Deniz Burleson

Nursing Care Plan For Multiple Trauma Patient

Deniz Burleson

Patient E, 33 y/o, is a well conditioned, active male. While at work he got crushed by a log that fell off a logging truck. An emergency medical technician rushes to the scene and directs the care of the patient. Patient E sustained significant trauma to his chest, abdomen, and lower extremities. He is conscious and has tremendous amount of pain. The EMT, only trained in basic life support, applies an oxygen mask to the patient and places him in antishock pants while awaiting the arrival of a helicopter. The compression of antishock pants can provide some circulatory support and stabilize his pelvis and femurs. Although Patient E was maintaining his airway at present, he was losing blood and his condition was becoming more serious. IV lines started one on each upper extremity. Lactated Ringers solution was infused side open until the patient had received two liters of fluid. The team could not examine the injuries to patients lower abdomen and lower extremities. EMT reports that patient E has multiple bruises to the lower abdomen, displaced pelvis and fracture to the left femur. The crew was able to palpate distal pulses on the right and left feet with the left foot being slightly weaker than the right. During transport patients neurologic status got worse. He was no longer awake and responsive. The crew increased the oxygen percentage 100% and obtained other vital signs. His peripheral pulse showed diminished right foot pulse only. Patient Es oxygen level dropped from 94% to 80%. EMT checks placement of the endotracheal tube to make sure that oxygen was functioning properly. Then it was assumed that the patient had developed secondary complications. After the flutes valve was displaced because of the pneumothorax, the patients oxygen saturation level increased from 88% to 90%. Upon arrival at the trauma center, Patient E was evaluated head to toe. A chest x-ray confirmed the development of pneumothorax. During the assessment it was noted that the patient had a cold and pulseless right foot. After the antishock pants were deflated by the trauma team, it was noted that color and pulse were returning to the right foot. When the pants were totally removed a large ring of keys was found in the patients front pocket. Increased gas expansion within the antishock pants caused increased pressure on the key ring. The pressure increase was enough to put pressure on the patients femoral artery, cutting off circulation to his right leg. His injuries sustained included fractured ribs of the right chest (causing the pneumothorax), a fractured pelvis, a ruptured spleen, a small liver laceration, fractured right femur, and a closed fracture of the right tibia and fibula.

He was taken to the operation room for repair of the splenic and hepatic injuries and orthopedic stabilization. Then he was transferred to the trauma ICU. During his ICU stay he developed respiratory distress syndrome but eventually was removed from the ventilator. His other injuries were stabilized and the patient did well.

Deniz Burleson

Problem
Ineffective airway clearance -Related to the development of a pneumathorax caused by fractured ribs -As evidenced by altered oxygen supply and ineffective breathing pattern

Outcomes
-Maintain adequate ventilation for the patient -Position patient in Fowler position if tolerated to promote better lung expansion and improved gas exchange -Suction patient as needed which aides to remove secretions from the airway and optimizes gas exchange

Nursing Interventions
-Closely monitor the patients heart rate and blood pressure the four times factor -Frequently evaluate the patents serum electrolyte levels q/1-2 h -Check and record patients response to medication q/3 h then q/4 h -Provide any other means of communication for the patient

Problem
Severe pain -Related to fractured ribs, hips, left femur, right tibia, fibula. Also splenetic and hepatic injuries -As evidence by patients facial grimacing, moaning, and guarding of surgical areas

Outcomes
-Pain management -Relieve patient discomfort and pain -Pace activities and prevent fatigue

Nursing Interventions
-Instruct patient that he needs to continue to give himself pain medications as prescribed per pain pump -Eliminate additional stresses or sources of discomfort in patients room -Provide rest periods, quiet environment -Change Dressing -Teach patient non-invasive pain relief techniques, such as relaxation, guided imagery, meditation, biofeedback

Problem
Possible skin impairment risk -Related to minimum activity capacity caused by fractured ribs, pelvis, left femur, fight tibia and fibula -Related to staying in bed for extended time

Outcomes
-Assess patients skin condition -Mobility as tolerated -Perform skin care routine -Care of incisions

Nursing Interventions
-Interpret patients skin daily and document findings -perform prescribed treatment regimen and monitor progress q/4 h -Check and clean perineal area after each void and b.movement -Check cast edges q/2 h -Check bony prominences q/2 h -Change dressing q/2-4 h for first 24 h, then as needed