24.1: Lily

Seven-year-old Lily is admitted to the emergency department following a road traffic accident. She was knocked down outside the school gates, when crossing the road.

She is brought into hospital with pain and swelling and deformity of her right thigh. Her mother accompanies her in the ambulance.

An x-ray confirms a midshaft fractured femur.

  • What are the primary nursing interventions once it has been determined that this is an isolated injury?

› Suggested answers

  • Neurovascular assessment

See:

www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Neurovascular_observations/

www.rcn.org.uk/professional-development/publications/pub-004685

  • Pain relief

See:

www.rch.org.au/uploadedFiles/Main/Content/anaes/Pain_assessment.pdf

www.aboutkidshealth.ca/en/resourcecentres/pain/painassessment/measurementofpain/pages/tools-for-measuring-pain.aspx

  • Initial management of the fracture

Fractures of the femur in children can be managed in different ways. Treatment is dependent on age of the child and location of the fracture.

Initial management is to relieve pain and to correct alignment. Traction is the usual management until a definitive plan of treatment has been determined, which may be continued traction or surgery. See:

Judd, J. (2008) ‘Application and care of traction’, in J. Kelsey and G. McEwing (eds), Clinical Skills in Child Health Practice. London: Churchill Livingstone