Ben Ivanos has just been admitted to an orthopedic unit after a motorcycle accident. Mr. Ivanos is 24 years old and healthy; he takes no medications. He had surgical reduction of fractures and now has casts on both legs and a cast on one arm.

Ben Ivanos has just been admitted to an orthopedic unit after a motorcycle accident. Mr. Ivanos is 24 years old and healthy; he takes no medications. He had surgical reduction of fractures and now has casts on both legs and a cast on one arm. He is receiving morphine sulfate intravenously via a patient-controlled analgesia (PCA) pump. Imagine that you are an orthopedic nurse and must plan care for Mr. Ivanos. You rank the following nursing diagnoses as a highest priority:

1. Acute Pain secondary to musculoskeletal trauma (arms, legs, body) and muscle spasms
2. Risk for Peripheral Neurovascular Dysfunction secondary to casts/traction You write the following desired outcomes (goals) on the care plan:

Goals for diagnosis Demonstrates correct use of PCA pump. Rates pain not higher than 4 on a scale of 1 to 10 at all times.

Goals for diagnosis 2 Peripheral pulses palpable Fingers and toes warm Fingers and toes without edema, pallor, or cyanosis Capillary refill less than 3 seconds

Choose 3-5 nursing interventions for this patient

ANSWER

 Nursing Interventions for Mr. Ivanos: Enhancing Care Following Orthopedic Trauma

Introduction

 In caring for Mr. Ivanos, a 24-year-old healthy individual admitted to the orthopedic unit after a motorcycle accident, it is crucial to prioritize nursing diagnoses and develop appropriate interventions to optimize his recovery and overall well-being. This essay will outline three nursing interventions to address the highest priority nursing diagnoses of acute pain and the risk for peripheral neurovascular dysfunction.

Patient Education and Support

 One vital intervention is patient education and support aimed at assisting Mr. Ivanos in understanding and correctly using the patient-controlled analgesia (PCA) pump.

To achieve this goal, the nurse can

 Provide clear and concise explanations

The nurse should offer comprehensive information regarding the PCA pump, including its purpose, operation, and the importance of pressing the button when experiencing pain (Pastino, 2023). By ensuring Mr. Ivanos understands the device, the nurse promotes his active involvement in pain management and enhances the effectiveness of pain relief.

Demonstrate the use of the PCA pump

 Visual aids and demonstrations can help Mr. Ivanos comprehend the correct use of the PCA pump effectively. The nurse can demonstrate how to administer the medication by pressing the button when experiencing pain, the lockout period between doses, and the importance of not exceeding the prescribed dose. Reinforcing proper technique ensures appropriate pain management and minimizes the risk of adverse effects.

 Encourage open communication

The nurse should create a supportive and non-judgmental environment, where Mr. Ivanos feels comfortable expressing his pain levels and concerns. By establishing effective communication, the nurse can promptly address any issues related to the PCA pump, monitor its efficacy, and make necessary adjustments to optimize pain control.

Pain Management Interventions

To achieve the desired outcome of maintaining pain levels not higher than 4 on a scale of 1 to 10 at all times, the nurse can implement several evidence-based pain management interventions, such as:

Administering analgesics as prescribed

 Apart from the PCA pump, the nurse may need to administer additional pain medications to ensure adequate pain relief, especially during the initial stages following surgery. Regular assessment of pain levels, continuous evaluation of the effectiveness of analgesics, and timely adjustment of dosages are essential to optimize pain management.

 Non-pharmacological pain management techniques

 Complementary measures can be employed to augment pharmacological interventions (Wells, 2008). These may include distraction techniques (e.g., playing soothing music, engaging in conversation), relaxation exercises (e.g., deep breathing, guided imagery), and the application of heat or cold packs. These strategies help promote patient comfort and reduce reliance on medications, thus minimizing potential side effects.

Monitoring Peripheral Neurovascular Function

To address the nursing diagnosis of the risk for peripheral neurovascular dysfunction, nursing interventions should focus on monitoring and promoting adequate circulation and nerve function in the extremities. The following actions can be implemented:

 Regular assessment of peripheral pulses

 The nurse should assess peripheral pulses (e.g., dorsalis pedis, posterior tibial, radial, ulnar) at regular intervals to ensure they remain palpable. Any changes or abnormalities should be promptly reported to the healthcare provider for further evaluation.

 Monitoring temperature and color of fingers and toes

Frequent assessment of the temperature and color of Mr. Ivanos’ fingers and toes can help identify signs of compromised circulation. Warmth, normal skin color, absence of pallor or cyanosis, and the presence of capillary refill within three seconds are positive indicators of adequate blood flow.

 Promoting limb elevation and range of motion exercises

 Encouraging regular limb elevation and gentle range of motion exercises, within the limits set by the orthopedic surgeon, can aid in preventing complications associated with immobilization, such as edema and impaired circulation (L. Miller et al., 2017). The nurse should educate Mr. Ivanos on the importance of performing these exercises and ensure they are conducted correctly and safely.

Conclusion

 Providing comprehensive care for Mr. Ivanos following his orthopedic trauma requires addressing the highest priority nursing diagnoses of acute pain and the risk for peripheral neurovascular dysfunction. By implementing the nursing interventions outlined above, including patient education and support, pain management strategies, and monitoring peripheral neurovascular function, the nurse can help optimize Mr. Ivanos’ recovery, promote pain relief, and minimize potential complications associated with immobility and casts/traction.

References

Miller, L., Jerosch-Herold, C., & Shepstone, L. (2017). Effectiveness of edema management techniques for subacute hand edema: A systematic review. Journal of Hand Therapy, 30(4), 432–446. https://doi.org/10.1016/j.jht.2017.05.011 

Pastino, A. (2023, January 29). Patient-Controlled Analgesia. StatPearls – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK551610/ 

Wells, N. (2008, April 1). Improving the Quality of Care Through Pain Assessment and Management. Patient Safety and Quality – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK2658/