Nursing Case Study Analysis: Miley Long's Fracture - Clinical Analysis

This nursing case study analyzes the care of Miley Long, a 64-year-old female with a fractured tibia. The analysis, based on Lewis’s Medical-Surgical Nursing, examines her condition as a comminuted fracture with neurovascular injury. The study explores treatment options including surgical and non-surgical interventions while considering age-related changes in the musculoskeletal system. It addresses physiological changes associated with aging, communication barriers due to language differences and cultural sensitivity. The case study highlights the importance of therapeutic communication, obtaining informed consent, and the roles of healthcare professionals, including the social worker and the EN. It also discusses duty of care, negligence, and vicarious liability within the context of Miley’s care. The student explores strategies to improve communication, cultural considerations, and legal aspects of patient care.

Running Head: NURSING CASE STUDY ANALYSIS 1
NURSING CASE STUDY ANALYSIS
Student Name:
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NURSING CASE STUDY ANALYSIS 2
1. Assessing the patient and applying Lewis’s Medical-surgical Nursing pages, the condition
that the patient is experiencing can be comminuted fracture (Erturer et al, 2011). The
patient can be assumed to have multiple bone breaks in three or more pieces. This fracture
has caused excessive bleeding causing neurovascular injury with severe trauma.
2. Miley’s old age and falling by slipping down is the primary reason that is causing the
condition identified as above. The twisting force has limited her movement, causing
multiple injuries on her ankle.
3. Miley’s NV status obtained by monitoring of pain, pulse, pallor, paralysis and paresthesia
needs to be informed to her and her family members or support group.
Researching the conditions in Lewis’s Medical-surgical Nursing, the list of treatment
needed for Miley includes surgical treatment. Surgical treatment might include external
fixation by operating on metal pins or screws in the bone below the fracture site. These
pins and screws are put on the bar outside the skin and it will allow stabilizing the frame
holding the bone in proper position so that they can heal. Nonsurgical treatment is not
suggested for the patient as this is not the case of closed fracture.
4. In Miley’s case, her cast is split to relieve her condition. As Miley is 64 years old, there
might be age related changes in her muscular system that will impact her recovery leading
to future problems. Aging has been found associated losing out of muscle mass known as
sarcopenia. This decrease in muscle tissue is dramatic beyond 60 years of age and it
diminishes muscular functions (Haentjens et al, 2010). Thus, bone recovery is slower due
to reduction in musculoskeletal system.

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5. As ageing is related to progressive loss in bone-muscle mass as well as strength,
decline in mass and strength is heightened in adverse health outcomes. Understanding
bone-muscle interaction, it can be said that the possible pathological events takes
place. Osteoclasts are specialised cells that absorbs worn-out bone cells and removing
them from bone. Similarly, other cells called the osteoblasts derives calcium from
blood and redistribute in upon the bone. With age osteoblasts cannot keep up with the
activity of osteoclasts. Thus, older adults suffering bone fracture directs more
resources to bone break. Losing cycle of bone removal and replacement explains the
reason cellular metabolism takes longer time to heal in older adults.
6. There are considerable physiological changes that takes place with aging in all organs.
The cardiac output decreases, arteriosclerosis develops and blood pressure increases.
Musculoskeletal - Osteoclasts are specialised cells that absorbs worn-out bone cells
and removing them from bone. Similarly, other cells called the osteoblasts derives
calcium from blood and redistribute in upon the bone. With age osteoblasts cannot
keep up with the activity of osteoclasts. Lungs are also seen to have impaired gas
exchange, with decreasing vital capacity and lower expiratory flow rates.
Renal - Creatinine clearance reduces with age though the serum
creatinine levels are seen to be relatively constant as a result of proportionate age-
related reduction in creatinine production (Wardhan, 2013).
Gastrointestinal (GI) - Changes in functionality is majorly from altered
motility patterns taking place in the gastrointestinal system with senescence as well as
atrophic gastritis, and altered hepatic drug metabolism taking place in elderly people.
Cardiovascular (CV) – CV in ageing individual is seen to cause changes in heart and

NURSING CASE STUDY ANALYSIS 4
blood vessels might lead to increase in personal risk of development of cardiovascular
disease.
Progressive evaluation of blood glucose takes place with age on multifactorial basis
and osteoporosis is noticed almost regularly due to declining bone mass. Skin
epidermis atrophies related to age and due to changes in collagen and elastin leads to
loss of skin tone and elasticity. Lean body mass is seen to reduce with age and
primarily arising from loss and atrophy of muscle cells. Metabolism is altered as well.
Psychosocial, cognitive and spiritual development - Psychosocial, cognitive and
spiritual development is hindered and altered with ageing.
7. During Miley’s routine observation including her neurovascular observation she did
not understand what was being asked. Hence, I will try and explain her regarding the
routine check-up that needs to be undertaken as a part of schedule monitoring. Then if
she is ready to provide her consent and she is comfortable then I will proceed with my
monitoring schedule. I will also try to pacify her whenever needed.
8. In this situation where routine monitoring is taking place for the patient, her expressed
consent will be sufficient for non-invasive procedure. In case Miley expresses her
consent to be a part of the routine examination and procedure, and comfortably
participates in the same then it can be conducted sufficiently.
9. When trying to gain consent from Miley, my communication is inhibiting as because
English is a second language for her and Greek is her first language. This could be a
major barrier that my communication is not getting across to her. The three factors
effecting my communication with Miley includes my English language used in

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communication, my communication skills that is inhibiting the communication and
my voice clarity which might inhibit effective communication.
10. In order to communicate in an effective manner with Miley, I need to adopt certain
strategies to improve interaction. Strategies to improve my communication includes
speaking slowly in the language English and using generalised terms which are easy
to understand. Second strategy will include enhancing my communication skills such
as my talking with use of gestures and body language so that it is easy for Miley to
comprehend. Third strategy I will be using includes using voice clarity. I will try to
modulate my voice and speak as slowly as possible getting feedback from Miley that
she has understood what has been communicated to her.
11. As later in the shift Miley’s daughter, Lucy visits and provides a lot of information
regarding Mile, I will make use of therapeutic communication skills to encourage
effective communication with Lucy. The therapeutic communication skills I will be
using includes listening, silence, and focusing with open-ended questions. I will make
use of listening and silence such that I can have sufficient information regarding
Miley. This will also assist Lucy to open up about Miley. I will make use of open-
ended questions such that I obtain the information that is crucial to treat Miley.
12. Developing of trust is important such that the patient and her family members can
easily confide crucial information that might be used in treating the patient. Moreover,
with trust patient recovery can be made faster.

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13. The use of social conversation might work in this situation to allow Miley and Lucy
to open up regarding their personal problems. It might assist in psychological
recovery of Miley. But in case Miley or Lucy is uncomfortable then it is not
encouraged.
14. Yes, active listening will be used when listening to Miley’s daughter Lucy such that
crucial information regarding Miley can be obtained. Such information might make
valuable contribution in the treatment of Miley.
15. After facing all the challenges while communicating with Miley there still have
remained various constraints in understanding her Greek culture. The document my
RN handed me over assisted me in understanding ways to provide effective care to
Miley regarding her culture, which will assist me in my behaviour and interaction. I
will avoid stereotyping in Miley’s case such that I am able to understand her
challenges better. Second cultural consideration is that I will respectfully ask patients
regarding their health-related beliefs and customs and then note them down such that I
an address them appropriately. Thirdly, I will be sensitive towards the patient’s
cultural customs which will assists me to understand and provide her treatment plan
appropriately.
16. The role of the social worker in Miley’s case will be to assists in helping individuals,
families and groups of people to enable coping with their problems she is facing such
as lack of financial support.

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17. As an EN I would owe Miley duty of care when showering her as well. It is my
responsibility to provide standard of care to Miley and be watchful, attentive and
cautious while treating her. Her burn is solely my responsibility hence I owe duty of
care towards her.
18. Negligence is the failure in exercising appropriate and or ethical ruled care expected
from exercising in specified circumstances (Ben-Shahar, & Porat, 2016).
Due to breach of negligence Miley has sustained injury. In this case I have breached
attentiveness and caution while dealing with her.
19. False
20. Defamation is seeking damage for loss of reputation. It impacts the client in terms of
financial loss.
21. Vicarious liability is the imposition of liability on one person for negligence from
another (Giliker, 2010).

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References
Ben-Shahar, O., & Porat, A. (2016). Personalizing negligence law. NYUL Rev., 91, 627.
Erturer, R. E., Sever, C., Sonmez, M. M., Ozcelik, I. B., Akman, S., & Ozturk, I. (2011).
Results of open reduction and plate osteosynthesis in comminuted fracture of the
olecranon. Journal of shoulder and elbow surgery, 20(3), 449-454. DOI:
10.1016/j.jse.2010.11.023
Giliker, P. (2010). Vicarious liability in tort: A comparative perspective (Vol. 69).
Cambridge University Press.
Haentjens, P., Magaziner, J., Colón-Emeric, C. S., Vanderschueren, D., Milisen, K.,
Velkeniers, B., & Boonen, S. (2010). Meta-analysis: excess mortality after hip fracture
among older women and men. Annals of internal medicine, 152(6), 380-390.
Lewis, S. L., Bucher, L., Heitkemper, M. M., Harding, M. M., Kwong, J., & Roberts, D.
(2016). Medical-Surgical Nursing-E-Book: Assessment and Management of Clinical
Problems, Single Volume. Elsevier Health Sciences. 10th Edition.
Wardhan, R. (2013). Assessment and management of rib fracture pain in geriatric population:
an ode to old age. Current Opinion in Anesthesiology, 26(5), 626-631.