, Edwards, De Steiger & Gabbe, (2018)). The scalp
mainly comprise of the skin, Sub- Cutaneous tissue, musculoaponeurotic layer, loose areolar
tissue and Pericranium. At the time of head injury laceration the separation mainly occurs within
loose areolar tissue layer.
The patient has constant pain because of the fracture of the ribs and tibia and fibula and also
crush injuries because of accident. The patient sustained splanchnic hematoma and crush
injuries. This must have caused access blood loss in the patient. This is the reason patient has 9
out of 10 pain. The body in order to control the blood loss has initiated the mechanism which
resulted in increased blood pressure 150/86mmHg, 28/per minute respiratory rate and 100bpm
heart rate. The crush injuries and rib fracture has affected the gas exchange in the lungs which is
causing low SPO2 of 93%.
Diagnostic assessments to diagnose the condition
The temperature of the Mr Kim Liu is 37.0°C and the heart rate is observed to be 100bpm.
The respiration rate is 28/per minute and the blood pressure is 150/86mmHg. Moreover, the
SpO2 is 93% (6 L per min via Hudson Mask). It has been examined that, there are no known
allergies and Mr Kim Liu suffers a pain of 9 out of 10 in spite of the intravenous morphine which
has been given by the healthcare professional on site.
A chest x-ray has shown some stable rib fractures. The leg x-rays tends to have
comminute fractures on left tibia and fibula and crush injuries. Moreover, the abdominal CT has
verified a splanchnic haematoma. Furthermore, Mr Kim Liu will be admitted to the theatre in a
while for an ORIF (open reduction and internal fixation) associated with the left leg fracture and
haemodynamic stability (Aghakhani & et.al. (2015)). It has been examined that, Mr Kim Liu
might also have laparotomy for the splanchnic haemorrhage.
Pharmacological management related with the condition.
Pharmacological management is associated with the use of multiple level of medications or
one medication which helps in treating the open fracture on the left tibia and fibula and head
laceration (Hart & et.al. (2020)). Drugs which has been used to effectively treat fractures mainly
includes non- steroidal anti-inflammatory analgesics and agents. Moreover, appropriate
antibiotics and tetanus prophylaxis is considered to be as an appropriate pharmacological
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management for the open fracture. Applying the ice packs and immobilizing the inured area is
one of the key significant way which helps in treating people with the open fracture on the left
tibia and fibula. Moreover, over the counter pain reliever like acetaminophen and ibuprofen are
the useful pharmacological management in order to reduce inflammation and pain (Holloway &
et.al. (2017)).
Pharmacological management is considered to be highly crucial in to remove the foreign
body elements at the time of pharmacological management of the head injury laceration (Tan,
Peters, Mckee, & Edwards, (2016)). It is very crucial to manage the pain of the Mr. Kim Lui by
providing them with proper medication. It is very important to ice the area in order to reduce the
pain and swelling among the patient (Byard, Herbst & Langlois, (2016)). Antibiotic ointment are
effectively applied to provide the effective pharmacological treatment to the person. Stitching in
the specific area and bacterial infection helps in giving the best possible treatment nad leads to
better care outcomes and results.
CONCLUSION
From the conducted study it has been summarized that, the lower leg fracture tends to
comprise of the fibula and tibia fractures. . The skin and sub- cutaneous tissue are very thin
within the medial and anterior tibia. Head injury laceration tends to occur because of the sharp
objects which leads to underlying structures within the nerves, muscles of facial expression and
arteries. Over the counter pain reliever like acetaminophen and ibuprofen are the useful
pharmacological management in order to reduce inflammation and pain.
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REFERENCES
Books and Journals
Aghakhani, K & et.al. (2015). CCharacteristics of Traumatic Brain Injury among Accident and
Falling Down Cases. Acta Medica Iranica, 652-655.
Bonato, L. J & et.al. (2017). Patient reported health related quality of life early outcomes at 12
months after surgically managed tibial plafond fracture. Injury, 48(4), 946-953.
Byard, R. W., Herbst, J., & Langlois, N. E. (2016). Age‐Related Vulnerability to Lethal
Craniocerebral Crush Injuries from Electrical Beds/Tables. Journal of forensic sciences, 61(5),
1257-1260.
Ekegren, C. L., Edwards, E. R., De Steiger, R., & Gabbe, B. J. (2018). Incidence, costs and
predictors of non-union, delayed union and mal-union following long bone
fracture. International journal of environmental research and public health, 15(12), 2845.
Hart, N. H & et.al. (2020). Functional basis of asymmetrical lower-body skeletal morphology in
professional australian rules footballers. The Journal of Strength & Conditioning
Research, 34(3), 791-799.
Holloway, K. L & et.al. (2017). Lower limb fracture presentations at a regional
hospital. Archives of Osteoporosis, 12(1), 75.
Pasco, J. A & et.al A. (2015). The epidemiology of incident fracture from cradle to
senescence. Calcified tissue international, 97(6), 568-576.
Tan, E. C., Peters, J. H., Mckee, J. L., & Edwards, M. J. (2016). The iTClamp in the
management of prehospital haemorrhage. Injury, 47(5), 1012-1015.
Turner, R. C. (2019). Surgical management of acute lacerations. Australian journal of general
practice, 48(9), 600.
Online
Tibial Shaft Fractures. 2020. [ONLINE]. Available through<
https://www.hopkinsmedicine.org/health/conditions-and-diseases/tibia-and-fibula-
fractures#:~:text=This%20is%20an%20isolated%20fracture,cast%20with%20the%20knee
%20bent. >
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