Group work: Class preparation:

1. Case Scenario: MUSCULOSKELETAL SYSTEM

Mr. S is a 48-year-old male known with diabetes mellitus and a smoker who takes delight in his

house renovation. He was busy fixing his roof which is one story up he suddenly lost balance as

he stood up, slipped, and fell to the ground. He was brought to the hospital by ambulance

accompanied by his wife. On assessment, you observe that the left leg is heavy bleeding, and

the affected limb is guarded. He is conscious, however confused, and reports a pain score of

9/10. The vital signs show the following: Blood pressure is 90/55 mm/hg, Pulse of 120bpm,

respiration rate of 32bpm, Hb of 8.9, and temperature of 38.9 degrees. He was sent for x-rays

and the investigation showed that the is a displaced spiral fracture in the Femur as well as a

close oblique fracture in the Tibia.

1. Blood pressure
2. Extensive blood loss
3. Hypovolemic shock
4. FRACTURE
5. Pain
6. Neurovascular assessment
7. Long-term management

Nursing Intervention

1. Apply pressure on the affected limb to stop the bleeding to prevent further hypovolemic
shock/anemia and do wound dressing to cover the wound and protect it from microbes
2. Commence with INTRAVENOUS FLUIDS to increase the blood pressure
3. Pain management to relieve pain in this case provide an opioid such as morphine
4. Immbolise bone by putting the cast
5. Perform neurovascular assessment (management of the current problem)
6. Advocate for early physiotherapy

Neurovascular assessment

Pain: Location / Intensity

Skin color: Any signs of discoloration

Pulses: Close to the affected limb

Skin Temperature: Indicate infection of inflammation

Movement: Detect nerve damage or paralysis

Capillary refill: 3-5 seconds vascular damage if the color returns later

Corrector procedure

1. External fixator
2. Traction
3. Joint placement

Cast:

1.Open: Slab of cast that serves as splints

2.Closed: Surrounds affected parts /bone

How to read a case scenario:

1. Highlight the cause of the problem

2. The onset /risk factors
3. The clinical picture/symptoms and link them to a diagnosis
4. Take note of the vital signs and see if the are any abnormalities linking to diagnosis
5. Highlight the diagnostic measures