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WIGHT GOODMAN MEDICAL SURGERY

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Wight Goodman Room 307 Wight Goodman, Patient was admitted to the floor last night from the ER for an orbital fracture. He was hit in the left eye by a softball yesterday. Apparently, he was pitching ... , and the batter hit a line drive hitting him in the right side of the face. They applied some ice to his face, and he decided to go to the post game keg party instead of coming to the ER. The patient stated that there was significant swelling, but his vision was fine, and the pain was controlled with beer and 800mg of Motrin. He was unable to sleep later in the evening as the pain became worse, and his vision became more impaired. The Maxillofacial surgeon was consulted, and they will see him this morning. They were not concerned as his intraocular pressure was normal in the ER. There is significant edema and discoloration to the left side of his face, and his left eye is almost completely swollen shut. His visual acuity is diminished, and the whites of his eyes are hemorrhaged. His pain has been well controlled with IV morphine 4 mg, q3 hours. He has a 20g SL to his right hand, that was started in the ER. He has no other health concerns. He’s being admitted for pain control, close observation of his intralocular pressure, and head injury. You responded correctly to 5 out of 6 evaluations: Category Your response Explanation Educational Needs Increased acuity Orbital fracture necessitates patient compliance as they are complex injuries Fall Risk Increased acuity Visual acuity is altered Health Change Increased acuity Patient has had an injury to his left eye, and potential for infection Pain Level Increased acuity As a result of sustained injuries Psychological Needs Normal acuity No indication of increased acuity Neurological Increased acuity GCS is normal at this time You correctly diagnosed 5 out of 5 options: Physiological Description Your Response Explanation Acute Pain True Patient has complained of pain Bleeding, risk for True Evidence from his nose/eye Impaired Comfort Safety True Patient requiring IV Morphine Description Your Response Explanation Deficient Knowledge True Orbital fracture necessitates patient compliance as they are complex injur Infection, risk For True Open wound draining, and potential for Meningitis Scenario 1 You correctly ordered 5 out of 5 actions: Your order Correct order Step Explanation 1 1 Wash hands and assess Per CDC protocol 2 2 Complete Neurological assessment Ordered and potential head injury 3 3 Check the blood from his nose for CSF (Halo test) Halo test determines if nose bleed is a result with a CSF leak 4 4 Pre-op education To reduce potential surgical complications 5 5 Ask Surgeon to discuss with patient the potential facial scarring In order to reassure patient that surgical scar Scenario 2 .............................................CONT......................................... [Show More]

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