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This report is based on Mr. Casey, who is 24 years old male, brought into the Emergency Department via ambulance because of the motor vehicle accident on the freeway. He has got a closed head injury, fractured femur and tibia plus and multiple rib fracture on the left side with an obvious flail segment. The main purpose of this report is to identify the actual and potential problems associated to Mr. Ben Casey and also describe sign and symptoms of those health problems. This report also described the pathophysiology related to the sign and symptoms which is given on case study of Mr. Casey and discuss about the nursing intervention of those actual and potential based on evidence rationales. The report also mentions the priority of care associated with the health problems and interventions according to their effectiveness for Mr. Casey. According to his case scenario the followings are actual and potential health problems identified by the group:

Actual health problems: Acute pain.
Potential health problems: pressure sore
Acute Pain
Acute pain is the actual problem for Mr Casey. It is very important to assess his pain frequently because he has severity of pain because of the accident and also the surgery as well. Patient is in semi consciousness but the facial expression can tell that he is suffering the pain which is non- verbal indication of pain. Mr Casey experiencing the pain and uneasiness on femur and tibia related to surgery evidence by his voiced pain, facial expression and stiffness. Pain before or after surgery caused by impaired functioning in the muscle and musculature those results in abnormal stresses being placed on the joints and soft tissues. Additional possible sources of the pain during the early post injury period include nerve root impingement, referred pain from the cervical injury and abnormal stresses placed on the shoulders because of poor positioning on bed. Patient become more restless and also the vital signs changes frequently often with post operational pain.
Pressure ulcers:
One of the potential problem can be identified on Mr. Casey is pressure ulcers which is very common on patient like Mr. Ben Casey who recently had a surgery and stay on bed for long time. People with spinal cord injury are disposed to developing this complication because of the combination of motor and sensory impairments that cause the skin to be subjected to prolonged unrelieved pressure and other damaging forces plus skin and circulatory changes that make the skin more vulnerable to these damaging forces. According to the case study for Mr. Casey he also is in spinal precaution which means he barely moves or reposition on bed, which lead to the higher risk of pressure ulcers. Mr.Ben had a surgery including ORIF of the left tibia (plates and screws) and an ORIF of the left Femur (femoral rod), which can lead to the physical impairment as well. Tample (2006) suggested that the patient suffers from pain, swelling and impairment of motor function after surgery. So, it is important to focus on body functions as well as participation and abilities while caring patients with ORIF surgery.

Nursing intervention
Pain management is most important to release the pain for post-operative patient like Mr. Ben Casey which helps him to be able to cope with the pain which is suffering .and it is also a fundamental aspect of nursing care (Lucas, 2008).As a nurse, pain assessment is a primary step in understanding and working towards the patient’s goals, but it can be managed by pharmacologically and/or in non- pharmacological way. It has proved that patient controlled analgesia (PCA) is the most effective and safe analgesia in patients with postoperative pain which include improved pain relief, greater patient satisfaction, less sedation and fewer postoperative complications. In case of Mr. Casey, as a nurse it is very important to educate him about the correct use of PCA, because patient with severe pain is not always to understand or do much regarding pain control, but with guidance and safety precaution they can release the pain by themselves. Anxiety also can increase the level of the pain or discomfort on Mr.casey’s because Mr Casey had an accident and also recently had multiple surgery .Nursing role included in Mr. Casey’s case is check the PCA to ensure correct delivery of the medication and also note the entire analgesia and doses rate requested by Mr. Casey (Walker, 2012). Mostly nursed have to careful any sign and symptoms after the analgesia and check regularly because depression and respiratory problems is the most common side effects of PCA use.
Teaching is the most important intervention for pressure sore patient with bed bounding because the most effective plan to prevent the pressure sore is educate Mr. Casey and his family. Mr Casey has a higher risk of pressure sore because he is on supine position and dependent on health professional to turning around. In this case nurses or other health professionals should assess his activities, equipment that has been use and other potential sources of skin damage in an attempt to recognize the most likely to cause pressure sore. A comprehensive ulcer care programme addresses both the ulcer itself and any factors that may contribute to its healing or the development of future pressure ulcers, interventions include prevention of additional pressure ulcers, managing tissues loads ,wound cleansing , use of dressing ,managing bacterial colonization and infection ,adjunctive therapies to promote wound healing surgery ,optimization of the patient’s health and nutritional status and education and training .nutritional status also effect on developing the pressure sore for Mr Ben Casey, because adequate diet provides enough calories for energy needs and additional protein for restoring muscle mass and wound healing as well , so in this case nurse has to investigate whether the diet Mr Casey is taking is adequate or not .For Mr Casey regular repositioning has to be done because it help to minimise the risk of pressure sore on pressure area while he is on bed .While doing the manual handing for Mr Casey ,nurses has to be aware about his condition as well as the technique of the equipment because sometimes misuse of the equipment  can cause tissue damage .
Priority of care associated with health problems
To keep Mr.Casey comfortable, pain control can help him to recover faster and it reduce his risk of developing some other complications after surgery, such as blood clot and pneumonia (Pritchard, 2009).Respiratory complication is also the most common cause for patient with spinal cord injury and ORIF of the left tibia and left femur. This complication occurs as a result of a reduction in both inspiratory and expiratory ability and impaired functioning in the muscles of inspiration because reduced ventilation of the lungs and atelectasis. Weakness in muscles also makes them more likely to fatigue, which can lead to ventilatory failure. For Mr Casey intervention include adequate ventilation, enhance breathing and coughing ability, mobilize secretions and provide him with the knowledge and skills that he will require to avoid complication after discharge.
Therefore, it is in priority to offer pain management education in discharge planning and also patients should be informed about side effects and use of analgesics. It is important for nurse to find out about the what happening on Mr Casey before deciding to give analgesia.
Evaluation
For Mr Casey, the main nursing role include is to evaluate pain relief therapies based on his current situation. Using the numerical rating scale clearly documents the effectiveness of intervention, it help nurses to evaluate the reaction after the analgesics and also help to understand the current pain level of patient (Mott, 2009).Also nurse need to evaluate on Mr Casey how often using the PCA, if he is using PCA much more frequently then nurses need to consult with doctor about his situation and increase the dose of pain medication to get him relax. It is necessary to make sure is there any redness or pressure sore on certain area to find out that patient apply their knowledge about the pressure sore or not. While evaluating Mr Casey, nurses have to make sure that he has knowledge about the postoperative care after surgery including pain scale, use of PCA etc.

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