Question

Marilyn Hughes is a 45-year-old female client admitted to the post-anesthesia care unit following a repair of a left mid-shaft tibia-fibula fracture. She returned from surgery with a below the knee ace bandage and splint dressing in place. Neurovascular checks are in a normal range. You are the post-anesthesia care unit (PACU) RN assigned to care for this client. The post-operative course proceeds smoothly until the client begins complaining of increasing pain in the left lower extremity. The RN assesses the client's left leg and notes that the client is complaining of sensations of “pins and needles” in the left lower extremity and complains of “tightness”. The RN assesses localized edema in the left foot and visible lower left extremity and notes a capillary refill of greater than three seconds noted in the left foot and less than three seconds noted in the right foot. The RN communicates the findings to the surgeon, who assesses the client and determines the need to return to the OR immediately for an additional procedure. The RN prepares the client for the return to surgery and is giving a handoff report on the phone to the operating room RN who is in the OR preparing the room for the client’s return.

Debriefing after a significant patient event is important for staff processing as well as improvement in patient care. The purpose of debriefing is to review staff performance looking for things that went well and those that did not. The discussion then focuses on determining opportunities for improvement.

Reflect upon the care Marilyn Hughes received during the scenario and provide a thorough response to each of the following questions.

The reflection: Address the following questions:

• What could have happened in this scenario if Marilyn Hughes’ condition was not treated expediently?
• How would you recognize that Marilyn Hughes’ condition was deteriorating?

Answer 1

Here the nurse has done the excellent job by identifying the problem quickly and informing surgeon.

Basically after the surgery for left leg mid shaft tibia fibula fracture patient develops pin prick sensation, pain and nurse notices increased capillary refilling time with edema of feet, this is clearly suggestive of ARTERIAL OCCLUSION most probably due to tight bandage dressing or secondly some intraoperative arterial injury which is leading to features of ischemia in post operative period.

So the scenario is explained.

Now the second Q is that how would nurse identify that patient condition is deteriorating?

Its quite simple, the symptoms like pain, pin prick sensation would increase and also the edema would increase. Similarly vitals like pulse, blood pressure should be monitored.