Hi, need to submit a 3000 words essay on the topic Critically evaulate the care and management of a Scaphoid fracture from the perspective of a Emergency Nurse Practitioner.

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I chose to focus on scaphoid fractures since they are part of the injuries that I am likely to come across as an emergency nurse practitioner (Rutter, 2008). This paper touches on the clinical assessment and differential diagnosis of scaphoid fractures. I will discuss different assessments that a nurse can perform and the diagnosis process that is supposed to be followed when dealing with a fractured scaphoid. I will also look at the psychological as well as the cultural factors that might affect the patient suffering from a fractured scaphoid. I will also include the treatment options available for scaphoid fractures. There are several issues related to the management of fractured scaphoids. And I will delve deep into some of these issues in my discussion. Clinical assessment and differential diagnosis Scaphoid fractures are quite difficult to diagnose correctly since X-Ray interpretations are normally vague (Gunal, Barton and Calli, 2010). This draws to attention the need of clinical assessment in the diagnosis process. The diagnostic process of a fractured scaphoid needs to be thorough enough to be able to make accurate diagnosis. Signs and Symptoms It is quite challenging to diagnose fractured scaphoids due to the lack of apparent signs that are common with bone fractures. The most common symptom or sign of a fractured scaphoid is tenderness and pain, which is usually accompanied by swelling on the wrist (Elhassan and Shin, 2006). However these signs are not very specific and one might make unnecessary outpatient reviews. In the health facility where I worked, MRI technology was used to a certain the presence of a fractured scaphoid on a patient (Garcia and Holtz, 2001). However, the patient had to undergo plain-film radiographs to ascertain that indeed there was a fracture on the wrist. The first step of the clinical assessment of the suspected fractured scaphoid was to take the patients history (Bickley, 2005). Taking the history of the patient was important as it showed the injury mechanism. For a fractured scaphoid, the injury mechanism normally involved: Falling onto the outstretched hand Forced dorsiflexion, with a radially deviated wrist Sometime there could be palmar flexion After checking the common signs of a fractures wrist such as swelling, lack of a strong grip and pain, the next step involved the use of radiographs (Elhassan and Shin, 2006). The lateral radiograph was used to indicate whether or not there was any sign of inconsistency in the alignment of the carpal and distal joints (Edwards and Stillman, 2006). If the patient had positive radiograph results but negative initial clinical findings were treated using cast immobilization for two weeks. After two weeks, the examination was repeated to examine whether there had been any form of healing or bony resorption at the site of the fracture. Emergency nursing practitioners carried out the initial clinical evaluation which in most cases showed the following (Muscari. 2001): Pain on the wrist Fullness and swelling off the snuffbox, which was a clear indication of effusion Tender palpation in the anatomical snuffbox and scaphoid tubercle Reduction in the range of motion Pronation and ulnar deviation that caused pain Reduced strength of grip When the radiographs failed to indicate the fracture, even when it was apparent there was one, the other option used was MRI.

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