You are required to integrate theory, demonstrate analysis using evidence and include other pertinent literature to support your answers.
You are allocated to care for the below patient on a morning shift after caring for her yesterday on the afternoon shift.
Ms Christine Jones is a 34 year old female bought into emergency by ambulance following a Motor Vehicle Accident in which her partner was killed. She arrived in ED unconscious, with full spinal precautions in place. Her mother’s details were found in the contacts list on her mobile phone. Her mother is listed her as next of kin (NOK ), so telephone consent was obtained for all necessary medical intervention to be performed as required prior to the mother arriving at ED. Christine’s mother lived a hour drive away.
On Christine’s admission to ED primary and secondary surveys were performed. A suspected left punctured lung was confirmed and a chest tube inserted; intubation and ventilation are commenced. Minor cuts and grazes were noted on her arms, legs and abdomen area as well as severe swelling of her right ankle and right wrist. A comminuted fracture of her L) femur was diagnosed.
Cervical, thoracic and lumbar x-rays were performed but revealed no indication of spinal fractures and spinal precautions were ceased. Full blood count, urine and sputum samples were sent with a positive pregnancy test result revealed post the x-rays being performed. The bHCG (Beta-Human Chorionic Gonadotropin) was indicative of Christine being approximately 10-11 weeks pregnant.
Due to the positive pregnancy test and the patient being unconscious and ventilated it is decided to manage the femur fracture conservatively until informed consent can be obtained from the patient for surgery.
It is now 2 days post the accident and Christine is currently in ICU having been weaned off the ventilator overnight and has regained consciousness with a GCS of 15. The chest tube is still in-situ and Christine is on IV antibiotics, Oxygen, CVC line in situ, IDC. Further x-rays of her right wrist and ankle are planned for the afternoon.
Before you enter the room this morning Christine’s mother takes you aside “I heard the nurses talking yesterday and they said Christine is pregnant- is that true? Can I ask you a favour? – I’ve been thinking; please don’t tell Christine about the positive pregnancy test and can you tell the doctor’s the same so Christine will consent to surgery of her fractured femur and further x-rays. She needs to think of herself first then the pregnancy. She won’t make a rational decision if she knows she is pregnant.” The monitor starts alarming within the room and you excuse yourself from the conversation.
The medical team is in Christine’s room when you and Christine’s mother enter the room and are informing Christine of the positive pregnancy test. They go on to give Christine two options for her fractured femur: The first option is surgery for ORIF (open reduction and internal fixation) of the femur and the second option is conservative treatment due to the risks associated with surgery whilst pregnant and having a punctured lung. The risks of conservative treatment are also outlined - longer recovery time, no weight bearing for 6 weeks, the alignment of the healing of the femur may not be exactly perfect therefore leading to further issues in the future (pain etc).
Christine’s mother asks to speak to you outside the room.
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