Case Study Analysis: Mrs. Gwen Boren's Nursing Assessment Report

This report presents a comprehensive analysis of Mrs. Gwen Boren's nursing case study. The assignment begins with an interpretation of the patient's condition, identifying both normal and abnormal subjective and objective data based on the provided scenario. It then delves into a detailed relate and infer section, discussing the patient's fracture, potential compartment syndrome, and mild head injuries. The report also includes a prediction of potential complications if the patient's condition is not improved. Furthermore, it develops, articulates, and prioritizes nursing diagnoses, focusing on tissue ischemia, acute pain, and impaired physical mobility. The core of the report lies in the goals, actions, and evaluation sections for the two highest priority diagnoses, outlining related nursing interventions, rationales, and expected outcomes. The assignment is supported by a reference list of relevant academic sources.

Student number:
CNA253 AT2 Scenario: Mrs Gwen Boren
Interpret:
In the following table, list the data that you consider to be normal/abnormal (not included in word count)
Normal (Subjective & Objective) Abnormal (Subjective & Objective)
The pain experienced by Mrs Gwen Boren is because of the
fracture in her left ankle sustained due to a fall. It is because of
this that the patient has restricted mobility and is confined to a
wheelchair. The oxygen saturation, heart rate and body
temperature was observed to be around the normal range.
According to the situation of Gwen Boren, it could be understood that the respiratory rate
of the patient is above the range of normal at 15-24 breaths per minute. The systolic
blood pressure that has been recorded is higher than the usual level of 120 mm/Hg. For
the patient, it is recorded above 130 mm/Hg.
Relate & Infer (550 words):
According to the case study of Gwen Boren provided, it could be understood that the pain that is experienced by the individual is because of the fracture in
her left ankle due to a fall at her place. The end of the fibula, also known as, lateral malleolus, is the bone which has been observed to be broken in the CT
scan. One of the major symptoms which are experienced by the patient is the swelling and a sensation of pain in the ankle area. Hence, it can be
comprehended that the patient is suffering from compartment syndrome. Because of the old age, it is possible that the patient may have slipped and should be
recommended bed rest for nearly a month and a half such that the ligaments near the area of fracture gets the necessary time to heal (Sherrington et al. 2016).
Depending upon the condition of the patient and assessing the degree of pain of the patient, mild head injuries could be reported because of her getting a
score of 15 on the Glasgow Coma Scale. It could be associated with her being generally confused about her surroundings and the treatment which would be
provided to her (Willett et al. 2016).
The intense compartment syndrome is a condition wherein expanded pressure inside a constrained space bargains the dissemination and capacity of the
tissues, subsequent in tissue ischemia; necrosis and nerve harm (von Keudell et al. 2015). This ascent in tissue pressure starts in a decline of the compartment
size or increment of the intracompartmental volume by oedema or potentially discharges (Raza and Mahapatra 2015). Following the arterio-venous angle
hypothesis, fine blood stream might be debilitated through expanded venous pressure, diminished blood vessel pressure and expanded fringe vascular

obstruction. Regularly, compartment disorders create during reperfusion following a time of ischemia (Han et al. 2015). During ischemia, there is a
continuous exhaustion of intracellular stores of high vitality phosphate bonds and glycogen stores. There is a development of results of glycolysis, especially
lactic corrosive, with going with hydrogen particle collection just as an expansion in intracellular diminishing agents (Wallin et al. 2016). Reperfusion may,
rather than re-establishing ordinary muscle metabolic action, cause destructive impacts by cleaning out fundamental antecedents for adenine nucleotide
resynthesis. Creation of oxygen free radicals happens with following lipid peroxidation, and calcium deluge happens upon reoxygenation with resultant
disturbance of oxidative rephosphorylation in the mitochondria (Lollo and Grabinsky 2016). Moreover, a few lines of proof propose that white platelets are
significant in the pathogenesis of reperfusion injury. Up regulation of both neutrophil receptors and endothelial leukocyte attachment particles prompts the
sequestration of white platelets in the muscle with prolongation of the reperfusion injury (Flores et al. 2018). This along these lines brings about harm to
remote organs, for example, lungs, liver, heart and kidneys.
When the patient was first found, she seemed to be confused which could be ascertained to the fact that she may have sustained the fracture because of some
other underlying complications or a decrease in the sodium/potassium balances (Rittenhouse et al. 2015). Hence, it was important to assess the level of
sodium/potassium in the blood of the patient such that it could be estimated that because of the level imbalanced, she experienced a fall.
Predict (150 words):
If the condition of the patient is not improved, there is a likeliness that the patient may not be able to walk by herself because of death of the tissue (van
Vlijmen et al. 2015). Moreover, if proper care is not undertaken of the ankle casts, there is a high chance that the patient may experience pressure sores, joint
stiffness and skin infection which may lead to her subsequent death (Marican, Fook-Chong and Rikhraj 2015). There is a risk of formation of infection
because of the skin infections which require immediate attention of the nursing professional.
Develop, Articulate and Prioritise Nursing Diagnoses – at least 3 (not included in word count)
Diagnosis 1: Tissue Ischemia
Diagnosis 2: Acute pain
Diagnosis 3: Impaired physical mobility
Goals, Actions and Evaluation 2 highest priority diagnoses only (550 words)
Diagnosis 1 Goal/Desired outcome/s Related actions Rationale Evaluate outcomes
DO NOT REWRITE
DIAGNOSIS
The primary goal is to
reduce the incidence of
a. Peripheral pulses are
required to be
a. Those are signs of arterial
obstruction, which can lead to
After the interventions have
been administered to the

tissue ischemia by the
usage of appropriate
nursing actions or
interventions
monitored with
symptoms like bluish
or purple pulses or
extreme pain while
touching the area
(Black, Brindle and
Honaker 2016).
b. Try to elevate the
oedematous leg below
the level of heart.
c. Thrombolytic therapy
could be considered for
the condition of the
patient (Jung et al.
2016).
d. Maintaining of cardiac
output at optimum
levels.
the loss of a limb if not
reversed instantly.
b. In arterial insufficiency the
elevation of the legs reduces
the flow of arterial blood to the
legs. Elevation increases
venous return and allows
oedema to be minimised
(Kobayashi et al. 2017).
c. This promotes perfusion when
blood flow intervention occurs
or when perfusion has fallen to
such an extreme degree it
causes ischemic damage
(Kobayashi et al. 2015).
d. This ensures the correct
perfusion of vital organs.
patient as found appropriate,
it is likely to observe
improvement in the
condition of the patient by
timely healing of the fracture
and no sight bluish tissue to
conclude tissue ischemia.
Diagnosis 2 Goal/Desired outcome/s Related actions Rationale Evaluate outcomes
DO NOT REWRITE
DIAGNOSIS
The primary goal is to
reduce the incidence of
pain in the ankle of the
patient by appropriate
nursing interventions or
actions
a. Cold or ice pack for
the first 24-48 hours is
necessary
b. Try to provide
alternative measures
for comfort like
a. Applying an ice pack to the
affected area aims to reduce
the incidence of hematoma
formation and oedema. In
addition, it also aims to reduce
the sensation of chronic pain to
After the interventions have
been administered, the
patient will demonstrate the
relief from pain and
participate in various
activities with little or no

position changes and
massage (Kurar 2016)
c. Maintain the act of
immobilisation
utilizing bed rest,
traction, cast and splint
d. Remove all plastic
sheets under the
affected limb in a cast
the patient
b. Alternative measures for
comfort increases the chance
of circulation in the affected
area and reduces pressure and
fatigue in muscles
c. Immobilization will relieve
pain and extends the injury of
the tissue. In addition, it
prevents the displacement of
bones (Basques et al. 2015)
d. Usage of plastic sheet can
increase the level of discomfort
because of the heat production
in the cast which is drying.
discomfort
Reference list:
Basques, B.A., Miller, C.P., Golinvaux, N.S., Bohl, D.D. and Grauer, J.N., 2015. Morbidity and readmission after open reduction and internal fixation of
ankle fractures are associated with preoperative patient characteristics. Clinical Orthopaedics and Related Research®, 473(3), pp.1133-1139.
Black, J.M., Brindle, C.T. and Honaker, J.S., 2016. Differential diagnosis of suspected deep tissue injury. International wound journal, 13(4), pp.531-539.
Flores, D.V., Mejia Gomez, C., Estrada-Castrillón, M., Smitaman, E. and Pathria, M.N., 2018. MR imaging of muscle trauma: anatomy, biomechanics,
pathophysiology, and imaging appearance. Radiographics, 38(1), pp.124-148.
Han, F., Daruwalla, Z.J., Shen, L. and Kumar, V.P., 2015. A prospective study of surgical outcomes and quality of life in severe foot trauma and associated
compartment syndrome after fasciotomy. The Journal of Foot and Ankle Surgery, 54(3), pp.417-423.
Jung, J.A., Yoo, K.H., Han, S.K., Lee, Y.N., Jeong, S.H., Dhong, E.S. and Kim, W.K., 2016. Influence of negative-pressure wound therapy on tissue

oxygenation in diabetic feet. Advances in skin & wound care, 29(8), pp.364-370.
Kobayashi, N., Hirano, K., Nakano, M., Ito, Y., Ishimori, H., Yamawaki, M., Tsukahara, R. and Muramatsu, T., 2015. Prognosis of critical limb ischemia
patients with tissue loss after achievement of complete wound healing by endovascular therapy. Journal of vascular surgery, 61(4), pp.951-959.
Kobayashi, N., Hirano, K., Yamawaki, M., Araki, M., Takimura, H., Sakamoto, Y., Mori, S. and Ito, Y., 2017. Clinical effects of single or double tibial
artery revascularization in critical limb ischemia patients with tissue loss. Journal of vascular surgery, 65(3), pp.744-753.
Kurar, L., 2016. Clinical audit of ankle fracture management in the elderly. Annals of Medicine and Surgery, 6, pp.96-101.
Lollo, L. and Grabinsky, A., 2016. Clinical and functional outcomes of acute lower extremity compartment syndrome at a Major trauma
Hospital. International journal of critical illness and injury science, 6(3), p.133.
Marican, M.M., Fook-Chong, S.M.C. and Rikhraj, I.S., 2015. Incidence of postoperative wound infections after open tendo Achilles repairs. Singapore
medical journal, 56(10), p.549.
Raza, H. and Mahapatra, A., 2015. Acute compartment syndrome in orthopedics: causes, diagnosis, and management. Advances in orthopedics, 2015.
Rittenhouse, K.J., To, T., Rogers, A., Wu, D., Horst, M., Edavettal, M., Miller, J.A. and Rogers, F.B., 2015. Hyponatremia as a fall predictor in a geriatric
trauma population. Injury, 46(1), pp.119-123.
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2016. Exercise and fall prevention self-management to reduce mobility-related disability and falls after fall-related lower limb fracture in older people:
protocol for the RESTORE (Recovery Exercises and STepping On afteR fracturE) randomised controlled trial. BMC geriatrics, 16(1), p.34.
Van Vlijmen, N., Denk, K., Van Kampen, A. and Jaarsma, R.L., 2015. Long-term results after ankle syndesmosis injuries. Orthopedics, 38(11), pp.e1001-
e1006.
von Keudell, A.G., Weaver, M.J., Appleton, P.T., Bae, D.S., Dyer, G.S., Heng, M., Jupiter, J.B. and Vrahas, M.S., 2015. Diagnosis and treatment of acute
extremity compartment syndrome. The Lancet, 386(10000), pp.1299-1310.
Wallin, K., Nguyen, H., Russell, L. and Lee, D.K., 2016. Acute traumatic compartment syndrome in pediatric foot: a systematic review and case report. The
Journal of Foot and Ankle Surgery, 55(4), pp.817-820.
Willett, K., Keene, D.J., Mistry, D., Nam, J., Tutton, E., Handley, R., Morgan, L., Roberts, E., Briggs, A., Lall, R. and Chesser, T.J., 2016. Close contact
casting vs surgery for initial treatment of unstable ankle fractures in older adults: a randomized clinical trial. Jama, 316(14), pp.1455-1463.