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.


In this case, we have a ten-year-old boy named Jimmy who was admitted to the pediatric intensive care unit (PICU) after a fall. He sustained a fractured left femur and mild head injury. This paper aims to discuss the management of Jimmy’s condition, focusing on his postoperative care, including the transfer out of the intensive care unit (ICU). We will explore the rationale behind the orders given, such as the use of a long leg cast, indwelling foley catheter, and neuro checks. Additionally, we will analyze the importance of these interventions in promoting Jimmy’s recovery and preventing complications.

Postoperative Care

Postoperative care is a crucial aspect of patient management, as it ensures a smooth transition from the operating room to the postoperative period. In Jimmy’s case, he underwent an open reduction internal fixation (ORIF) of the left femur, which involved aligning the fractured bone fragments and securing them internally with surgical implants. Following the surgery, it is essential to monitor Jimmy closely and provide appropriate care to promote healing and prevent further complications.

Long Leg Cast

The application of a long leg cast in Jimmy’s case is a standard part of postoperative management for fractures of the femur. This cast provides immobilization and support to the fractured bone, allowing for proper alignment and healing. Immobilization is crucial in preventing any further displacement of the fractured fragments and promoting bone union. Additionally, a cast can help alleviate pain and provide stability, enabling Jimmy to move more comfortably during the healing process.

Indwelling Foley Catheter

The use of an indwelling foley catheter in Jimmy’s case is likely aimed at ensuring adequate bladder drainage and monitoring fluid balance. After surgery, patients may experience temporary bladder dysfunction due to the effects of anesthesia, pain medications, and immobility. This can lead to urinary retention and the inability to empty the bladder adequately. Inserting a foley catheter allows for continuous urinary drainage, reducing the risk of urinary retention, urinary tract infections, and other associated complications.

Neuro Checks

Jimmy’s neuro checks, which are to be performed every two hours, are an essential component of his postoperative management after sustaining a mild head injury. Neurological assessment is crucial in detecting any changes in his neurological status and preventing potential complications. The purpose of neuro checks is to assess the patient’s level of consciousness, cognitive function, motor skills, and pupillary response. These checks help identify any signs of deterioration, such as increased intracranial pressure, hematoma formation, or neurological deficits, which may require further intervention.

Transfer out of the ICU

The decision to transfer Jimmy out of the ICU is based on the clearance provided by the neurologist. Clearance from the neurologist indicates that Jimmy’s neurological status has been assessed, and no significant concerns have been identified. Once cleared, Jimmy can be safely transferred to a less intensive level of care, such as a general pediatric unit or a step-down unit. The transfer allows for the allocation of ICU resources to more critically ill patients while promoting a more developmentally appropriate environment for Jimmy’s continued recovery.


In summary, Jimmy, a ten-year-old boy, suffered a fractured left femur and mild head injury after falling from a townhome. His postoperative care included the application of a long leg cast, insertion of an indwelling foley catheter, and neuro checks every two hours. These interventions aim to promote healing, prevent complications, ensure adequate bladder drainage, and monitor Jimmy’s neurological status. The decision to transfer him out of the ICU is based on neurologist clearance and provides a more appropriate level of care for his continued recovery. By implementing these aspects of postoperative care, Jimmy’s overall prognosis is likely to be improved, and he will have a higher chance of achieving a successful recovery.