Subjective assessment A 64-yea
Subjective assessment
A 64-year-old lady who has just had the cast removed after 6/52of immobilization for a Colles’ fracture of her right wrist. Shehas been referred to physiotherapy for exercises.
The patient tripped and fell on an uneven section of thepavement while hurrying to the bus stop on her way to work.
After the application of the cast on the day of injury, thepatient did not receive any instruction regarding the prevention ofjoint stiffness or swelling before being sent home.
She had no problems that she felt were worth reporting duringthe time of immobilization.
Objective assessment
A thin, slightly stooped woman.
Holding right wrist in left hand in guarded position across herbody.
Her hand and fingers are swollen and quite pink with scaly andflakey skin.
There is a visible deformity/bulge just above the wrist from thefracture callus.
Pain present when the fracture site is touched and when movingher hand and finger joints. Pain in her shoulder when lifting herarm to dress.
ROM limited from pain and stiffness in the shoulder and fromswelling, pain and stiffness in the wrist, hand, thumb and fingerjoints.
Right handgrip strength is 25% of her left (right dominant).
Her stated goal is to ‘get back to normal.’
Questions
1. What underlying factors or conditions would you consider inthis situation?
2. What other assessments would you consider important with thispatient (i.e. labs, imaging)?
3. Provide at least TWO nursing diagnoses for this patient.
Thanks
Answer:
Joint stiffness is a common problem associated with plastercast. Due to the immobility of the part for days will lead tostiffness of the joint. Through physiotherapy we can restore thmobility of the joint. Other causes such as due to any dislocationfrom the position may lead to stiffness of joints. Malformation ofthe fracture is another reason. This will affect the movement aswell as injuries to nearby structures.
2,
Proper assessment of patient is needed. Through xray we canidentify any dislocation or malformation of fractures. CT scan alsohelp as to understand the bone formation and status of fracture andbone.And also done physical examination to identify the ROM of thejoint. And assess the need of physiotherapy.
3,
Acute pain. While we are trying to move the joint it may painfulto patient.
Activity intolerence related to restricted movements. Due to thejoint stiffness at wrist of hand there is limited activities canperformed by the person.
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