Assignment 1 - Written (M/S focus) Weight: 40% Must Complete: Yes Word Length: 2000 words Notes: Written assessment This assessment relates to: Learning Outcomes 1-5 Each Question is weighted equally....

Running Head: Critical Analysis
Critical Analysis 8
Assessment 1
Musculoskeletal Case Study- Critical Analysis
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Introduction
The essay critically evaluates and analyzes a clinical case study of an 8 year old girl Ha
iet Potter,
ought to the emergency ward after a simple fall at school and confirmed to have femoral shaft fracture at the left thigh. Ha
iett has a medical history of Osteogenesis Imperfecta or
ittle bones. The essay illustrates the case study and elaborates the (a) Mechanism of injury of falls in younger patients, the medications and their pharmacology for the patient, immediate nursing priorities of the patient, (d) the ongoing holistic care for the patient and the post operative complications for the patient.
Mechanism of injury of falls in younger patients
The unintentional falls are the main reason for the non fatal injuries in the young children of age less than 10 years which requires emergency hospital admissions (Gill & Kelly, 2017). These children possess curiosity, lack of judgment and immature motor skills which makes them more vulnerable to falls (Gill & Kelly, 2017).In the children of age 2-10 years of age, about one half of the injuries take place at home while the one quarter of them occur at schools by falling from playground equipments (Tracy, Englum, Ba
as, Foley, Rice & Shapiro, 2013). The falls in this age group mostly lead to higher number of long bone fractures (p<0.05) (Tracy et al. 2013).
Etiology of these fractures varies with the child’s age. Ha
iet Potter sustained the femoral shaft fracture despite the mechanism of simple fall. A possible reason for this may be a history of osteogenesis imperfect popularly known as
ittle bone disease. The bones of children having this disease are fragile and
eak easily (Tracy et al. 2013). Osteogenesis Imperfecta is a genetic skeletal disorder which occurs due to autosomal dominant mutation in COL1A1 and COL1A2 genes which encode for Type I procollagen (Adiyeke, 2018). The condition may range from mild to severe. Ha
iet seems to have severe impact as he could not tolerate simple fall or blow during play and could not resist torque. The bone underwent femur fracture just at simple fall, due to generalized osteopenia mediated by osteogenesis imperfecta (Tracy et al. 2013). The osteopenia may lead to neurological conditions like myelomeningocele or cere
al palsy, resulting into fracture even with mild trauma like simple fall while tripping or running (Adıyeke,2018).
Limb length disparities and external rotations are observed after the femur fracture to detect any angular deformities, overgrowth or shortening of limbs post fall (Lewis, 2014). Persistent restrictions in the range of motion may occur due to femoral fracture. These conditions are assessed by the nursing team at the time of hospital admission. Ha
iet Potter is diagnosed with no shortening or rotation. The femur fractures which do not undergo shortening are acceptable and do not need a surgery. The condition can heal well regaining the normal function, and the patient will have equal length of legs.In severe cases the treatment may involve flexible intramedullary nails to stablize the fracture. External fixation also helps to hold the bones together in case the muscles are also injured (Orthoinfo, 2019). Both these techniques help the patient walk immediately. Further treatment may help to improve the unacceptable angulation and non union in thighbone fracture. As the children’s bones grow faster, the healing will regain the normal shape.
    Medications
Ha
iet is prescribed the analgesic medicines Oxycodone and Morphine for acute pain. The use of opioids is considered disputed moreover they are avoided for their risk of addiction (Strayer, Nelson & Motoy, 2017). However, Schwarz (2016) asserted the safe use of morphine in emergency departments is allowed initially for treatment of severe pain. The morphine may be replaced by the other analgesics in due course of time (Walford, 2015). Ha
iet is given Pamidronate 30 mg, to be taken once a month. It is used to treat the bone damage and weak bones. The drug inhibits the resorption of bones (Rogers, Gordon, Benford,Coxon& Luckman, 2014). Therefore the pain management of Ha
iet is optimal and in compliance to the best practice.
Mechanism of Action
The P-C-P structure of Pamidronate like bisphosphonates is helpful in antiresorptive mechanism of action and tissue selective targeting of the mineral in bone (Rogers et al, 2014). They have high affinity for the calcium ion. The antiresorptive potency of bisphosphonates is increased by the primary amino alkyl groups with longer R2 side chain(Rogers et al. 2014).
Increased affinity of Pamidronates for the mineral of bone, clears off the drugs rapidly from the circulation and facilitates localization of the hydroxyapatite mineral surfaces of bone (National Clinical Guideline Centre, 2016). These drugs prevent the resorption of bone by direct effect on the osteoclads.
Oxycodone belongs to the opioid analgesics and is used to relieve the patient from severe pain. Morphine (opioid) is also given as treatment of pain...