Femoral Fracture Case History and Initial Assessment

History Taking and Initial Care 👀 Pyelonephritis – Check for fever and urination pain and monitor body temperature rise 👀 FEMORAL FRACTURE – Check accident progress and pain area, check blood pressure and pain score 👀 Pulmonic embolism – Check for shortness of breath and oxygen saturation 👀 Pneumonia – Cough, phlegm color change, body temperature, respiratory rate check 👀 Congestion heart failure (CHF) – Check swelling and shortness of breath, monitor weight change 👀 Myocardial infarction (MI) – Check the location and duration of chest pain, check blood pressure and heart rate 👀 Stroke – Check the time and speech impairment of symptoms, observe blood pressure 👀 Diabetic ketoacidosis (DKA) – Check thirst and frequency of urination, check respiratory rate (Kussmaul breathing) 👀 Sepsis – Check fever, history of infection, monitor changes in body temperature and heart rate

 

 

 

 

 

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Comprehensive Simulation Scenario for Nurse Training: Femoral Fracture Case History and Initial Assessment

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Scenario Title: Structured History Taking and Vital Assessment for Femoral Fracture Patient

Setting: Emergency Room / Orthopedic Unit

Characters:

• Nurse (RN) – Emergency nurse conducting primary assessment
• Mr. Joon Park (Patient) – 59-year-old male, presenting with suspected femoral fracture

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Phase 1: Patient Identification and Communication

Nurse: Good morning, Mr. Park. I’m the nurse assigned to assist you today. Could you please confirm your full name and date of birth?

 

Patient: Good morning. My name is Joon Park, and my date of birth is February 3, 1965.

 

Nurse: Thank you, Mr. Park. Before we begin, I’d like to reassure you that everything we discuss today will remain confidential. I’ll ask you a few questions to better understand your condition and symptoms. If at any time you feel discomfort or need a break, just let me know.

 

 

 

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Phase 2: History of Present Illness (HPI)

 

Nurse: When did the injury occur?

 

Patient: Yesterday afternoon.

 

Nurse: Can you describe what happened? Were you able to move your leg right after the incident?

 

Patient: I slipped on the stairs and fell. After that, I couldn’t move my leg at all due to severe pain.

 

Nurse: On a scale from 0 to 10, with 10 being the worst pain imaginable, how would you rate your pain at this moment?

 

Patient: It’s about 8.

 

Nurse: Have you noticed any swelling, discoloration, or other visible changes in your leg?

 

Patient: Yes, my leg is swollen, and there’s some bruising on the thigh.

 

Nurse: Does anything make the pain better or worse?

 

Patient: It gets worse when I try to move or bear weight on it. Keeping it elevated helps a little.

 

Nurse: Have you taken any painkillers or applied ice since the injury?

 

Patient: No, I haven’t taken any medication, but I applied ice last night.

 

Nurse: That’s helpful to know. Let’s now discuss your health background.

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Phase 3: Past Medical History (PMH)

Nurse: Have you ever experienced any fractures or serious injuries before?

 

Patient: No, this is my first time having a serious injury.

 

Nurse: Are you currently taking any medications, including prescription drugs, over-the-counter medications, or supplements?

 

Patient: I take calcium supplements regularly, but no medications.

 

Nurse: Have you had any recent surgeries or hospitalizations?

 

Patient: No recent surgeries or hospital stays.

 

Nurse: Any known allergies to medications, latex, or foods?

 

Patient: No allergies that I know of.

 

 

 

 

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Phase 4: Family History (FH)

Nurse: Do you have a family history of osteoporosis, frequent falls, or bone-related conditions?

 

Patient: Yes, my mother had osteoporosis and broke her hip in her 70s.

 

Nurse: That information is important. Let’s move on to your lifestyle.

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Phase 5: Social History (SH)

Nurse: What is your occupation, and does it involve any physical activity or heavy lifting?

 

Patient: I work in construction. I frequently lift heavy materials and work on elevated surfaces.

 

Nurse: Have you participated in any recreational activities or physical tasks lately that may have increased your risk for injury?

 

Patient: Not recently, but working at heights is part of my routine and may have contributed to the fall.

 

Nurse: Do you smoke or consume alcohol?

 

Patient: I don’t smoke. I drink occasionally, about once or twice a month.

 

 

 

 

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Phase 6: Vital Signs Assessment

Nurse: Before proceeding with further evaluation, I’ll check your vital signs. Let me know if you feel any discomfort.

 

6.1 Temperature

Nurse: I’ll begin with your temperature using a tympanic thermometer. Please remain still.

(Performs hand hygiene, inserts thermometer correctly.)

 

Nurse: Your temperature is 37.8°C, which is slightly elevated and may indicate inflammation from the injury.

 

6.2 Blood Pressure

Nurse: Now I’ll measure your blood pressure. Please rest your arm at heart level.

(Wraps cuff, ensures proper placement, inflates and records.)

 

Nurse: Your blood pressure is 135/85 mmHg, which is slightly elevated and likely related to pain and stress.

 

6.3 Pulse

Nurse: Next, I’ll check your pulse. Please stay relaxed while I count the beats.

(Finds radial pulse, counts for one minute.)

 

Nurse: Your pulse is 98 beats per minute—mildly elevated, also likely due to pain.

 

6.4 Respiratory Rate

Nurse: Finally, I’ll assess your respiratory rate. Please breathe normally.

(Observes chest movement discreetly for one minute.)

 

Nurse: Your respiratory rate is 20 breaths per minute, which is within the normal range.

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Phase 7: Clinical Summary and Patient Education

 

Nurse: To summarize your vital signs:

• Your temperature is slightly high, suggesting a potential inflammatory response.
• Your blood pressure and heart rate are elevated, likely due to pain and stress.
• Your respiratory rate is within the normal range.

Based on your symptoms and the mechanism of injury, we suspect a femoral fracture. Immediate goals include:

1. Pain Management – Administer prescribed analgesics.
2. Swelling Control – Elevate the leg and apply intermittent cold packs.
3. Imaging – We’ll perform X-rays to confirm the type and location of the fracture.
4. Lab Work – Blood tests to check for anemia, infection, or bone metabolism issues.
5. Immobilization – Temporary splinting or traction to prevent further damage.

Please inform us right away if you experience increasing pain, numbness, tingling, or changes in your leg’s color or temperature.

Patient: Thank you for explaining everything clearly.

 

 

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Phase 8: Closing and Transition to Diagnostic Tests

Nurse: Thank you for answering all the questions, Mr. Park. Based on your information, we’ll now proceed with the X-ray and blood tests.

We’ll also begin managing your pain and apply elevation and cold compresses. Once the imaging results are in, the orthopedic team will determine whether surgical or conservative management is needed.

Do you have any questions before we begin the next steps?

 

Patient: No, thank you. I understand everything.

 

Nurse: You’re welcome. We’ll get started now and keep you informed throughout the process. Please let me know if anything changes or if you feel uncomfortable.

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Learning Objectives for Nurse Trainees

• Conduct structured, MECE-based patient interviews for trauma cases
• Gather complete medical, social, and family histories to assess fracture risk
• Perform accurate vital signs assessments and interpret pain-induced variations
• Provide clear and empathetic explanations about diagnostic and treatment procedures
• Prioritize pain management, injury stabilization, and prevention of complications

End of Scenario

 

 

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Femoral Fracture Case History and Initial Assessment