Case study Essay
Length: – 1800 words
Sally with Talipes who has had TendoAchilles lengthening
Sally is a 4 month old baby girl with unilateral talipes equinovarus (TEV) and congenital hip dysplasia. Serial plasters in hospital began since day three of her birth and today she is admitted to the day surgery unit for left Tendo Achilles lengthening and plaster cast application. Following surgery Sally has returned to the ward with an intravenous cannula in her right hand and a plaster of paris cast encasing her left lower leg and foot. The focus of this essay is Sally’s two priority nursing problems, which are post surgery pain related to Tendo Achilles lengthening and the plaster cast application, and secondly peripheral tissue integrity related to pressure from the cast (Ackley, Ladwig,2010). The essay will cover the two priority nursing interventions for both of these problems, what is involved in implementing these interventions, what should be considered when implementing these interventions, and the expected outcomes when evaluating the efficacy of the interventions.
Sally’s first priority nursing problem is post-surgery pain R/T Tendo Achilles lengthening and plaster cast application (Ackley, Ladwig, 2010). Sally’s pain is evidenced by her observed grimacing and crying with continuous lifting of her legs off the cot mattress and her Mother’s subjective statement “I can’t seem to settle her, she doesn’t even want to breastfeed she’s so distressed” (Browne, et. al., 2007; Hockenberry & Wilson, 2011). When attempting to measure pain in infants the FLACC Pain Tool is popular for children less than 3yrs old, as it is a behavioural observational scale of Face, Legs, Activity, Crying, and Consolability scored from 1-10 not requiring self-report (Hockenberry & Wilson, 2011). Sally’s FLACC pain scale is scored as an 8/10 because her face shows quivering of chin and or a clenched jaw, whilst her legs are kicking and drawing up with restless or arching activity of her body, and she is crying and difficult to console (Hockenberry & Wilson, 2011). Behavioural observations are a major indicator of pain and distress in younger children, because communication is difficult or self-report is not yet possible (Srouji, R., Ratnapalan, S., & Scheeweiss, S., 2010). Pain can also be assessed without self report by assessing physiological signs such as heart rate, blood pressure, respiration, oxygen saturation and palmer sweating (ANZCA, 2005; Browne, et. al. 2007; Simons & Moseley, 2008; Simons & Moseley, 2009; Srouji, et al., 2010). Sally’s post operative observations are 152 beats/min heart rate (HR) and 36 breaths/min respiration rate (RR), which as elevated (see appendix 1) indicate acute pain, when compounded by her behaviour (Browne, et. al. 2007; Kliegman, et al. 2006; Simons & Moseley, 2009). The two priority nursing interventions in addressing Sally’s pain are administration of pharmaceutical analgesia and methods of non-pharmacological relief, as substantiated by scientific and clinic indication that pain is multidimensional with physical, psychological and behavioral aspects (He, Jahja, Lee, Ang, Sinnappan, Vehvilainen-Julkunen, 2010).
Firstly, suitable pharmaceutical analgesia are opioids and/or non-opioids administered by the nurse following the doctors order in Sally’s medical chart, with recommended dose of analgesic based on weight and physiological development, the timing and frequency of the analgesic, and the routes of delivery such as intravenous or oral (AAP & APS, 2001; ANZCA, 2010). The nurse administering the medication order should consider the doctors recommendations and act accordingly otherwise (Levett-Jones, Bourgeouis, 2011).In Sally’s case, scoring 8/10 in the FLACC tool and being post operative with an existing related cause to her pain, it is suitable to commence treatment with opioid analgesia for moderate to severe pain, such as Morphine Sulfate via her existing cannula line at an...
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