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(NRNP 6541) i Human: Andrew Chen latest update

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PRIMARY DIAGNOSIS: S89.021A: Salter-Harris type 2 physeal fracture of the right distal tibia. The Salter-Harris (SH) Classification System is a way to grade fractures that involve the growth plate (physis). Seventy-five % of lower extremity fractures in children are SH type 2. (Levine et al., 2022) When a Pt presents with ankle symptomsa detailed history and physical examination are crucial. Although a nurse practitioner may provide initial care and refer to a pediatric orthopedic specialist, obtaining details about the trauma may help narrow down the differentials and testing needed. In addition, a basic understanding of the pediatric anatomy can leadto a better understanding of the mechanism of injury. Bone growth is not completefor a male until somewhere between the ages of 14 to 17 years old. Growth plates are made of cartilage and as the child ages, the cartilage hardens into bone which isless flexible and rubbery. (Su & Larson, 2015) AC is 14 years old and because his growth plates are still primarily cartilage, the risk of SH fracture is high. AC presented with right ankle pain, swelling and bruising. On exam, his inability to walk/bear weight and the presence of right ankle bony tenderness make a fracture much more likely. (Levine et al., 2022) The Ottawa Ankle Rules (OAR) were initially developed for adult Pts but have been shown to be useful in pediatric Pts over 5 years old. The goal of the OAR’s are to decrease the incidence of unnecessary x- rays, increase the efficiency of care(waiting time) and keep the cost of medical care down. According to OAR, imaging is necessary if there is pain in the malleolar zone and at least one of the following: ⦁ Bone tenderness along the distal 6 centimeters (cm) of the posterior edge of the medial or lateral malleolus. ⦁ Inability to bear weight for 4 steps immediately after injury and at initialmedical evaluation. ⦁ Midfoot pain with tenderness over the navicular bone or the base of the 5thmetatarsal. The overall sensitivity of the OAR is 98.3% so it can be a useful clinical decisiontool. (Knipe & Foster, 2016)

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Karen Floyd i-Human Case Study/
Karen Floyd i-Human Case Study
Updated september2023-2024
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Questions –yields 90%
How can I help you? My stomach hurts
Do you have any other symptoms or concernswe I occasionally feel “bloated” although I’m not sure my belly is
should discuss? actually bigger when I feel that way. I…well pass a lot of gas and…
even belch a lot compared to other people I know. Sort of
embarrassing for a woman you know. Do you think that’s related
to all of this?
Is your pain affected by what, when, or how It seems to be worse with rich foods. I haven’t really noticed it as
much you eat? associated with when or how much.
Do you now or have you ever smoked or No, I never have.
chewed tobacco?
Are you taking any over the counter or herbal I take a multivitamin daily, and acetaminophen from time to
medications? time for stress headaches
Are you taking any prescription medications? No prescription medications
Do you have any allergies? Not that I know of
Have you ever been hospitalized? Just for the c-section and the bike accident thing
Any previous medical, surgical, or dental I had a c-section at 27 without any complications. When I was 17, Ihad a
procedures? bike accident and had a complicated fracture of my right
tibia. They had to fix that with surgery.
Can you tell me about any current or past I don’t know really what’s important. The only thing besides this
medical problems you have had? stomach problem is that lately I’ve been getting occasional hot flashes
and my skin is sort of dry. I also get headaches now and then which
isn’t new and that probably isn’t important anyway. Is that the kind of
things you want to know?

, Do you have diarrhea?




Occasionally. Sometimes I’d say my bowel movement is loose and
watery. Does that count?




Is there any blood in your stools or with your Anything red? Not that I have noticed
bowel movement?
Do you have a problem with constipation? Definitely. For as long as I can recall in my adult life, I have alternating
periods of constipation and just the opposite if youknow what I mean
that lasts several days. When I am constipated, I feel like I cannot get
everything out, even after a
BM.
Have you been having fevers? I don’t think so, can you check that for me
How often does this abdominal pain occur? It’s been coming and going for years now. It never really goesaway
entirely, but then it also doesn’t seem to be getting a lot
worse. It’s just there all the time. So frustrating.

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