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Focus: Musculoskeletal and Integumentary Systems

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Clay Davis has been in the hospital for a week. The craniofacial surgery that he underwent to reduce the symphyseal fracture of the mandible at midline was successful, and the patient is healing well. His facial edema—particularly along the jaw lines—has begun to recede, although the swelling is still quite evident. His lower face is still somewhat discolored, but this bruising is also receding. His lips remain swollen. He is wearing a jaw wrap to maintain mandibular alignment and to apply pressure to reduce the possibility of further tissue swelling and pain.

During the past week, Clay has made steady progress. Within the first 48 hours post-op, he was able to ambulate PRN with the assistance of nurses and care aides. He has had bathroom privileges since that time, and incontinence has not been an issue. Clay's intravenous line was discontinued 48 hours ago, and his nasogastric tube was removed yesterday morning. The scald to his upper torso, which extends from the sternoclavicular joint leftward across to the upper deltoid of the left arm and down to the left nipple line, has also been healing. Skin discoloration is minimal; the redness has disappeared. Blisters have healed, and the damaged skin has begun to peel. There is no evidence to predict any residual scarring as a result of the burn.

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Patient Update

Stevie-Rose and her grandson, Clay, sat together on his bed on the Pediatric Unit at Okla Trauma Center, reading Dev Pikey's Captain Underpants. Clay sat close to his grandmother, clearly appreciating the comfort of her presence, her soft voice, and her gentle touch. Stevie-Rose had been there when he woke up that morning, and she and his parents were taking turns being there for him. Now, after breakfast, Stevie-Rose was reading Clay a few chapters from the book. She'd been doing this for a number of days now. Clay put his hand on the book.

"Would you like me to stop for awhile, Clay?" Stevie-Rose looked down at her grandson. He nodded and attempted a little smile through his swollen lips.

"Walk around?" he asked, opening his lips just enough to express the words. Clay raised his eyebrows in hope as he did so. His grandmother smiled and stood up.

"Excellent idea, my boy. A little exercise is just what you need. Excellent for your circulation and excellent for your health!" Stevie-Rose laughed and pulled the wheelchair nearby closer to the bedside. "Hmm," she said, "I don't really think you need this anymore, but I am not a nurse working here, so I can't make that decision." She smiled at him. He pulled down his blankets and moved carefully to the edge of his bed. "Don't look down, Clay. It's not good to tip your face downward. It might hurt a bit if you do that," she cautioned warmly.

"I know, Grandma," he said. "Everyone keeps telling me that. ...

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