Jimmy, ten years old, was admitted to the pediatric intensive care unit after a fall from the second-story townhome were sustained a fractured left femur and mild head injury.

Case Study: Jimmy, ten years old, was admitted to the pediatric intensive care unit after a fall from the second-story townhome were sustained a fractured left femur and mild head injury. Currently, Jimmy is two days post open reduction internal fixation of the left femur. Orders were updated to transfer Jimmy out of Intensive Care Unit (ICU) after being cleared by the neurologist. He has a long leg cast, indwelling foley catheter and will require neuro checks every two hours.
What are two priority nursing diagnoses for this child?
What are the priority nursing interventions for this patient after being transferred from the ICU?
What are the risks of foley catheter placement?
Does the patient still require an indwelling foley catheter? Provide a rationale to support your answer.

ANSWER
Priority Nursing Diagnoses

Risk for Impaired Physical Mobility
Jimmy’s fractured left femur and long leg cast significantly restrict his mobility. This immobility can lead to muscle atrophy, decreased strength, and potential complications such as pneumonia and deep vein thrombosis (DVT).

Risk for Urinary Tract Infection (UTI)
Jimmy’s indwelling Foley catheter increases his risk of developing a UTI. Catheters provide a pathway for bacteria to enter the bladder, and prolonged catheter use increases the risk of infection.

Priority Nursing Interventions

Promoting Physical Mobility
Despite his leg injury, Jimmy’s physical mobility should be encouraged within safe limits. Assist Jimmy with range-of-motion exercises and bed mobility as tolerated. Encourage him to participate in activities that don’t strain his injured leg, such as upper body exercises or using a wheelchair for short distances.

Maintaining Urinary Tract Catheter Care
Proper catheter care is essential to prevent UTIs. Ensure the catheter is secured properly to prevent displacement. Maintain a closed drainage system. Clean the catheter insertion site daily with sterile saline solution. Encourage adequate fluid intake to promote urine flow and prevent catheter blockage.

Monitoring Neurologic Status
Jimmy’s recent head injury warrants ongoing neurologic monitoring. Assess his level of consciousness, orientation, and pupillary response every two hours or as ordered. Monitor for signs of increased intracranial pressure, such as headache, vomiting, and nuchal rigidity.

Pain Management
Jimmy’s fractured femur and head injury may cause significant pain. Administer pain medication as prescribed and assess his pain level regularly. Encourage non-pharmacological pain management techniques such as relaxation exercises and distraction.

Preventing Complications
Implement preventive measures to reduce the risk of complications such as pneumonia and DVT. Encourage Jimmy to deep breathe and cough regularly to promote lung clearance. Elevate his lower extremities to reduce swelling and prevent DVT.

Risks of Foley Catheter Placement

Urinary Tract Infection (UTI)
UTIs are the most common complication associated with indwelling Foley catheters. Bacteria can easily travel up the catheter and into the bladder, causing infection.

Catheter-Related Bladder Spasm (CRBS)
CRBS is a painful bladder spasm caused by irritation from the catheter. Symptoms include frequent urination, urgency, and pain.

Catheter Encrustation
Catheter encrustation occurs when mineral deposits build up on the catheter, increasing the risk of infection and blockages.

Urethral Injury
Catheter insertion and removal can cause urethral irritation, bleeding, and even perforation.

Does the Patient Still Require an Indwelling Foley Catheter?

The decision to continue using an indwelling Foley catheter should be made on a case-by-case basis, considering individual patient factors and clinical status. In Jimmy’s case, the indwelling catheter may still be necessary for accurate urine output monitoring, particularly in the initial post-operative period. However, as his condition stabilizes and he regains bladder control, the catheter should be discontinued to minimize the risk of complications.

Once Jimmy is able to void spontaneously and has demonstrated bladder control, the Foley catheter should be removed. This will reduce the risk of UTIs, catheter-related complications, and promote urinary tract health.