Priority Nursing Diagnoses

1. Risk of Impaired Physical Mobility related to musculoskeletal impairment secondary to left femur fracture.

Rationale: Jimmy’s left femur fracture limits his ability to ambulate and perform self-care activities. The long leg cast further restricts his mobility, increasing the risk of impaired physical mobility.

2. Risk of Infection related to indwelling foley catheter and potential for urinary tract infection (UTI).

Rationale: Indwelling catheters are a common cause of UTIs, especially in patients with decreased mobility and neurologic deficits. Jimmy’s young age and hospitalization further increase his susceptibility to infection.

Priority Nursing Interventions

1. Promoting Physical Mobility
2. Encourage active range-of-motion exercises for unaffected extremities to maintain muscle strength and prevent contractures.
3. Assist Jimmy with bed mobility and transfers, using proper body mechanics to prevent further injury.
4. Collaborate with physical therapists to develop a safe ambulation plan once Jimmy’s condition stabilizes.
5. Preventing Urinary Tract Infection (UTI)
6. Maintain strict catheter care practices, including hand hygiene, sterile technique, and proper catheter placement and securing.
7. Monitor urine output and appearance for signs of infection, such as cloudy or foul-smelling urine.
8. Encourage adequate fluid intake to promote flushing of the urinary tract and reduce the risk of infection.
9. Neurologic Monitoring
10. Conduct neurologic checks every two hours as ordered, assessing pupillary response, level of consciousness, and motor function.
11. Document any changes in Jimmy’s neurologic status promptly and notify the physician if concerns arise.
12. Educate Jimmy and his family about the importance of neurologic monitoring and the signs and symptoms that may indicate a worsening neurologic condition.

Risks of Foley Catheter Placement

1. Urinary Tract Infection (UTI): As mentioned earlier, indwelling catheters are a common cause of UTIs, increasing the risk of bladder infection, kidney infection, and sepsis.
2. Catheter-Associated Bladder Trauma (CABT): Repeated insertion or removal of catheters can cause urethral irritation, bleeding, and perforation.
3. Encrustation and Blockage: Over time, mineral deposits can build up on the catheter, leading to encrustation and potential blockage of the urinary tract.
4. Urethral Strictures: Prolonged catheter use can lead to scarring and narrowing of the urethra, making future catheterization more difficult.

Does the Patient Still Require an Indwelling Foley Catheter?

Given Jimmy’s young age, recent hospitalization, and potential for impaired mobility, he may still require an indwelling foley catheter for the time being. However, the decision to continue using the catheter should be regularly reviewed and reassessed as Jimmy’s condition improves.

Factors to consider when evaluating the need for continued catheterization include:

1. Jimmy’s ability to void voluntarily: If Jimmy can empty his bladder completely and regularly without the assistance of a catheter, it may be appropriate to remove the catheter.
2. Urinary output and appearance: Monitoring urine output and checking for signs of infection can help determine if the catheter is contributing to urinary problems.
3. Jimmy’s overall health and mobility: As Jimmy’s condition stabilizes and his mobility improves, the need for a catheter may decrease.

The decision to discontinue catheterization should be made in collaboration with the physician, considering the patient’s individual needs and progress.