Task Peter Bowman is a thirty-eight (38) year old plumber who has just been brought to the Emergency Department by ambulance after a fall from his roof. An X-Ray has revealed a fractured left femur...

Task
Peter Bowman is a thirty-eight (38) year old plumber who has just been brought to the Emergency Department by ambulance after a fall from his roof. An X-Ray has revealed a fractured left femur and fractures to his left second and fourth ribs. He has no other significant injuries. He did not hit his head and there was no loss of consciousness at the scene. The following assessment data is available:
Primary Survey
A – patent
B – RR 24 and shallow, bilateral chest expansion, equal air entry
C – pale, not diaphoretic, left foot cool and pale
D – alert and orientated to time place and person. Pain 7/10 left leg and 8/10 left side of chest

E – swelling and bruising to left leg, grazes to back, left elbow and forehead, 20 gauge intravenous cannula (IVC) insitu left cubital fossa, 18 gauge IVC insitu right hand.


Observations
HR 120, BP 100/60, RR, 24, SpO2 90% on R/A, Temp 36.2, BGL 5.2 mmol


The emergency registrar has conducted an initial assessment of Peter and provided the following orders:


Insert indwelling urinary catheter (IDC) and record hourly urine measures, 0.9% Sodium Chloride IL IV over 30 mins, oxygen to keep Sp02 above 96%, sit in high fowler’s position and morphine 7.5 mg IV STAT.

This assessment task requires you to submit a report in which you discuss your interpretation of Peter's assessment findings and your subsequent nursing management. In addition to an introduction and conclusion, your paper should include the following sections:
Underlying Pathophysiology
It is important that registered nurses understand the disruptions to normal physiology that cause the abnormal assessment findings we observe in the clinical setting. The information provided in the scenario includes a number of abnormal assessment findings. This section requires you to:


• Discuss the underlying pathophysiology of Peter’s injuries (fractured femur and fractured ribs) by explaining the disruptions to normal physiology that have caused the abnormal assessment findings in the case study.


Nursing Interventions
The clinical scenario includes a number of orders or nursing interventions. In order to maintain patient safety and achieve the best clinical outcomes for Peter, it is important that these interventions are prioritised appropriately. It is also essential for registered nurses to understand how the interventions we provide are linked to the underlying pathophysiology of the patient’s condition. This section of the report requires you to:


• Prioritise the orders provided in order of clinical urgency


• Provide a rationale for each intervention listed in the case study.  Each rationale should include an explanation of why you have prioritised the intervention in that order and an explanation of how the intervention will improve Peter's condition based on the underlying pathophysiology you have already discussed.

You must support the discussion in both sections of your report with a MINIMUM of 10 recent (less than 6 years old) and credible sources. Credible sources include the following:


• peer reviewed journal articles (which are the highest quality sources)
• text books
• evidence summaries
• best practice guidelines
• government documents
• health facility clinical guidelines, pathways and policies/procedures
• websites containing content aimed at health professionals.
This paper is a piece of formal academic writing and should therefore adhere to academic writing conventions.  Sub-headings are acceptable, but point form and tables should not be used.

Rationale
This assessment task addresses the following subject learning outcomes:
•    be able to collect, interpret and document subjective and objective assessment data in the acutely ill person

•    be able to link the underlying pathophysiology of selected acute health challenges to their clinical manifestations .

•    be able to apply theoretical knowledge, critical thinking, problem solving and the use of best evidence to the planning and implementation of safe and appropriate nursing interventions for people experiencing selected acute health challenges