Case Study on Orthopaedic Trauma for Surgery-myassignmenthelp

Question: Discuss about theCase Study on Orthopaedic Trauma for Emergency Surgery. Answer: The health care industry has improved significantly over the past few decades, and now the care plans and the strategies are more patient centered and targeted than ever. One of the most targeted patient centered care plans can be the ones focused on the trauma patients. There can be various types of trauma; however this assignment focuses on orthopedic trauma (Panteli, Pountos and Giannoudis 2016). Orthopaedic trauma can be defined as the severe injury of the musculoskeletal system that is often facilitated by any sudden accident and it demands emergency medical attention as well. It has to be understood in this context that orthopedic trauma can easily be life threatening if immediate and adequate medical attention is to given to the patient. And hence, it is very important for the health care initiatives to be taken on an urgent basis and all the while obtaining a clear understanding of the underlying pathophysiological interventions as well (Capone et al. 2014). This assignment w ill attempt to outline the pathophysiology critically with respect to the case study of a patient named Leigh Richards. This assignment focuses on the case study of a critical patient named Leigh Richards who had undergone a devastating accident. The patent in the case study, Leigh is a 39 year old man who had been an irrigation consultant working in the Murray bridge area. During the accident the patient had been a restrained passenger sitting inside the rally car, the car hit a tree because of travelling exceedingly over the permitted speed limit on a dirt road. His injury details as expressed in the case study include being trapped inside the car after the accident by a cabin intrusion that pinned his leg. Following the unfortunate event, the emergency care team cut through the car to rescue the patient and emergency care for his orthopedic trauma had been initiated. In this regard the patient had a daughter who is a second year nursing student who did not understand the use of pharmacology in the orthopedic trauma that her father had been facing (Rossaint et al. 2010). It has to be understood that in this case the patient had sustained a severe injury in his leg due to an accident that caused a cabin intrusion to pin his legs inside the car. Now orthopedic trauma comprises of severe injuries in the different parts of the musculoskeletal system including the bones, joints and the ligaments. The most common and frequently observed interventions for such conditions include surgical procedures however, in certain cases, especially for pain management, wound management and hemorrhage management purposes, the role of pharmacological interventions are also crucial (Zhang 2012). According to the signs and symptoms that has been discovered in the case study the most the patient has been suffering from pins and needles and functions in his legs as well, which is a very common condition with respect to compartment syndrome. In relation to the different signs and symptoms discovered in the case study the most probable diagnosis for the patient is compartment syndrome which can be a devastating condition if not rapidly diagnosed or properly managed in the patient. On a more elaborative note, it has to be mentioned that compartment syndrome is of grief medical condition that involves an acute increase in the pressure located in the muscle compartment which can be resolved it by a crush injury and can easily lead to muscle and nerve damage restricting the blood flow through the body surrounding the affected muscle tissue (Roscoe, Roberts and Hulse 2015). Compartment can be defined as the confined space in the thick layer of tissue called fascia present in between t he muscles separating the groups of muscles in arms and legs. In this case is the compartment syndrome caused by the car accident on the patient resulted to applying an acute pressure on the compartments in between the muscles leading to accumulated pressure on the muscles blood vessels and nerves leading to the excess pressure on the fascia. Due to the fact that the fascia are not capable of stretching the direct response of the pressure is exerted on the muscles, capillaries and nerves in the compartment obstructing the blood flow to muscles and the nerve cells. According to the Cone and Inaba (2017), compartment syndrome occurs when the pressure within any defined compartmental space increases past the critical pressure threshold leading to decreasing the perfusion pressure to that particular compartment. It has to be mentioned that compartment syndrome has a range of clinical manifestations, however pain and paresthesia is the most plausible type of compromise complications. Par esthesia can be described as the altered sensation, which generally begins with pins and needles sensation, numbness and tingling sensation. The patient in the case study, Leigh Richards, has been exhibiting pins and needles sensation as well in the injury site along with acute pain, hence it can be stated that for the patient acute compartment syndrome manifested as pain and onset of paresthesia (Von Keudell et al. 2015). Pharmacology can be defined as the branch of biology that focuses on drug interaction and their physiological effect on the body. It basically deals with the theories of pharmacokinetics involving ADME of the drug or pharmacon used, elaborating more, this theoretical concept discusses the absorption, distribution, metabolism and excretion of the drugs used with respect to the biological system of the body (Kier 2012). Another very important theory on which the ADME of the pharmacon are based includes the receptor theory. This theory serves as the operational model for exploring and analyzing the drug-receptor interaction in the functional system with respect to the G-protein coupled receptor behavior (Pan et al. 2013). These theories serve in helping to understand the sequence of physiological effect on the biological system of the patient and to understand the action on the disease pathology. In order to discuss the pharmacology of compartment syndrome, the major health issue of the patient in the present scenario, the primary focus needs to be on pain management. Analgesics are the most common medication type that is used to relive the patient of the acute pain that the patient had been suffering from, most of which have sedative properties, which is extremely beneficial for patients with trauma. In this case, the patient had already been given Fentanyl for pain management in the theatre, hence in the next phase the patient would require Oxycodon for pain management. Oxycodon is a narcotic medication that is used to relieve severe pain in the patients. It is either administered as extended release tablets or on the form of concentrated solutions. This drug belongs to the class of opioid analgesics and it is a semisynthetic derivative of derivative of codaine that acts as a narcotic analgesic with considerable effectiveness making it apt for the trauma patients. The mechanism of action of this medication can be best understood while correlating with drug receptor theory. According to Okura, Higuchi and Deguchi (2015), the active agent works as a weak agonist of the mu, kappa and delta opioid receptors of the central nervous system. It mainly targets the mu receptor which remains coupled with G-protein receptors and act as modulators of synaptic transmission. The opiate binds to the key receptor and stimulates the conversion of GTP into GDP in the G-protein complex. It helps in targeting the cyclic AMP system and as a result into closing the N type voltage operated calcium channels and results into hyperpolarization which reduced neuronal excitability of the patient. Considering the ADME of the drug, this drug is well absorbed in adults and the oral bioavailability of the drug is 60 to 87%. And the distribution volume is 2.6 L/kg. The protein binding capacity is 45% and metabolism is hepatic. The excretion mechanism of this medication and it's metabolites are primarily via the kidney. The most suitable dosage for Oxycodon in case of trauma patients are at least 20mg orally on a daily basis, however given the need for analgesia for Leigh Richards 40mg of extended release capsules will be the most suitable for the patient. The side effects of this medication include constipation, drowsiness, nausea, stomach pain, loss of appetite, sleepiness, tiredness, dry mouth headache and fatigue. This particular medicated against a varied range of different health conditions such as brain tumor, hypothyroidism, addison's disease, extreme loss of body water, depression, suicidal thoughts, addiction, alcohol intoxication, slow heartbeat, irritable bowel disease, liver problems etc. However oxycodone can be taken with any food item without any restrictions all the alcohol is contraindicated while taking oxycodone. Drug interaction of this meditation is associated with CYP3A4 enzyme activity, any drug group that apps on this particular enzyme activity has probability of interacting with oxycodone like antibiotics such as Erythromycin Fluconazole Erythromycin etc. Nursing consideration for patients that are taking oxycodone includes checking if the patient has applied allergy which can lead to hypersensitivity reactions after taking off the coat on and checking if the patient has any of the concentrated health conditions before administering the medication (Wirz et al. 2018). Another very important component of pharmacology of this particular disease and the present health conditions of latest depression in the case study, proper wound management and infection control has to be mentioned. Given the present conditions of the patient and the severity of compartment syndrome and taking oxycodone the most plausible and suitable antibiotics that can be given to the patient includes cefalotin and metronidazole. Considering cefalotin first, this particular medication is second generation derivative of antibiotics cephalosporin and is used to treat many kinds of infection as a potent broad spectrum antibiotic. The mechanism of action of this medication is based on the bacteriocidal activity of the agent. It is facilitated by cell wall synthesis in aviation with respect to the affinity of penicillin binding proteins. It has to be mentioned in this context that these proteins are vital in the peptidoglycan synthesis and their inhibition inhibits synthesis of vital cell wall components. The dosage for his medication that can be prescribed to leave Richards is 7.15 kg per mg single IV dose administered in a 6 hourly basis. Considering the ADME of this drug, this particular drug is absorbed rapidly from the site of injection. The distribution volume is 0.26 litre per kg and metabolism is hepatic (Sadleir, Clarke and Platt 2016). The medication is metabolized to a least active desacetyl metabolite which is excreted unchanged through the urine of the patient. All that has to be mentioned that the renal excretion of this medication is less than 65%. Considering the contraindications of this medication skeleton is contraindicated against health conditions including renal dysfunction, colitis, dialysis, and sodium restriction. Considering the drug interactions, cefalotin interacts with calcium gluconate, diphenhydramine, furosemide, penicillamine, probenecid and amikacin. Side effect of this medication includes local irritation such as Rash itching redness at injection site, hypersensitivity reaction such as bronchospasm fever anaphylaxis and urticarial or maculopapular rash. Renal insufficiency and nephrotoxicity are two least common side effects of this medication. Considering the nursing consideration it has to be mentioned that the nurse administering this particular medication must be where the patient has any allergic reactions to cephalosporin kind of antibiotics or if the patient has anyone else disorders with sodium restriction. This particular medicine also results in diarrhoea hence the nurse administering medication will have to educate the patient regarding the side effects and possible antique precautionary action for diarrhoea nausea and vomiting which can occur after taking his medication (Yang et al. 2015). The next suitable antibiotics for this patient should be metronidazole. It is a medication that is used to treat selective anaerobic bacteria infection. The mechanism of action for this medication is associated with the ability of selected anaerobic bacteria to reduce metronidazole to its active form which then binds to the DNA disrupting the helical structure and intern results in indicating bacterial nucleic acid synthesis and facilitates cell death. Considering the ATM of this particular medication it has to be mentioned that his medication is excellently absorbed 80% from the injection site. The distribution of this medication is 0.51 to 1.1 litre per kg in adults. The metabolism of metronidazole is hepatic facilitated by hydroxylation oxidation and glucoronudation (Jakobsson et al. 2017). The excretion is via urine in the form of nitro containing compounds which are the derivatives of this medication after metabolism. The dosage of this medication for an adult patient like Leigh Richards the patient the case study, is given in 15 mg per kg per single IV dose. The contraindication of this medication includes history of blood dyscrasias, active organic disease of the central nervous system, and hypersensitivity to this group of antibiotics. The adverse reactions include gastrointestinal such as candida growth, hematological including transient leukopenia, neurological such as convulsions seizure meningitis and optic and peripheral neuropathy. Along with that liver dysfunction and mild rashes have also been reported as side effects of this particular medication. This particular medication interacts with Other Drugs including cyclosporine, disulfiram, fluorouracil, phenytoin, cimetidine, bisulfan, corticosteroids and BCNU. Nursing consideration for this medication includes educating the patient regarding the precautions and side effects of this medication checking for any hypersensitivity reaction and whether the patient has any contraindicated diseases before administering this medication. While administering this medication the patient will also have to check if the patient has had the following complications such as aseptic meningitis long-term therapy Candidiasis sodium restriction, impaired functions, etc (Vardakas et al., 2012). These medications will help the patient with the pain and the wound infection risk that the patient had been in the next 24-48 hours and will be able to help him to his recovery. However, in case the compartment syndrome, a few nonpharmacological interventions will be needed to applied such as proper dressing of the wound and the cutting the cast, followed by 10-20% pressure reduction. And in case the condition persists, fasciotomy is indicated to help the patient recover (Dalton et al. 2014). Conclusion: On a concluding note, it can be stated that the patient under discussion in the case study represented a unique and severe orthopedic injury. On further assessment of the patient condition, the patient was discovered to be having severe laceration injuries in the entire left side of his body facilitated by the accident and the cabin intrusion pining his leg that required inline extrication by the SAAS ambulatory services in order to rescue him. It has to be mentioned that for such severe orthopedic injuries there are various pharmacological procedures involved and each of them have a significant impact on the recovery of the patient and the hospital stays. Along with that, it has to be mentioned that for the care plan to be effective for the patient, a detailed idea of the pharmacology of compartment syndrome and how it impacts the patient after a musculoskeletal injury or trauma, is crucial for both the nursing professional and the patient family as well. 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