Critically evaulate the care and management of a Scaphoid fracture Essay

Critically evaulate the care and management of a Scaphoid fracture from the perspective of a Emergency Nurse Practitioner - Essay Example I chose to focus on scaphoid fractures since they are part of the injuries that I am likely to come across as an emergency nurse practitioner (Rutter, 2008). This paper touches on the clinical assessment and differential diagnosis of scaphoid fractures. I will discuss different assessments that a nurse can perform and the diagnosis process that is supposed to be followed when dealing with a fractured scaphoid. I will also look at the psychological as well as the cultural factors that might affect the patient suffering from a fractured scaphoid. I will also include the treatment options available for scaphoid fractures. There are several issues related to the management of fractured scaphoids. And I will delve deep into some of these issues in my discussion. Clinical assessment and differential diagnosis Scaphoid fractures are quite difficult to diagnose correctly since X-Ray interpretations are normally vague (Gunal, Barton and Calli, 2010). This draws to attention the need of clinic al assessment in the diagnosis process. The diagnostic process of a fractured scaphoid needs to be thorough enough to be able to make accurate diagnosis. Signs and Symptoms It is quite challenging to diagnose fractured scaphoids due to the lack of apparent signs that are common with bone fractures. The most common symptom or sign of a fractured scaphoid is tenderness and pain, which is usually accompanied by swelling on the wrist (Elhassan and Shin, 2006). However these signs are not very specific and one might make unnecessary outpatient reviews. In the health facility where I worked, MRI technology was used to a certain the presence of a fractured scaphoid on a patient (Garcia and Holtz, 2001). However, the patient had to undergo plain-film radiographs to ascertain that indeed there was a fracture on the wrist. The first step of the clinical assessment of the suspected fractured scaphoid was to take the patients history (Bickley, 2005). Taking the history of the patient was import ant as it showed the injury mechanism. For a fractured scaphoid, the injury mechanism normally involved: Falling onto the outstretched hand Forced dorsiflexion, with a radially deviated wrist Sometime there could be palmar flexion After checking the common signs of a fractures wrist such as swelling, lack of a strong grip and pain, the next step involved the use of radiographs (Elhassan and Shin, 2006). The lateral radiograph was used to indicate whether or not there was any sign of inconsistency in the alignment of the carpal and distal joints (Edwards and Stillman, 2006). If the patient had positive radiograph results but negative initial clinical findings were treated using cast immobilization for two weeks. After two weeks, the examination was repeated to examine whether there had been any form of healing or bony resorption at the site of the fracture. Emergency nursing practitioners carried out the initial clinical evaluation which in most cases showed the following (Muscari. 2 001): Pain on the wrist Fullness and swelling off the snuffbox, which was a clear indication of effusion Tender palpation in the anatomical snuffbox and scaphoid tubercle Reduction in the range of motion Pronation and ulnar deviation that caused pain Reduced strength of grip When the radiographs failed to indicate the fracture, even when it was apparent there was one, the other option used was MRI. In many health facilities which deal with emergency care for minor

Mumbai Attacks Assignment Example | Topics and Well Written Essays - 1500 words

Mumbai Attacks - Assignment Example The main objective of the terrorist was to damage the image of the country and hamper its economic situation. Another important aim of those terrorists was to attract the attention of the world towards their demands and cause by injuring and killing many innocent people. The attacks happened in Chhatrapati Shivaji Terminus, Leopold Cafà ©, Taj Mahal Hotel, Bomb blasts in taxis, Oberoi Trident and Nariman House. Bad International Intelligence had influences the success of Mumbai attack. India’s police and security system were often co ordinate poorly. They were not highly equipped or trained. Moreover the security system of the country was influenced by the political leaders and structure of India. Different legal and legislative bodies were involved to look after the security system India (Rath, 2010). Intelligence agencies, central investigative department, law enforcement, intelligence bureau, India police service, Central Reserve Force were all answerable to the Prime Minister. The military were also responsible to look after foreign threats and terrorist attacks. Too many government body involvements create an ineffective security management system. State and central authorities formed many joint committees and task force to handle crisis situations. But often the actions of these forces and committees become slow and complicated which creates major problems in International int elligence. The federal political system of India has such policies which posses’ problem in performing duties of intelligence units. For ineffective functions of this departments helped in the success of Mumbai attacks. There was a high possibility facing terrorist attack through sea route. Taj Hotel is a very prominent site which can be easily targeted. The intelligence department of India provided this information to the state government but the information was ignored by most of the