Module 12

Question 1

An 84 year old woman had an internal fixation for her fractured hip. She complains that her elastic stockings feel tight and hot and asks you to remove them. How would you respond to this request? What is the rationale for your action?

Answer 1

Leave them on, advise patient that they reduce the risk of a DVT (50% risk from hip fractures and ORIFs)

Improve comfort by reducing bed linen on end of bed to keep legs cool.

Ensure correct fit and that they are not rolling/gathering.

Encourage ambulation as tolerated to reduce bedrest, length of stay and overall time wearing them.

Provide empathy and reassurance.

Question 2

With regards to skin traction, explain why the traction force is applied over a wide area and applied distal to the fracture?

Answer 2

Applied over wide area to evenly distribute pulling force.

Applied distal to the fracture to maintain pulling force on ‘end’ of the bone.

Question 3

The acronym RICe is used in nursing. Explain what this means and who would be the likely candidates to receive it.

Answer 3

Commonly used for sprains and strains.

R - REST
Helps limit movement that can worsen injury.

I - ICE
Applied to area to reduce swelling and help stop bleeding (vasoconstriction)

C - COMPRESSION
Applying pressure to the area to help stop bleeding (cloth or bandage) and provide comfort.

E - ELEVATE
Raising injured area above rest of body to reduce swelling.

Question 4

Falls and the consequences in the elderly population are becoming increasingly common. What interventions would you put in place to minimise the risk for an elderly patient in hospital?

Answer 4

Falls risk assessment and plan
MMSE
Non-slip socks
Aids and equipment nearby
Call bell within reach
Nurse near nursing station
Bed lowered to the ground
PCA/guard if confused
Supervised mobilisation
Review of meds and minimise agents known to cause falls such as antidepressants, diuretics, sedatives and antihistamines.

Question 5

Explain why bladder and bowel function and care is different for patients with spinal cord injury compared to the population at large.

Answer 5

Bowel transient time may increase.
Patient cannot feel the sensation of fullness in bladder or rectum.
Over-distention of bowel may cause hyper-reflexia.

Question 6

What is the routine bladder and bowel care of patients with spinal cord injury?

Answer 6

Bladder management is by way of Urodome, long term IDC or suprapubic catheter.

http://aci.health.nsw.gov.au/__data/assets/pdf_file/0019/155215/Management-Neurogenic-Bowel.pdf