Directions: Answer the case study questions. In order to receive full value, submit one original post addressing the questions, and at least two responses to your classmates' postings. References: APA format 6th ed. Three current references (not more than 5 years old, unless classic research or updated clinical guidelines). See discussion board posting and grading rubric.

Emergency Problems - Case Study

L.M. is a 51-year-old man who presents to the urgent care clinic with several large gashes to his inner left thigh. The injury was sustained by a fall at a construction site, where he is employed for the summer. He fell into an area that contained a large amount of construction debris, and he is not certain exactly which materials caused the gashes. He is in pain and trying to hold a soiled piece of cloth over the  wounds.

It was all he could find, and he was anxious to stop the bleeding, which is fairly profuse. A fellow worker drove him immediately to the clinic, which is not far from the construction site. Because of the close vicinity to the clinic - the co-workers had not attempted any cleansing or  treatment at the scene of the accident.

• CC: "Do I have to have stitches? Will I be able to work? How serious is this? Man, it really hurts!"

• Physical examination: Blood pressure is 90/60; pulse rate is 96; respiration rate is 28/min, and he is evidencing pain as the wounds are examined. Examination reveals three separate lacerations to the inner thigh, the largest quite close to the groin area. This laceration is approximately 5 inches in length; two adjacent gashes are 3 inches and 2 inches in length. The largest wound also appears to be the deepest. The patient has full range of motion to the limb and good distal circulation and sensation.

Questions:

1. How would you proceed with this patient when he first presents to urgent care?

• How would you cleanse the wound?

• The first question should be: can you handle this or do you need the MD to see him?

• Discuss the conditions in which you think this case might be beyond the scope of practice for an APRN.

2. Describe the steps in evaluating these wounds.

• Are additional data needed from the history and physical examination before treatment decisions are made?

• Would you order any laboratory tests and/or imaging?

• LM is most concerned with returning to work. What do you need to do before you can reassure him?

3. How would you categorize this wound?

• How would you proceed with suturing?

• How would you distinguish between staples and sutures: which would be indicated?

• How long should they be left in?

• How will you teach him to care for the wound? What should he be taught to look for if he needs to come back in?

4. What pharmacotherapeutics might this patient need and why?

• Does he need a tetanus shot?

• What if he can't remember when he had his last tetanus shot?

• What are the guidelines for this.

• Does he need antibiotics?

• Would you irrigate the wound with antibiotics? Will you use antibiotic cream or not?

• How will you dress this wound?

• What will you teach him about caring for the wound?

5. What complementary therapies, if any, might be included in a plan of care for thispatient?

6. What health promotion strategies are especially important for this patient?

7. What follow up and education does this patient need?