Question

A nurse is caring for an adolescent

Exhibit 1:
1400:
Adolescent brought to emergency department by parents following a fall while skateboarding. Adolescent reports pain in their right leg as 10 on a scale of 0 to 10 and is unable to bear weight.
Adolescent is awake, alert, and oriented x 3. Lungs clear, respirations even and regular. S1 and S2 with regular rate and rhythm. Abdomen soft and nontender with active bowel sounds in all four quadrants. Right lower extremity with open wound and displaced bone. Right lower extremity pulse +1, extremity cool to touch, edema present, capillary refill 4 seconds.
Exhibit 2: Vital Signs
1400:
Temperature 37° C (98.6° F)
Weight 54.5 kg (120 lb)
Heart rate 89/min
Respiratory rate 20/min
Blood pressure 124/82 mm Hg
Oxygen saturation 98% on room air
1630:
Temperature 38° C (100.4° F)
Heart rate 94/min
Respiratory rate 20/min
Blood pressure 126/84 mm Hg
Oxygen saturation 98% on room air
2300:
Temperature 37° C (98.6° F)
Heart rate 75/min
Respiratory rate 16/min
Blood pressure 120/80 mm Hg
Exhibit 3: Provider Prescriptions
1415:
X-ray of right leg
Surgery consult
Morphine 4 mg IV every 2 hr as needed for pain.
Exhibit 4: Nurses' Notes
1430:
Adolescent transported to x-ray.
1445:
Adolescent returned from x-ray and sent to surgery.
1600:
Adolescent returned from surgery following an open reduction internal fixation of the right tibia. Adolescent is resting comfortably, parents at bedside. Capillary refill 1 second. Pedal pulse +2 Extremity cool to the touch. Adolescent rates pain as 0 on a scale of 0 to 10.
1630:
The adolescent reports pain as 10 on a scale of 0 to 10.
1700:
Adolescent still reporting pain as 10 on a scale of 0 to 10 following administration of pain medication. On assessment, right foot is cool and pale. Unable to palpate pedal pulse. Adolescent reports tingling and numbness in right foot.
​1710:
Notified provider regarding assessment findings that might indicate compartment syndrome.Awaiting provider's response.
2300:
Adolescent is drowsy and reports nausea. Respirations shallow. Lungs clear. Unproductive cough present. S1 and S2 with regular rate and rhythm. Abdomen soft and nontender with hypoactive bowel sounds in all four quadrants. Right lower extremity fasciotomy, dressing clean, dry, and intact. Extremity pulse +3. Capillary refill 2 seconds. Right extremity is warm to the touch. Adolescent reports no numbness or tingling. Adolescent reports pain as 2 on a scale of 0 to 10.
Exhibit 5: Diagnostic Results
1445:
X-ray reveals an open fracture of the right proximal tibia.
Exhibit 6: MAR
1430:
Morphine 4 mg IV
1630:
Morphine 4 mg IV
Findings that indicate patient is improving?
a) Capillary refill increased from 1 second to 2 seconds
b) Pulse increased from +2 to +3 in the right extremity
c) Respiratory rate decreased from 20/min to 16/min
d) Pain reported decreased from 10 to 2 on a scale of 0 to 10

Answer 1

The adolescent patient shows improvement post-surgery as indicated by an increased pulse in the right extremity from +2 to +3, a significant decrease in pain level from 10 to 2, and the right extremity warming up, reflecting better blood circulation.

Step-by-step explanation:

Findings Indicating Patient Improvement

To identify the signs that indicate the adolescent patient is improving after the open reduction internal fixation and subsequent fasciotomy for a right tibia open fracture, we can evaluate the provided clinical data. The findings of the patient’s progress include:

Pulse improvement from +2 to +3 in the right extremity, signifying better perfusion to the area.

Decreased pain level from a score of 10 to 2 on the pain scale, indicating effective pain management and recovery.

Change from cool and pale extremity to extremity warm to the touch, which is a sign of improved blood flow.

These indications suggest an overall positive trajectory in the patient’s recovery from the injury and subsequent surgery.