Case Study Analysis
Introduction
Mr. Steve Agius is a 34 year old man who has been admitted to my ward in the hospital following a sporting injury he sustained to his left ankle while playing with his children in the neighborhood park. Ankle injuries are among the most common injuries seen in the primary care setting and in emergency departments (1997). Mr. Agius weighs 110kg and is 160cm. The patient has been admitted for bed rest, physio and investigations. He is in a four bed room with three other men of varying ages.
This is the patient’s second experience of hospitalization. His first experience was not very positive. This time, he is actually reluctant to be hospitalized for his injury. While being admitted for bed rest, Mr. Agius is also waiting for results from tests investigating the reason for his fall and to evaluate the injuries.
During his stay in the hospital ward, Mr. Agius feels he is out of his routine. Nevertheless, he is very appreciative of the efforts the staff makes to assist him and keep him comfortable. In fact Mr. Agius had no idea just how much knowledge the nurses have and the way in which they are able to achieve so much for all their patients in the one day. And it is not only the nurses' abilities that Mr. Agius appreciates. Everyone has been very good to him, and somehow they all seem to know everything about him.
Problem Description
Upon observation, Mr. Aguis’ injuries include a swollen, very painful left ankle which he is unable to weight bear. He also has multiple cuts, abrasions and grazes over his body from his fall after injuring his ankle. No other obvious injuries or symptoms are present.
Mr. Agius over the past 24 hours hospital stay has become increasingly withdrawn and non communicative. Mr. Agius has some areas of his skin where the cuts abrasions and grazes are located that are draining haemo serous fluid onto his pyjamas.
This injury of Mr. Agius is probably just ankle sprain. The doctor has reviewed Mr. Agius and has suggested that he can commence some gentle range of motion exercise to the left leg and mobilizing but no weight bearing. Mr. Agius is increasingly finding it difficult to get comfortable in bed and still having quite a lot of problems moving in and out of bed.
Mr. Agius finds the daily hospital routine quite tiring. He is assisted out of bed into a special chair in order to shower. He finds it a frustrating experience as he is not accustomed to having other people do so much for him. Only now has Mr. Agius started being concerned about his weight, mainly because the nurses find it difficult to move him. Following his shower Mr. Agius has a session of physiotherapy where his limbs are taken through a range of movements, and he does deep breathing exercises.
He also finds it disconcerting that the nurses need to make his bed sometimes while he is still in it as he cannot tolerate sitting out of bed for prolonged periods of time and that he has to be assisted with his hygiene needs.
Possible Solutions
Falling is a problem, especially for the very young and for older adults. It is a concern not only for individuals but also for their families and communities (1999). Falling can in turn cause serious problems and in turn range from death to fractures and soft tissue injury that may or may not require hospitalization to reported fear of falling again. In Mr. Agius’ case, he required hospitalization.
Ankle injuries should be assessed as soon as possible after the trauma so that findings will not be obscured by swelling or hematoma. Palpation for tenderness and swelling localizes the site of the ligamentous tear. Tears of the anterior talofibular ligament are very common and are likely if the talus may be moved forward 4 mm or more as the foot is pulled forward and into slight internal rotation. The ability to tilt or invert the foot by more than 25 to 30 degrees implies rupture of the ligaments (1997).
Without adequate care, acute ankle trauma can result in chronic joint instability. Use of a standardized protocol enhances the management of ankle sprains (2001). When managing patients with ankle trauma in the primary care setting, other clinical variables should be considered, such as distance to the nearest radiology service, patients' and family anxiety, and possible musculoskeletal damage induced by waiting to perform a radiograph only if the patient worsens or does not improve.
Early management includes RICE (rest, ice, compression and elevation). Cryotherapy should be used immediately after the injury. Heat should not be applied to an acutely injured ankle joint because it encourages swelling and inflammation through hyperemia. Crushed ice in a plastic bag may be applied to the medial and lateral ankle over a thin layer of cloth. Alternatively, the foot and ankle may be cooled by immersion in water at a temperature of approximately 12.7°C (55°F). The foot and ankle should be cooled for approximately 20 minutes every two to three hours for the first 48 hours, or until edema and inflammation have stabilized. Benefits of cryotherapy include a decrease in metabolism that limits secondary hypoxic injury (2001).
To milk edema fluid away from the injured tissues, the ankle should be wrapped with an elastic bandage. The bandaging should start just proximal to the toes and extend above the level of maximal calf circumference. A piece of felt cut in the shape of a "U" and applied around the lateral malleolus increases hydrostatic pressure to an area that is prone to increased swelling ( 2001).
Next, the injured extremity should be elevated 15 to 25 cm (6 to 10 in) above the level of the heart to facilitate venous and lymphatic drainage until the swelling has begun to resolve (). This is what exactly was done to Mr. Agius. Nonsteroidal anti-inflammatory drugs are preferable to narcotics for pain relief (2001).
The need for proper rehabilitation after an ankle sprain cannot be overemphasized, especially when the debilitating consequences of decreased range of motion, persistent pain and swelling, and chronic joint instability are considered ( 2004). After initial acute treatment, a rehabilitation regimen is pivotal in speeding return to activity and preventing chronic instability (2001). Mr. Agius has to religiously follow these recommendations in order for his ankle injury to heal well.
It is also the nurse’s responsibility to educate Mr. Agius regarding his condition: what to do, what not to do among many others. The patient also has to know the care he is receiving and why ( 2004).
For Mr. Agius problem of being bored and frustrated in the hospital, his family should be with him most of the time, if possible all the time. He needs their support and their presence and encouragement would help lift Mr. Agius spirit up.
Conclusion
Mr. Agius’ ankle injury will heal well seeing that the nurses attending him and his family are supportive. He has to follow the nursing interventions so that there would be no complications. He has to be patient and cooperative regarding the nursing interventions that are given to him. An ankle sprain is not really a life-threatening injury. By just following the right interventions and following them religiously ensures that everything will heal and go back to normal. Mr. Agius will be walking normally in no time at all.
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