Nursing care in patient with close fracture shaft left femur and open fracture subtrochanteric right femur with hypovolemic shock : A case study

Abstract

was hit by a sedan car two hours before being taken to the hospital. Both of his thighs were deformed and swollen. There were torn wounds on his right thigh and scratches on both legs and left arm. The left side at the back of his head also appeared to have tears and swelling. The patient was not able to describe the accident in detail. The rescue team splinted both legs and applied neck collar before sending him to Pak Phli Hospita. The treatment were IV fluid and antibiotic. The patient was then forwarded to Nakhon Nayok Hospital and diagnosed with right subtrochanteric femur fractures (open fracture) and left femoral shaft fracture (closed fracture). Upon arrival, he was shocked due to blood loss but received timely treatment in the emergency room. Such treatment included oxygen, intravenous therapy, blood transfusion, and auture for head injury. The patient then received on-skin traction with 5-kg weight applied on both legs for five days. Once the patient was stabilized, the surgical treatment was performed by undergoing an open reduction internal fixation with the proximal femoral plate on the right femur and an open reduction internal fixation with a broad locking compression plate on the left femur. The underlining challenges in nursing care for this case involved hypovolemic shock due to blood loss from fracture of both thighbones, risk of infection due to open wound fracture, risk of various complications before and after surgery, and the anxiety in self-care when returning home.

Nurses play a critical role in providing nursing care for patient with broken thighbones and open wound together with the shock. It is a very challenging orthopedic case Therefore, the nurses must be well equipped with pieces of knowledge and skill in evaluating patient' symptoms correctly and quickly, monitoring risk, and providing timely and accurate medical care to prevent any complication. After receiving a series of medical treatment and being hospitalized for 28 days, the patient’s conditions significantly improved, and the doctor allowed him to go home. However, since fracture occurred on both thighbones, the patient was asked not to weigh on both legs and remain using a wheelchair. He was also asked to continue taking medications as prescribed and follow up with the appointments as scheduled.