8/13/2019 Ms Case - Nuero 2
1/2
Case: A 45-year-old white male steel worker presented to the
Urgent Care Clinic three days
after an accident at work. He received a crush injury from a
bucket at the end of a boom, which
continued to move forwardeventually pinning him between a steel
beam and the side of the
bucket. An observer below saw the accident, stopped the boom and
brought him to ground
level. He was unconscious at the time. Bystanders called 911 and
the patient aroused
spontaneously within a few minutes.
Emergency department (ED) evaluation with CT of the head, neck,
chest, and abdomen noted.
A series of four right lateral spinous process fractures from
T10 to L1 and two right rib fractures
#9 and #10. The remainders of the studies were reported as
normal. CBC and metabolic profile
were normal and a 12-panel drug screen was negative.
Physical examination: Patient ambulated into the clinic alert
and oriented x3. He complained of
much back pain, as well as difficulties breathing and moving.
Records from the ED were
obtained and reviewed. Chest X-ray noted consolidation at right
base, believed to be a small
pulmonary contusion. O2 saturation was 98%. The patient was
advised of the findings and was
given prescriptions for an antibiotic and pain medication.
Pulmonary toilet discussed and
cigarette cessation was encouraged.
A few weeks following the initiation of physical therapy, he
continued to complain of right back
pain and upper left chest pain. A follow-up chest X-ray revealed
a displaced left 4th rib fracture
not noted on prior studies. Patient was very motivated to get
well. Pain management was
ongoing with Oxycontin twice daily, low dose oxycodone for
breakthrough pain and Valium for
sleep.
Eight weeks later, the patient complained of difficulty with
both physical therapy and his work-
hardening program. He still required an opiate at least once
daily for pain control. He did notfeel strong, was somewhat
depressed, and was having a recurrence of right back muscle
spasms.
Questions
1. What is your differential diagnosis?
a. Rationalize your diagnosis by providing pertinent facts about
the disease
b. Include other signs and symptoms not manifested by your
client.
c. Provide necessary diagnostic procedure and laboratory exam,
treatment including
medications, and nursing care plan
2. Develop the concept map for your client by following
guidelines below:
a. There was no right or wrong way to do the map.b. The map
should be what you felt was useful informationc. Identify relevant
concepts in the material. From this identification a
hierarchical
structure is developed selecting appropriate linkages to from
valid propositions.
d. The client is the center of the map
