ACTIVITY 2: CASE SCENARIO

A RLE Enhancement Presented to the

Faculty of the College of Nursing
Xavier University - Ateneo de Cagayan

In Partial Fulfillment of the Requirements of

Nursing Care Management 120 -
Disaster Nursing

Proponents:

Regular, Sureen May Sumandar, Ezra Alexandria

Rodriguez, Angela Jean Telow, Jered Brae

Rodriguez, Kate Angelique Tomarong, Jave Mark

Rollan, Ana Maria Teresa Torion, Zenn Pauline

Romorosa, Christine Marie Tutanes, Francis Elijah

Sabio, Sofia Franz Yasay, Joselo

BSN 4 - NC

April 24, 2023

CASE SCENARIO:

A 32-year-old female called and stated that she fell down and thinks she may
have broken her wrist. Upon arriving to the location, a man who identifies himself
as the patient's husband states "It's so like her to fall and get hurt, she's very
clumsy." You walk into the kitchen and see your patient seated at the table
supporting her right wrist. Two young children are sitting at the table as well. You
introduce yourself and ask what happened. Her husband, standing behind you,
says "She fell down the stairs." Meredith, the patient, glances over your shoulder
at her husband and replies softly, "I tripped down the steps walking into the
garage and fell forward." "I told her not to call you guys," her husband says. "But
she wouldn't listen." As you begin to assess her arm you note obvious deformity
and swelling to Meredith's wrist. She winces with any palpation or movement. As
you visualize Meredith's arm you make note of several large bruises of varying
age on her upper and lower arm.

1. What are some potential concerns about the scene you are on?
There are several potential concerns regarding the scene that should be taken
care of which includes the following:
a. Potential for further harm: Given the obvious deformity and swelling of
Meredith's wrist, it's possible that she has sustained a serious injury that
requires urgent medical attention. Delaying or denying treatment could
potentially lead to further harm or complications.
b. Domestic violence: The husband's comment about Meredith being clumsy
and not wanting her to call for medical help, coupled with the bruises of
varying ages on her upper and lower arm, raise the possibility of domestic
violence. The fact that Meredith appeared to hesitate and glance at her
husband when answering your questions also suggests that she may be
afraid of him or under his control.
c. Lack of consent: The husband's comment that he told Meredith not to call
for medical help raises concerns about her autonomy and ability to make
decisions for herself. It's important to ensure that Meredith is fully informed
and consents to any medical treatment or intervention that is provided.
d. Child welfare: The presence of young children at the scene raises
concerns about their welfare and safety. If there is domestic violence or
other forms of abuse occurring in the home, the children may also be at
risk. It's important to be aware of any signs of neglect or abuse and to
ensure that appropriate measures are taken to protect the children if
necessary.
 2. What type of fracture that Meredith could have?
According to the American Academy of Orthopaedic Surgeons, there are five
common types of fractures. These include stable fracture, open (compound) fracture,
transverse fracture, oblique fracture, and comminuted fracture. Fractures are often
differentiated by the type of break it creates in the bone.
● If the broken ends of the bone line up and are barely out of place, it is considered
a stable fracture.
● Bone piercing through the skin or by a blow that breaks the skin at the time of
fracture indicates an open (compound) fracture.
● Transverse fracture happens when the fracture forms a horizontal line.
● If it is an angled pattern, it is an oblique fracture, and if the bone shatters into
three or more pieces, it is called comminuted fracture.

Based on the information provided, it is possible that Meredith has a distal radius
fracture, which is a common type of wrist fracture. This type of fracture occurs when the
radius bone in the forearm breaks near the wrist joint. It is often caused by a fall onto an
outstretched hand, which is consistent with Meredith's description of tripping and falling
forward. The obvious deformity and swelling, as well as the pain and wincing with
palpation, suggest a significant injury to the wrist.
The presence of bruises on Meredith's upper and lower arm may also indicate
that she sustained additional injuries during the fall. It is important to thoroughly assess
her for any other injuries and provide appropriate care and treatment as needed. There
is only one way of confirming the type of fracture and it is through an X-Ray.
In addition, the patient may also have a stable fracture, which refers to a type of
bone break where the two ends of the broken bone remain relatively aligned and do not
move out of position. In Meredith's case, the obvious deformity and swelling of her wrist
indicates a break in the bone, but there is no significant displacement or angulation of
the bone ends, which suggests that it is a stable fracture.
Stable fractures are typically less severe than unstable fractures and can usually
be treated without surgery. The fact that Meredith is able to support her wrist and move
her fingers suggests that the fracture is not causing severe pain or functional
impairment.
The presence of bruises on her upper and lower arm may indicate that she fell
with some force, but it is unlikely that the impact caused significant damage beyond the
wrist fracture.
 3. What are your nursing management of Meredith's situation?

NURSING CARE PLAN 1

CUES NURSING NURSING NURSING RATIONALE EXPECTED
DIAGNOSIS OBJECTIVE INTERVENTION OUTCOME/
EVALUATION

SUBJECTIVE Acute pain RT SHORT TERM Independent SHORT TERM

- "I tripped physical injury GOALS 1. Assess and record 1. Pain assessment GOALS
down the AEB winces with After 60 minutes of the patient’s level of determines the After 60 minutes of
steps walking palpation and nursing pain. effectiveness of nursing
into the movement and interventions, patient interventions. Many interventions,
garage and fell evident signs of will be able to: factors, including the patient was able to:
forward." as deformity. ● Demonstrate level of anxiety, may ● Apply and
verbalized by the use of affect the perception utilize
the patient. appropriate of pain. appropriate
diversional diversional
OBJECTIVE activities and 2. Maintain 2. Immobilization activities
- Obvious relaxation immobilization of relieves pain and and
deformity and skills. affected part using bed prevents bone relaxation
swelling at the ● Uses rest, cast, splint, displacement and skills.
wrist. pharmacologi traction. extension of tissue ● Complied to
- Winces with cal and injury. the
any palpation nonpharmaco pharmacolo
or movement. logical 3. Elevate and support 4. Promotes venous gical and
- Large pain-relief injured extremity. return, decreases nonpharmac
bruises of strategies. edema and may ological
varying age in reduce pain. pain-relief
upper and LONG TERM 4. Explain procedures strategies.
lower arm. GOALS prior to starting. 5. Allows the patient
After 8 hours of to prepare mentally LONG TERM
nursing for activity and to GOALS
interventions, patient participate in After 8 hours of
will be able to: controlling the level of nursing
● Display an discomfort. interventions,
improved 5. Perform and patient was able to:
well-being supervise active and 5. Maintains strength ● Display an
such as passive ROM exercises. and mobility of improved
baseline unaffected muscles well-being
levels for and facilitates such as
pulse, BP, resolution of baseline
respirations, inflammation in levels for
and relaxed injured tissues. pulse, BP,
muscle tone 6. Provide alternative respirations,
or body comfort measures 6. Improves general and relaxed
posture. (massage, backrub, circulation; reduces muscle tone
● Describe a position changes). areas of local or body
satisfactory pressure and muscle posture.
pain control at fatigue. ● Rates pain
a level below 7. Provide emotional level at 4
5. support and encourage 7. Refocuses from 9.
stress management attention, promotes a
techniques (progressive sense of control, and
relaxation, may enhance coping
deep-breathing abilities in managing
exercises, visualization, the stress of
or guided imagery). traumatic injury and
pain, which is likely to
8. Identify diversional persist for an
activities appropriate for extended period.
patient age, physical
abilities, and personal
preferences. 8. It prevents
boredom, reduces
muscle tension, and
 can increase muscle
Dependent strength; it may
9. Administer enhance coping
medications, as abilities.
indicated.

9. Given to reduce
pain or muscle
spasms.
 NURSING CARE PLAN 2
CUES NURSING NURSING NURSING RATIONALE EXPECTED
DIAGNOSIS OBJECTIVE INTERVENTION OUTCOME/
EVALUATION

SUBJECTIVE Impaired SHORT TERM INDEPENDENT SHORT TERM

- Patient Physical Mobility GOALS GOALS
reports: "I related to the After 8 hours of 1. Educate the patient to reduce swelling, After 8 hours of
tripped down broken wrist as nursing on the importance of and assist them with nursing
the steps evidenced by interventions, keeping their wrist positioning as interventions,
walking into decreased range patient will be able elevated needed. patient was able to:
the garage of motion to: 1. Report
and fell 1. Report 2. Provide assistive to stabilize the wrist reduced
forward." reduced pain devices such as a sling and promote healing. pain and
and or cast discomfort
OBJECTIVE discomfort in in the
- Patient the affected 3. Encourage the can help improve affected
winces with wrist patient to perform wrist mobility and wrist
any palpation 2. demonstrate gentle range of motion prevent complications 2. demonstrate
or movement improvement exercises to the such as stiffness and improvemen
- Swelling, in wrist affected wrist several joint contracture. t in wrist
obvious mobility by times a day. mobility by
deformity, and being able to being able
bruising perform 4. Assist the patient with can help promote to perform
around the gentle range activities of daily living independence and gentle range
wrist joint of motion
as needed, and self-care while also of motion
exercises encourage them to preventing further exercises
perform as much as injury or complications
LONG TERM they are safely able to LONG TERM
GOALS independently GOALS
After 3 days of After 3 days of
nursing 5. Assess the patient's This intervention can nursing
interventions, safety and provide help ensure the interventions,
patient will be able resources and referrals patient's safety, patient was able to:
to: for domestic violence provide emotional 1. maintain
1. maintain support if necessary. support, and reduce independen
independenc the risk of future ce in
e in activities domestic violence activities of
of daily living incidents. daily living
and mobility and mobility
at home upon DEPENDENT at home
discharge 1. Administer Promotes patient's upon
2. demonstrate medications for pain comfort and discharge
improved management, as facilitating their 2. demonstrate
mobility and ordered. healing process improved
ability to mobility and
perform 2. Consult with the to monitor healing ability to
recreational healthcare provider to progress. perform
activities obtain orders for recreational
imaging or other activities
diagnostic tests

COLLABORATIVE
1. Collaborate with the Promotes the patient's
physical therapist to physical mobility and
develop a range of facilitate their
motion and mobility recovery process
exercise plan for the
patient.

2. Collaborate with the Ensure that the

healthcare team to patient receives the
assess the patient's comprehensive care
need for additional and support they
interventions such as need to continue their
social work support or recovery process and
home health services address any
upon discharge. underlying issues that
may impact their
health and well-being.
 NURSING CARE PLAN 3
CUES NURSING NURSING NURSING RATIONALE EXPECTED
DIAGNOSIS OBJECTIVE/S INTERVENTION/S OUTCOME/
EVALUATION

SUBJECTIVE: Anxiety related to SHORT-TERM INDEPENDENT: SHORT-TERM

- When physical trauma GOALS: GOALS:
asked as evidenced by At the end of 2 1. Recognize 1. Since a cause At the end of 2
about fearfulness, fear of hours of nursing awareness of of anxiety hours of nursing
what has consequences, intervention, the the client’s cannot always intervention, the
happened, and poor eye patient will be able anxiety. be identified, patient was able to:
the patient contact to: the client may ● Verbalize
glances ● Verbalize feel as though awareness
over at her awareness of the feelings of feelings
husband feelings and being and healthy
will full healthy ways experienced are ways to deal
apprehens to deal with counterfeit. with them.
ion them. Acknowledgme ● Verbalize
stating, “I ● Verbalize nt of the client’s accurate
tripped accurate feelings knowledge
down the knowledge of validates the of the
steps the situation. feelings and situation.
walking communicates
into the LONG-TERM acceptance of LONG-TERM
garage GOALS: those feelings. GOALS:
and fell At the end of 1 day Fear and At the end of 1 day
forward.” of nursing anxiety will of nursing
intervention, the diminish as the intervention, the
OBJECTIVE: patient will be able client begins to patient was able to:
- Patient to: accept and deal ● Appear
winces ● Appear positively with relaxed and
with any relaxed and reality. This is report
palpation report anxiety an indicator of anxiety is
or is reduced to the client’s reduced to a
movement a readiness to manageable
manageable accept level.
level. responsibility for ● Demonstrat
● Demonstrate participation in e an
an recovery and to appropriate
appropriate “resume life”. range of
range of feelings and
feelings and 2. Use presence, 2. Being lessened
lessened touch (with supportive and fear.
fear. permission), approachable ● Demonstrat
● Demonstrate verbalization, promotes e
problem-solvi and demeanor therapeutic problem-sol
ng skills and to remind clients communication. ving skills
effective use that they are not Interaction time and effective
of resources. alone and to with the nurse is use of
encourage essential for resources.
expression or clients with
clarification of anxiety to feel
needs, that they are not
concerns, alone, with no
unknowns, and reasons for
questions. them to
experience that
condition, and
help them deal
with anxiety.
Interview
techniques may
be utilized to
build rapport.
The use of
therapeutic
 communication
techniques
makes it easier
for the client to
express
feelings,
understand their
needs,
incorporate
interventions to
meet those
needs, and
guide the client
toward
identifying a
plan of action
that can lead to
a satisfying and
socially
appropriate
resolution
(Cacayan et al.,
2021).

3. Familiarize the 3. Awareness of

client with the the environment
environment promotes
and new comfort and
experiences or may decrease
people as the anxiety
needed. experienced by
the client.
Anxiety may
 intensify to a
panic level if the
client feels
threatened and
unable to
control
environmental
stimuli. The
lighting,
temperature,
sounds, smells,
and color
palette of an
environment are
very important
to how
comfortable,
relaxed, and
safe the client
feels.

4. Interact with the 4. The nurse or

client in a health care
peaceful provider can
manner. transmit his or
her own anxiety
to the
hypersensitive
client. The
client’s feeling
of stability
increases in a
calm and
 non-threatening
environment.
Based on data
analysis,
nurses’ attitudes
or behaviors
matter when
interacting with
a client with
anxiety. It is a
huge factor in
establishing
rapport with the
client in gaining
cooperation
during
treatment, and
care, providing
interventions,
and helping
clients deal with
their anxiety
(Cacayan et al.,
2021).

5. Accept the 5. If defenses are

client’s not threatened,
defenses; do the client may
not dare, argue, feel secure and
or debate. protected
enough to look
at behavior.
Sometimes it is
 necessary to
acknowledge
what the client
says and affirm
that they have
been heard.
Acceptance is
not necessarily
the same thing
as agreement; it
can be enough
to simply make
eye contact and
let the client
know that they
are understood.
Clients who feel
their nurses are
listening to them
and taking them
seriously are
more likely to be
receptive to
care (Rivier
University,
2023).

6. Converse using 6. When

simple language experiencing
and brief moderate to
statements. severe anxiety,
clients may be
unable to
 understand
anything more
than simple,
clear, and brief
instructions.
Because of the
shock of the
initial trauma,
many people
may not recall
the information
provided during
that time.
Providing
frequent and
understandable
explanations
may reduce the
client’s fear and
anxiety, clarifies
misconceptions,
and promotes
cooperation.

7. Reinforce the 7. Talking or

client’s personal otherwise
reaction to or expressing
expression of feelings
pain, discomfort, sometimes
or threats to reduces anxiety.
well-being (e.g., By using
talking, crying, nonverbal cues
walking, and such as nodding
 other physical or and saying “I
nonverbal see”, the nurse
expressions). can encourage
the client to
continue talking.
Active listening
involves
showing interest
in what the
client has to
say,
acknowledging
that you are
listening and
understanding,
and engaging
with them
throughout the
conversation
(Rivier
University,
2023).

8. Lessen sensory 8. Anxiety may

stimuli by intensify to a
keeping a quiet panic state with
and peaceful excessive
environment; conversations,
keep noise, and
“threatening” equipment
equipment out around the
of sight. client.
increasing
 anxiety may
become
frightening to
the client and
others. Harsh
lighting and loud
noises can lead
to anxiety or
agitation, while
dark and cold
spaces can lead
to feeling
unmotivated,
especially in the
winter. Cluttered
spaces can also
overwhelm the
client and
create feelings
of anxiety
(Lindberg,
2023).

DEPENDENT:

1. Instruct the 1. Short-term use

client on the of antianxiety
appropriate use medications can
of antianxiety enhance client
medications. coping and
reduce
physiological
 manifestations
of anxiety.

COLLABORATIVE:

1. Arrange 1. Consultation
referrals or with a
consultations psychiatrist is
with a helpful to initiate
psychiatrist, longer-term
psychologist, therapy and to
and other provide
medical follow-up
professionals. planning.
Longer-term
therapy
currently
consists of
SSRIs, often
with additional
psychotherapeu
tic techniques.
Psychology
consultation and
testing are
indicated if
cognitive
impairment is of
concern or if the
client may be a
candidate for
cognitive-behavi
oral therapy.
2. Teach the use of 2. The method of
appropriate suicide
community prevention
resources in found to be
emergency most effective is
situations (e.g., a systematic,
suicidal direct-screening
thoughts), such procedure that
as hotlines, has a high
emergency potential for
rooms, law institutionalizati
enforcement, on. Suicide
and judicial attempts can be
systems. precipitated by
adverse life
events such as
divorce or
financial
disaster.