Today scheduled on your Nursing Sick Call list is a 23 year old patient who submitted a slip last night for right foot pain. On the slip, he stated that he noticed his foot hurting that day and doesn’t know why it is hurting. Your review of his health record in preparation for the Nursing Sick Call indicates that he has no medical conditions; takes no medication on a daily basis; and has an allergy to sulfa medication. At Sick Call, you ask the following questions:
At Sick Call, you ask the following questions:
What were his activities right before it started to hurt?
He denies any unusual physical activity, although he was walking in the day room to get breakfast yesterday and he recalls that he had a misstep and felt like his sneaker “stuck” to the floor and “his leg kept going.” He may have twisted it at that time.
What is his pain level?
He did not have pain immediately, but it began in the evening, and so he dropped the slip. Today when he woke up, he noticed his ankle was all “black and blue.” He has a dull pain, 2/10 without movement that increases to a 7/10 with movement. It definitely feels better when he does not move it, but that is almost impossible to do here during the day.
Has he ever injured that ankle before?
Any medical problems/conditions?
Next, conduct a physical evaluation of Mr. Howard
Obtain vital signs
HIs vital signs included the following: Blood pressure – 120/74; pulse 68; respirations – 16; oxygen saturation – 98% and temperature 98.8℉. He describes his pain currently as a 2/10 and 7/10.
Alert, oriented X 4, No acute distress.
Skin warm and dry, color appropriate for ethnicity.
Lungs clear without adventitious sounds.
Heart S1, S2 and regular, no murmurs, rubs or gallops auscultated.
Abdomen soft, non-tender to palpation; + bowel sounds x 4.
Right ankle with ecchymosis approximately 6 cm wide, 3 cm high; slight +1 swelling to ankle noted; +++ tenderness to ecchymotic area and right malleolus; right sole of foot also tender to palpation; strong and equal pedal pulses bilaterally; Capillary refill < 2 seconds to left and right toes; Right lower leg non-tender to palpation; Passive movement of right foot/ankle elicits ++ pain; Sensation intact to right foot – sole, toes, dorsum – and equal to left.
Alteration in Comfort – right ankle pain – ? s/p trauma/twist
What are you going to do?
Contact provider to see if x-ray needed, what the treatment plan will be, and the follow-up required.
Provider diagnosed the patient with a right ankle sprain. Provider states no x-ray at this time; place on provider list for tomorrow; place ace wrap on right ankle for support; may have Tylenol 325mg 2 tabs PO BID for 5 days; May have ice now for comfort, and TID for 2 days.
Education for the patient with a sprain includes:
- If there is swelling to the area, apply ice right away to reduce swelling. Wrap the ice in cloth or a towel. Do not place ice directly on the skin. Apply ice for 10 to 15 minutes every few hours for the first day and every 4 – 6 hours after that for up to three days.
- After 3 days, either heat or ice may be helpful if you still have pain. In the correctional environment, use hot water on a facecloth (then wrung out) for heat if you have it, or a heat pack if available.
- Rest the joint for at least a day. If possible, keep the joint raised above your heart.
- If you were given an ace wrap for support, be sure to rewrap it daily, taking care to inspect the skin and ensure that the compression is supportive but not tight.
- Try not to use a strained ligament while it is still painful. When the pain starts to go away, you can slowly increase activity by gently stretching the injured joint.
Let nursing staff know if any of the following occur:
- Swelling does not start to go away within 2 days.
- You have symptoms of infection, including red, warm, painful skin or feel like you have a fever.
- The pain does not go away after several weeks.
The following steps may lower your risk of a sprain in the future:
- Wear protective footwear during activities that place stress on your ankle and other joints.
- Make sure that shoes fit your feet properly.
- Always warm-up and stretch before doing exercise and sports.
- Avoid sports and activities for which you have not trained.
Keep pressure off the injured area until the pain goes away. Most of the time, a mild sprain will heal in 7 to 10 days. It may take several weeks for pain to go away after a bad sprain. The ecchymosis (“black and blue bruise”) may take many days to resolve.
The patient may need further education on wrapping the ankle and crutch walking.
Check out our posts about Sprains and Strains on CorrectionalNurse.Net
Classes available at The Correctional Nurse Educator include Sprains and Strains for the Correctional Nurse.
*As always, your company or facility policies, procedures and Nursing Protocols/Guidelines take precedence over any written recommendations on this website.
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