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Case Study Musculoskeletal
Kevin Flynn
A 17-year-old adolescent with a fractured femur who is hospitalize with skeletal traction prior to
surgery.
You are a nurse working on an Adolescent Unit of a large suburban hospital.
Kevin Flynn, age 17, has just been admitted to your unit from the Emergency Department (ED). He
fractured his right femur and right wrist when tackling a teammate on the football field during football
practice at school.
You receive report on Kevin from the ED nurse, and note new medication orders that have just been
written.
Assessment Data
Medical diagnosis: open fracture of right femur shaft with large skin wound, and right Colles’
fracture
Balanced skeletal suspension traction with Thomas splint to right leg
Cast on right arm from finger to above the elbow
Height 180 cm (5’11”), weight 84.1 kg (185 lbs)
BP 110/70, P 60, R 20. T 36.6 degrees C (97.9 degrees F)
No history of previous injury or medical problems
No known allergies
Dextrose 5% in water at 50 mL per hour
Acetaminophen and hydrocodone bitartrate (Vicodin ES) tabs II every 4 hours as necessary for
pain
Cefazolin sodium (Ancef) 1 g IVPB every 6 hours
1. You recall that a Colles’ fracture involves a break in the distal:
A. Radius; A Colles’ fracture involves a break in the radius at the epiphysis within one inch of
the wrist joint.
2. You review assessment data already entered in Kevin’s record. Which of the following
assessment data are consistent with Kevin’s fractures? (4 correct answers)
A. Pain in the right upper leg: b/c an open fracture causes soft tissue trauma and immediately
causes pain. Blood loss from a fractured femur can be significant.
B. Large skin wound on the right thigh: b/c an open fracture is one in which the bone has
punctured the skin, causing a skin wound.

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C. Swelling in the right thigh: b/c swelling at the fracture site is a classic sign of a fracture,
especially an open fracture accompanied by soft tissue damage. Fractures also commonly
cause localized tissue damage and ecchymosis.
D. Pain in the right wrist: b/c the Colles’ fracture, although a closed fracture, is expected to be
painful, secondary to tissue trauma, inflammation and swelling.
NOT CHOSEN:
Footdrop in the right foot
Elevated blood pressure
3. Because one of Kevin’s fractures is an open fracture, you know that he is a t risk for developing
which of the following infections?
A. Tetanus: The tetanus bacillus can potentially be introduced into the body through a wound
contaminated with dirt, soil or dust. The tetanus bacillus produces a toxin, Clostridium
tetani, that can grow anaerobically at the site of injury and cause tetanus with its associated
local systemic manifestations.
Because of Kevin’s risk for tetanus, his immunization history was carefully checked in ED. His most
recent booster was administered when he was 14, three years ago. No further immunization is required
at this time.
Tetanus boosters are recommended every ten years. With serious injuries like Kevin’s, however, a
booster would be given if the most recent one was administered more than five years prior to the time
of injury.
You have reviewed Kevin’s medical record and now proceed to his room and introduce yourself.
Kevin is uncomfortable but pleasant. He says he can’t believe he won’t be able to play football again
this season!
4. All of the following assessments are indicated. Which one do you prioritize at this time?
A. Vital Signs: Close monitoring of vital signs is necessary for early detection of life-threatening
complications of serious fractures such as shock, fat emboli, and pulmonary emboli.
Tachycardia would occur with all three complications. In addition, urine output should be
monitored for a decrease, which would characterize shock.
NOT CHOSEN:
Pain level
Skin Condition

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Case Study Musculoskeletal Kevin Flynn A 17-year-old adolescent with a fractured femur who is hospitalize with skeletal traction prior to surgery. You are a nurse working on an Adolescent Unit of a large suburban hospital. Kevin Flynn, age 17, has just been admitted to your unit from the Emergency Department (ED). He fractured his right femur and right wrist when tackling a teammate on the football field during football practice at school. You receive report on Kevin from the ED nurse, and note new medication orders that have just been written. Assessment Data Medical diagnosis: open fracture of right femur shaft with large skin wound, and right Colles’ fracture Balanced skeletal suspension traction with Thomas splint to right leg Cast on right arm from finger to above the elbow Height 180 cm (5’11”), weight 84.1 kg (185 lbs) BP 110/70, P 60, R 20. T 36.6 degrees C (97.9 degrees F) No history of previous injury or medical problems No known allergies Dextrose 5% in water at 50 mL per hour Acetaminophen and hydrocodone bitartrate (Vicodin ES) tabs II every 4 hours as necessary for pain Cefazolin sodium (Ancef) 1 g IVPB every 6 hours 1. You recall that a Colles’ fracture involves a break in the distal: A. Radius; A Colles’ fracture involves a break in the radius at the epiphysis within one inch of the wrist joint. 2. You review assessment data already entered in Kevin’s record. Which of the following assessment data are consistent with Kevin’s fractures? ...
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