Question

Surgical Case 1: Marilyn Hughes 

Guided Reflection Questions 

1. How did the scenario make you feel?

2. 2. How would you recognize that Marilyn Hughes' condition was deteriorating?

3. 3. What interventions exist to alleviate compartment syndrome, and what assessments indicate improved perfusion to the extremity?

4. 4. Why is it important to maintain the limb at heart level versus elevating it above heart level?

5. 5. What could have happened in this scenario if Marilyn Hughes' condition was not treated expediently?

6. 6. What key elements would you include in the handoff report for this patient? Consider the SBAR (situation, background, assessment, recommendation) format.

7. 7. What would you do differently if you were to repeat this scenario? How would your patient care change? 

Answer 1

1)I am fairly comfortable with compartment syndrome and its treatment,so I am ok with this scenario.

2) she would show physiologic signs of increased pain such as increased blood pressure,heart rate and respiration.she would also complain of pain that is not resolved by medications and other interventions.lastly her feet and toes would continue to be pale and eventually turn blue and she would lose all feeling to that lower extremity.

3)lowering the leg so it is not too high (at the heart level) will increase circulation to the affected extremity.also loosening the dressing will allow the blood flow to return to the foot.signs of improved perfusion of the foot includes the return of color to the toes,decreased capillary refill time to the toes and return of pedal pulses feeling to the feet.

4)having the limb at the heart level improves arterial perfusion and prevents further fluid accumulation in the affected limb.

5)if the patients circulation to the limb was not restored,she could possibly her toes,foot or leg due to ischaemia of the tissues.

6)I would state that this is a 45 year old female who is orif of a left mid shaft tibia fibula fracture.she has lactated ringer at 75ml/hr.she was given inj.morphine iv 6mg at 14.15 hrs.she developed severe pain her left lower extremity for the past hour returning from surgery.she had absent pedal pulse in the left foot and numbness in that extremity.her leg was lowered on the bed and the dressing was loosened.this improved her pain and resulted in increased perfusion to her left foot.her last vital signs were HR 94b/m,BP 153/90 mg,RR 21,SPO2 98%.

7)I would probably lower her leg earlier in the sequence of events.otherwise I feel comfortable with all of my actions.