NR 304 Week Four In-Class Questions
Introduction
A 25-year-old man, D.M., arrives at the emergency department (ED) complaining of right ankle pain. He explains that he stepped on another player’s foot while playing basketball, causing his ankle to invert. Upon examination, there is noticeable swelling over the lateral malleolus, extending down to the area of the fourth and fifth metatarsals. D.M.’s pedal pulses are intense bilaterally (3+), and his vital signs are stable, with a blood pressure of 124/76, a heart rate of 82 beats per minute, and a respiratory rate of 18 breaths per minute.
Subjective data that the patient may note include right ankle pain, ankle inversion, and difficulty walking on the affected foot. Objective data that can be observed include swelling over the lateral malleolus and toes, intense pedal pulses, and stable vital signs. The following initial assessment questions can be asked to gather more information: How would you rate your pain on a scale of 0 to 10? Can you describe the pain (e.g., sharp, dull, throbbing)? What factors make the pain better or worse? Is the pain intermittent or constant? Does the pain radiate to any other areas? Has the swelling increased since the injury? Has a similar injury occurred in the past, and if so, when did it happen?
NR 304 Week Four In-Class Questions
These initial assessment questions aim to gather information about the nature of the pain, its characteristics, aggravating or alleviating factors, duration, radiation, and any relevant medical history. This information will assist in forming a preliminary understanding of the injury and guide further evaluation and treatment decisions. The initial management would follow the RICE method (Rest, Ice, Compression, and Elevation) to prevent additional swelling and injury. This includes advising the patient to rest the injured ankle, applying ice to reduce swelling, using compression through an elastic bandage, and elevating the leg to minimize fluid accumulation. Additionally, anti-inflammatory medication, pain medications, and proper hydration with fluids can be administered.
An X-ray examination detects no fracture, and a second-degree sprain is diagnosed. The physician orders immobilization using an elastic bandage and an air stirrup brace. D.M. is given instructions for crutch use and instructed not to bear weight on his ankle for two days. After this initial period, he is advised to transition to partial weight-bearing until the ankle has fully healed. The correct technique for applying an elastic wrap involves starting at the base of the toes, ensuring the foot is positioned at a 90-degree angle. The bandage is then wrapped around the foot, maintaining a snug but not overly tight fit. A figure-eight wrapping technique is used, crossing over the ankle and then back to the foot. This method supports the ankle, helps stabilize the joint, and reduces swelling.
NR 304 Week Four In-Class Questions
D.M.’s incorrect preference for resting the crutches directly under his arms while walking is addressed. Placing the crutches directly under the components can lead to discomfort and potential nerve damage. Instead, the correct technique involves positioning the crutches slightly below the arms, allowing weight distribution on the hands and avoiding unnecessary pressure on the nerves. This proper technique ensures stability and mobility and minimizes discomfort or potential complications. Instructing D.M. on using the three-point gait with crutches, the correct first step would be to step first with the unaffected leg. This gait involves bearing weight on one leg while using the crutches for support and balance. By initiating the step with the unaffected leg, D.M. can maintain stability and safely progress with the assistance of the crutches.
Conclusion
A 25-year-old man presents at the emergency department with right ankle pain after injuring it while playing basketball. Upon examination, there is swelling over the lateral malleolus and down to the fourth and fifth metatarsals. The patient’s pulses are intense, and vital signs are stable. Initial assessment questions aim to gather more information about the pain and its characteristics. The RICE method is recommended for initial management, including rest, ice, compression, and elevation. X-ray results show no fracture, and a second-degree sprain is diagnosed. Immobilization with an elastic bandage and air stirrup brace is prescribed, along with instructions for crutch use. Proper techniques for wrapping the ankle and using crutches are emphasized to ensure stability, and mobility, and minimize complications.
