NURS 6560: Week 10: Assessment and Care of Patients with Neurologic and Orthopedic Conditions and Plastic/Reconstructive Surgery

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NURS 6560: Week 10: Assessment and Care of Patients with Neurologic and Orthopedic Conditions and Plastic/Reconstructive Surgery Essay Assignment Paper

NURS 6560: Advanced Practice Care of Adults in Acute Care Settings II | Week 10

Jill Joyce experienced years of back pain that prevented her from completing even the most basic tasks. Bulging discs and degenerative changes in her spine were affecting nerve function, which caused pain that could be alleviated only with surgery (Healthy Life, 2008). Like Jill’s back pain, many conditions related to neurology, orthopedics, and plastic/reconstructive surgery may affect patients’ function and mobility. In your role as advanced practice nurse, you must not only diagnose and treat these patients but also help them manage changes in their function and mobility.

Learning Objectives

By the end of this week, students will:

  • Evaluate medical and surgical patients with conditions related to neurology, orthopedics, and plastic/reconstructive surgery
  • Develop differential diagnoses for medical and surgical patients with conditions related to neurology, orthopedics, and plastic/reconstructive surgery
  • Develop treatment plans for medical and surgical patients with conditions related to neurology, orthopedics, and plastic/reconstructive surgery

Learning Resources

Required Readings

Colyar, M. R. (2015). Advanced practice nursing procedures (1st ed.). Philadelphia, PA: F. A. Davis Company.

  • Chapter 28, “Bone Marrow Aspiration and Biopsy”
  • Chapter 29, “ Lumbar Puncture”
  • Chapter 31, “Arthrocentesis”
  • Chapter 32, “Assessment for Compartment Syndrome and Pressure Testing”
  • Chapter 35, “Dislocation Reduction”
  • Chapter 36, “Ganglion Cyst Aspiration and Injection”

Doherty, G. M. (2015). Current diagnosis and treatment: Surgery (14th ed.). New York, NY: McGraw Hill.

  • Chapter 36, “Neurosurgery”
  • Chapter 40, “Orthopedic Surgery”
  • Chapter 41, “Plastic & Reconstructive Surgery”
  • Chapter 42, “Hand Surgery”

Weber, E. C., Vilensky, J. A., & Fog, A. M. (2013). Practical radiology: A symptom-based approach. Philadelphia, PA: F. A. Davis Company.

  • Chapter 2, “Shoulder, Pelvis, and Limbs”
  • Chapter 3, “Spine and Spinal Cord”
  • Chapter 4, “Brain”
  • Chapter 11, “Imaging of Bone Disease and Endocrine Disorders”

Kuntz, A. F., Lai, W.-S., Norton, P. T., Yao, L. L., & Gay, S. B. (2013). Skeletal trauma radiology. Retrieved from http://www.med-ed.virginia.edu/courses/rad/ext/index.html

Shonka, D. C., Gay, S. B., Marx, W. F., Frederick, J. A., Vu, Q. D. M., Higginbotham, J., … Rehm, P. K. (2013). Introduction to head CT. Retrieved from http://www.med-ed.virginia.edu/courses/rad/headct/index.html

Required Media

i-Human Patient Cases. (2014). Retrieved from https://ih2.i-human.com/users/sign_in

AshtonMoh. (2011). Lumbar puncture 2 [Video file]. Retrieved from https://www.youtube.com/watch?v=QoUGM4wqUU0

Doe, J. (2012). Knee aspiration [Video file]. Retrieved from https://www.youtube.com/watch?v=Jx8HmJJOGas

Optional Resources

American Academy of Orthopaedic Surgeons. (2015). Broken bones & injuries. Retrieved from http://orthoinfo.aaos.org/menus/injury.cfm

American Society of Plastic Surgeons. (2015). Evidence-based practice guidelines and practice parameters. Retrieved from http://www.plasticsurgery.org/for-medical-professionals/legislation-and-advocacy/health-policy-resources/evidence-based-guidelinespractice-parameters.html

Boyd, A. S., Benjamin, H. J., & Asplund, C. (2009). Splints and casts: Indications and methods. American Family Physician, 80(5), 491–499. Retrieved from http://www.aafp.org/afp/2009/0901/p491.html

This week, you study neurologic and orthopedic conditions with plastic surgery considerations. Both neurologic and orthopedic conditions are seen in the trauma areas of the hospital. These conditions encompass cardiovascular, pulmonary, and metabolic aspects of care in the ICU. For this Discussion, focus on adolescent patients, and consider potential diagnoses, treatment, and/or referral options for the patients in the following 3 case studies.

Case Study 1

A 17-year-old male was celebrating his birthday with friends and alcohol. At one point he jumped into the hotel pool three stories below, hitting the side of the pool with his chest. EMS arrived and packaged him with spinal support. He arrives in the ER with breathing difficulty, chest pain, GCS 10, and O2 sat of 94%. You do initial assessment in the first 10 minutes and find that his chest is asymmetric for breathing and contusions are noted all over his chest. His CXR shows multiple rib fractures on both sides and pulmonary contusions. His cervical spine is stable in a collar. His thoracic and lumbar films are negative for fractures. In the next hours, what are your priorities, and what plan would you have for this patient as he moves to the ICU? At what stage of development is he, and how does that affect his care?

Case Study 2

A 13-year-old female restrained passenger of a vehicle was involved in an MVA at 60 mph on the highway. The vehicle experienced a frontal impact. The patient arrived in the ER with closed fractures of the left tibia and fibula with angulation, dislocation of the right ankle, multiple pelvic fractures, and femur fracture on the left side. Her BP is 92/54 with pulse of 130. What is your plan for this patient, and what are the considerations to prevent further morbidity? At what stage of development is she, and how does that impact her care?

Case Study 3

A 19-year-old male private in the U.S. Air Force was driving with friends when they dared him to “surf the car.” He fell off the roof of the car while it was moving at a speed of approximately 40 mph. He landed face first. He is now in the ICU with a closed head injury. His intracranial pressure is elevated, and his pupillary response is slowing. At this time, what medications do you recommend, and what other medical treatments do you recommend? In addition, after the acute situation is controlled and the patient awakens, what medication do you use for his agitation?

To prepare:

  • Review and select 1 of the 3 provided case studies. Analyze the patient information.
  • Consider a differential diagnosis for the patient in the case study you selected. Think about the most likely diagnosis for the patient.
  • Think about a treatment and management plan for the patient. Be sure to consider appropriate dosages for any recommended pharmacologic and/or nonpharmacologic treatments.
  • Consider strategies for educating patients and families on the treatment and management of the trauma care.

By Day 3

Post an explanation of the differential diagnosis for the patient in the case study you selected. Explain which is the most likely diagnosis for the patient and why. Include an explanation of unique characteristics of the disorder you identified as the primary diagnosis. Then, explain a treatment and management plan for the patient, including appropriate dosages for any recommended treatments. Finally, explain strategies for educating patients and families on the treatment and management of neurologic and orthopedic conditions.

Read a selection of your colleagues’ responses.

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By Day 6

Respond to at least two of your colleagues on 2 different days in both of the ways listed below. Respond to colleagues who selected different case studies from yours.

  • Describe how culture might affect the diagnosis, management, and follow-up care of patients with the neurological, orthopedic, or plastics disorders your colleagues discussed.
  • Based on your personal and/or professional experiences, expand on your colleagues’ postings by providing additional insights or different perspectives.​

Discussion Part II: Pharmacology

To prepare:

Read the following articles to enhance your knowledge of commonly prescribed medications:

Family Practice Notebook. (2015). Nonsteroidal anti-inflammatory. Retrieved from http://www.fpnotebook.com/Pharm/Analgesic/NnstrdlAntInflmtry.htm

Press, C. D. (2013, September 10). Infiltrative administration of local anesthetic agents. Retrieved from http://emedicine.medscape.com/article/149178-overview

All of the following groups of medications are commonly prescribed in the acute care setting. Choose one of the topics below to discuss. If it is a medication group, select a specific drug within that group. (This is a good way for you to prepare for clinical practice, because you will get to know the drugs you will prescribe for patients.). Focus your discussion on the hospital or ICU setting and IV usage.

  1. Glycopeptides
  2. Oxazolidinones (Bs)
  3. Monobactams
  4. Ansamycins
  5. Metronidazole
  6. Lincosamides (Bs)
  7. Tinidazole
  8. Lidocaine
  9. Marcaine
  10. NSAIDs

Note: When sharing your initial post, select a topic that has not yet been discussed. If all topics have been discussed, then you may select that topic again, but select a different drug within the medication group.

By Day 3

For this Discussion, address 1 of the following options:

Option 1

Post a description of a patient you have taken care of (inpatient as an RN, or as an NP student) who has been prescribed the medication you selected. Include the scenario, indication, dosing, complications, and outcome. Then explain whether or not you would have ordered the same drug and same dose.

Option 2

Conduct an evidence-based drug search on the drug you selected and post an explanation of any possible issues. Are there any drug interactions? Any black box warnings? To what type of patient would you prescribe this medication?

Option 3

Post an explanation of the properties of the drug you selected, including usages and dosing in the hospital or ICU. Describe a patient you would prescribe this medication to.

Note: To be considered as one of your required responses, your pharmacology rationale must include a supporting reference.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!

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