Swelling from the injury 

Stiffness of elbow and wrist 

Joint instability –difficulty in moving the joint as he did before. 

Infection – if had metalwork/surgery 

Mal-union – a fracture that does not health properly and may be twisted or deformed. 

Non-union – the bone does not heal at all. 

Soft tissue irritation 

Compartment syndrome – swelling within the cast can cause increased pressure within the limb compressing the nerves and blood vessels within the arm. 

annie

 

Cracking, softening or breakdown of the cast. 

Circulatory and nerve impairment .

Arterial compression – checking for white, blue, purple or black extermeties. 

Venous pressure – check limb for redness, pain and sometimes swelling. 

Nerve compression – pins, needles, numbness and limitation of movement. 

Pressure/cast sores.

Stiffness of joints.

Skin reactions.

Annie Group A

 

 

There are several nursing concerns for Mayeme.  The competence framework for orthopaedic practitioners states that professionals must understand the child’s cognitive abilities and able to communicate in an appropriate manner.  English is not Mayemes first language so he made need an interpreter.  The framework also states that the health professional needs to ensure that the child’s parents/guardians are there to be involved in the care of their child as they will be involved in the caring of the child at home.  

Mayeme has not been to hospital before and may find the environment intimidating or he may be nervous.  The nursing experience should aim to be a positive one for the child so the nurse will aim to communicate with Mayeme effectively.  The nurse should have good communication skills as these are essential in building a therapeutic relationship.  The nurse needs to be aware of safeguarding issues which may present themselves when taking to the patient and in this case it states that he pulled out in front of a car so did he see the car and did he do it on purpose.  The nurse would ideally have some safeguarding training or be aware of who to talk to if they had any concerns.

The competence framework for orthopaedic practitioners has a section on Comfort enhancer.  The pain and anxiety experienced by Mayeme needs to be assessed using an appropriate pain assessment tool and analgesia given if needs and again with him being a child and English not being his first language this is a concern.  You would want to be able to talk to Mayeme and build up some trust.  You would also want to anticipate pain that he may have when he goes home and give him advice on how to deal with it using analgesia or other techniques. 

A cast was placed on Mayemes arm and so consent needs to be gained to do this along with pain relief when the cast is applied. You would want to give Maymeme and his parents/carers advice about looking after the cast including what he can and can’t do and how the cast will affect his activities of daily living.  The patient and family need to be educated in what may go wrong with the cast and what symptoms to be aware of including sensation in fingers and developing pressure ulcers developing under the cast. 

Information about caring the cast should be given to Mayeme and family verbally and the health professional should ensure that they understand.  The information should also be supplied written down and a contact number given.  In this case we don’t know what Mayeme understand about the cast and does he understand what he has been told.

Sam Group A

·         does Mayeme have a good support network?

·         Mayeme’s mental health

·         Psychological consequences of the injury/care episode

·         Why did Mayeme give a false name?

·         Is the bone healing correctly/complications?

·         Is the wound being cared for correctly/follow-up advice being followed? Prevention of cast sores

·         Cast removal

·         Mayeme was given the bicycle to provide easy transport, how is Mayeme coping without this and is he attending school?

·         Using communication skills/tools to ensure Mayeme’s understanding

·         Appropriate language

·         Building a therapeutic relationship based on trust/safeguarding

·         Holistic care

·         Understanding of consent for minors

·         Using pain assessment tools to gauge severity of pain and appropriate analgesia
Lyndsey (group B)

Perhaps most concerning is the circumstances around the accident. I would be asking Him about the accident, did he deliberately move in front of the car?

Id ask him open questions about his feelings at the time of the accident and afterwards, to get a general idea of his mental health. 

 

Id also be thinking about his parents/guardian, and bringing them into the care episode to support him. Id ask for some contact details and go from there. If unable to, id contact his school and explain the situation to them (presuming school uniform). If Mayeme is unhappy with involving his family, id seek another appropriate adult, such as his social worker or his form tutor. 

 

My overall goal is to build a therapeutic relationship with him, to establish trust and make him feel safe in my care. 

 

If he feels safe, then he is more likely to return to the fracture clinic. If I can build some trust, then perhaps he will admit his real name. Id try to establish what his fear of revealing his true self is, it may be that in his home country, medical care is expensive, and he may have been trying to avoid a large bill, not realising that care is free at the point of use in the UK.

 

Id be an advocate for Mayeme, this may be his first experience in and UK hospital, he may be scared. Id explain at each step of his treatment what was happening and why. Id stress the importance of following up in clinic with his injury. 

 

As English is not his first language, I would use an interpreter if possible, to help him better understand the significance and impact of his injury. 

 

 

 

·       What policies and guidelines are in place to help support you? 

The NMC code

Royal College of Emergency Medicine, Best Practice Guideline, Emergency Department Care. 

Royal College of Paediatrics and Child Health, Intercollegiate Committee for Standards for Children and Young People in Emergency Care Settings

Damien. Group B

The nursing concerns would include Mayemes mental health.  You would want to explore why he is harming himself so you can make referrals to the appropriate teams.  The nurse would aim to build up a therapeutic relationship to do this.  The section partner guide within the orthopaedic guidelines states that the nurse should provide holistic care through effective communication.  There has been a malunion of his fracture which has caused functional problems for him so the nurse will need to be aware of the psychological impact this would have on him.  Pain due to the malunion would be another nursing concern and the section comfort enhancer within the orthopaedic states that nurses should be aware of pain that a patient may experience.  The safety of Mayeme is another nursing concern due to his self harm and there is a section within the orthopaedic guidelines regarding the patients level of risk (risk manager).
Sam Group A