How to Answer History Presenting Symptoms Questions (Complete Guide)
Understanding this question requires applying core subject principles.
What This Question Is About
This question relates to history presenting symptoms and requires a structured academic response.
How to Approach This Question
Break the problem into smaller parts and analyze each logically.
Key Explanation
This topic involves history presenting symptoms. A strong answer should include explanation, application, and examples.
Original Question
History of Presenting Symptoms: A 46-year-old male construction worker presented to the ER complaining of mid-tibial pain after being struck by a vehicle. The patient was working in a closed driving lane when a motor vehicle entered the lane at approximately 70 mph. The vehicle struck him and another construction worker. The driver and the other construction worker expired at the scene. Upon arrival, the patient was hemodynamically stable, and an advanced trauma life support protocol was initiated. Assessment: Examination of the patient revealed a left eyebrow laceration, superficial abrasions on the lateral knee and a gross deformity of the left leg. At the mid-tibial level anteriorly, there was a 0.5-cm open wound and no open wounds were discovered around the knee joint. All four extremities were noted to be soft and compressible and the patient was neuro-vascularly intact. Radiographs revealed a comminuted midshaft tibia and fibula fracture. There also appeared to be subcutaneous air at the knee joint. Radiographs of the left femur and ankle were negative. CT scan of the head was negative for any fracture or intracranial processes. Interventions/Therapeutic Management: Initial orthopedic management in the trauma bay involved administration of cefazolin, gentamicin, tetanus and provisional irrigation of the left leg open wound. A reduction maneuver was performed with longitudinal traction to pull the tibia out to length. The left lower extremity was then placed in a well-padded posterior mold splint. The left eyebrow laceration was managed with nylon sutures. Post-reduction radiographs demonstrated improved alignment of the fracture. A CT scan of the left lower extremity demonstrated the comminuted midshaft tibia/fibula fractures with 1-cm overlap between the proximal and distal tibia. Deep subcutaneous air was noted at the fracture site, which tracked proximally to the knee joint. Review Questions: 1. As the nurse taking care of this patient, what 5 main areas would you focus your assessment on? Please provide rationales for why you selected those particular areas of assessment. 2. What is meant by the term comminuted 3. What is the rationale for ordering cefazolin, gentamicin, and a tetanus toxoid for this patient? 4. What is meant by the term reduction? What is meant by the term fixation? 5. Staying by this patient’s side, you notice the physician apply the splint as noted above. Discuss the rationale for splinting. 6. In the above discussed interventions, there were already radiographs/x-rays ordered to initially diagnose the fracture in the lower extremity. Why was a CT of the same extremity done if the fracture had already been diagnosed?
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