NU 606 Week 4 Discussion 1: Case-Based Discussion JL fell, fracturing her L tibia distal to her ankle resulting in redness, pain, and swelling.  The patient was diagnosed with a simple fracture,

NU 606 Week 4 Discussion 1: Case-Based Discussion

JL fell, fracturing her L tibia distal to her ankle resulting in redness, pain, and swelling.  The patient was diagnosed with a simple fracture, “a single break in the bone in which the bone ends maintain their alignment and position” (VanMeter 2018, p.167). Her pain is caused by soft tissue damage. Damage occurs due to the breaking of the bone from the blood vessels that have broken (VanMeter 2018, p.167). “The inflammatory response develops as a reaction to the trauma in the presence of debris at the site” (VanMeter 2018, p.167-168). The inflammatory process causes her swelling. “Swelling is the result of the increased movement of fluid and white blood cells into the injured area” (Nationwide Children’s, 2021). The movement of fluid is what results in redness and swelling at the affected extremity. It is an acute process related to the fracture and the fall.

As healing begins, JL can expect to feel less pain, and the bone will be set in place and her leg cast to keep the bone in place. The swelling should also go down as the inflammatory response will stop. JL shole expect some discomfort in the bones and joints that were immobilized as the cast is removed. She will also expect some atrophy in the muscles of her affected leg, while the skin will be drier and have more hair (UCSF Health, 2021). The atrophy results from disuse of the leg. The skin changes after cast removal result from the constant covering of the skin with the cast. The hair growth results from friction from the cast. The friction stimulates the hair follicles in the skin to produce new hairs, leading to more hair growth (The Independent, 2011).

Immobilizing the fractured bone reduces the risk of increasing more debris and fragments from the bone fracture forming. Immobilization also helps with the healing of the bone as it is easier for the bone to heal “to prevent bone edges from moving and damaging other muscles, vessels or nerves and further complications” (Jacob, 2020). Immobilization can also help reduce inflammation as the bone pieces no longer agitate or move to create a more significant inflammatory response.

If the edema increases in the casted area within 24 hours of having a cast, this can result in compartment syndrome. Compartment syndrome can develop shortly after the fracture occurs, with more extensive inflammation (VanMeter 2018, p.169). In this process, “increase pressure of fluid within the non-elastic covering of the muscle compresses the nerves and blood vessels causing severe pain and ischemia or necrosis of the muscle” (VanMeter 2018, p.169).

Some common signs and symptoms of compartment syndrome are “pain, pallor (pale skin tone), paresthesia (numbness feeling), pulselessness (faint pulse) and paralysis (weakness with movements)” (USF Health, n.d.).

The feeling fatigued, anorexic, and a low-grade temperature can result from an infection, because of the bone fracture or as a second infection not related to the bone fracture.

The patient is not at high risk for osteomyelitis because the fracture was simple and not open, in which the fracture has broken through the skin. Osteomyelitis usually results from bacteria or fungi entering the blood from a fracture then spread to the bones.  Staphylococcus bacteria cause most cases of osteomyelitis. A bacterium is generally found on the skin or in the nose of healthy individuals (Mayo Clinic, 2020). An opportunistic infection most likely causes osteomyelitis.

To promote healing of the bone, the patient should keep the cast on for about 6-8 weeks to ensure recovery with a simple fracture, reducing the risk of fragments inducing a more aggravated inflammatory response causing more pain and more swelling. Two, to increase foods high in vitamin D and calcium to promote healthy bone growth and maintenance. Lastly, complete and promote weight-bearing exercises to promote muscle health and circulation, better healing of limb effect, and refer patient physical therapy for a week and muscles post un casting of the leg to ensure recovery and resuming of normal function.

Resources

Jacob, P. D. (2020, July 24). What Is Splinting Used For? Broken Bones, Pain, Swelling.

MedicineNet. https://www.medicinenet.com/what_is_splinting_used_for/article.htm

Mayo Clinic. (2020, November 14). Osteomyelitis – Symptoms and causes.