FRACTURE AT RIGHT FEMUR – ORIF [CASE STUDY]
I. INTRODUCTION
We as a student nurses, wellness of the patient is the primary objective. And the best way to promote these is by means of actualization.
Fracture is any break in the continuity of bone. In some cases, a bone may fracture without visibly breaking. Fractures occur when the bone is subjected to stress greater than it can absorb. It can be caused by a direct blow, crushing force, sudden twisting motion, or even extreme muscle contraction. When the bone is broken, adjacent structures are also affected, resulting in soft tissue edema, hemorrhage into the muscles and joints, joint dislocations, ruptured tendons, severed nerves, and damaged blood vessels. Body organs may be injured by the force that caused the fracture or by the fracture fragments. And according to the physician the kind of fracture that Mr. M.C experience is comminuted fracture that the bone splinters at the site of impact, and smaller bone fragments lie between the two main fragments. Femur is the largest and strongest bone and has a good blood supply. Because of this and its protective surrounding muscle, the shaft requires a large amount of force to fracture. Once a fracture does occur, this same protective musculature usually is the cause of displacement, which commonly occurs with femoral shaft fractures. Orthopedic surgeons often encounter femur fractures because these fractures most often result from high-energy trauma, one must have a high index of suspension for complications or other injuries like vehicular accident that experience by Mr. M.C . While a variety of treatment options exist for a fracture that is associated to injury. We have chosen Mrs. M.C with the case of fracture, comminuted at the distal third right femur because the patient showed willingness and interest to learn and understand about her condition. We also want to know, and understand more about his case.
General Objectives:
At the end of the study or learning, the level 3 nursing students will be able to rectify, expound, and relate all ideas or perception to the nursing approach in doing valid and outmost care with the patient experiencing Fracture in the right Femur and undergone ORIF procedure.
Specific Objectives: The level 3 student nurses will be capable of: 1. Proposing the overall assessment findings with the patient experiencing Fracture in the right Femur. 2. Expounding thoroughly and articulately the anatomy and physiology of the systems involved in Fracture. 3. Providing illustration and explanation of the pathophysiology of the Fracture in the right Femur with regards to the patient. 4. Devising a well planned, with the principle of SMART a comprehensive nursing care plan that is applicable to the patient with Fracture in the right Femur. 5. Inculcating health teachings for the patient to follow and be in great help for his condition. 6. Elucidating and discuss the rationale of the different nursing interventions to the patient and to the family as well. 7. Evaluate the effectiveness and accuracy of the outcome of the nursing interventions. 8. Providing the needed information or knowledge to attain a healthy living
II. PERSONAL DATA
Name: Mr. MGC Address: # 334 Hugo Perez Trece Martires Cavite Birthday: August 18, 1979 Age: 29 Birthplace: Cavite Nationality: Filipino Case #:012744 Room #: 303-C Hosp. #: 3322Attending Physician: Dr. B, Dr. A, Dr. Barr, and Dr. G How admitted: Via Stretcher Admission Date & hour: November 13, 2008 04:30 AM In case of emergency, please notify: MRS. MC Relation: Wife Contact #: 09164295484
B. Physical Assessment Patient has posterior bandage of the right Femur, has pale pink nail beds on the right foot, and complained of pain in the operative site but unfortunately, we failed to ask for the pain scale and we did not have enough time to further assess and handle the patient.
C. Medical History For his past medication, we also failed to get information from the patient because we did not have enough time and to handle the patient.
IV. History of Present Illness 2 days prior to surgery, Mr. M was on his way home at night from work via motor vehicle. There was a road construction in the highway. He assumed that the construction truck was way far from the excavated hole so he regulated his speed to find out that the hole was directly after the
truck. He couldn’t swerve to the other lane
because there were fast cars so he fell under the hole.
V. Anatomy and Physiology
The femur or thighbone is the only bone in the thigh. It is the heaviest and strongest bone in the body. Its proximal end has a ball-like head, a neck and greater and lesser trochanters. The head of the femur articulates with the acetabulum of the hipbone in a deep secure socket. Skeletal muscles are formed when the muscles are attached to the skeleton or bone, which move the limbs and other parts of the body.
The muscle that is attached to the femur is known to be the Quadriceps group, which is consisted of the rectus femoris and three vastus muscles. All four muscles insert into tibial tuberosity via patellar ligament. VI. Pathophysiology
VII. MEDICAL MANAGEMENT
A.X-RAY Patient was diagnosed of Fracture at the distal 3 rd right Femur
B.PRE-OP MEDICATIONS 1) Ketorolac tromethamine Action: Inhibit prostaglandin synthesis, to produce anti-inflammatory, analgesic, antipyretic effects. Indication: short-term management of moderately severe, acute pain (for single-dose treatment or multiple-dose treatment)
2) Cefuroxime Action: Second-generation cephalosporin that inhibits cell-wall synthesis, promoting osmotic instability; usually bactericidal. Indication: For bone or joint infection; Perioperative prevention
3) Ranitidine Action: Competitively inhibits action of histamine on the H2 at receptor sites of parietal cells, decreasing gastric acid secretion. Indications: For active duodenal and gastric ulcer, maintenance therapy for duodenal or gastric ulcer, pathologic hyper secretory conditions, GERD, erosive esophagitis and heartburn.
4) Metoclopramide hydrochloride Action: Stimulates motility of upper GI tract, increases lower esophageal sphincter tone and blocks dopamine receptors at the chemoreceptor trigger zone. Indication: To prevent or reduce postoperative nausea and vomiting.
5) Paracetamol Action: Thought to produce analgesia by blocking pain impulses by inhibiting synthesis of prostaglandin in the CNS or of other substances that sensitize pain receptors to stimulation. The drug may relieve fever through central action in the hypothalamic heat-regulating center.
C.HEMATOLOGY Lab Results HEMOGLOBIN Date: 11/12/08 10:16 pm Release: 11/12/08 10:37 pm
Hemoglobin NV: 140-175g/L RESULT: 139g/L
Hematocrit NV: 0.41-0.50 RESULT: 0.41
HEMATOLOGY DATE: 11/13/08 4:50am Release: 11/13/08 5:22 am
Hemoglobin Mass Concentration NV: 12-17 gms% RESULT: 13gms%
Erythrocyte, Volume Fraction (Hct) NV: 40-45 % RESULT: 39%
VIII. Surgical Procedure An incision is made in the right thigh, exposing the fractured part of the bone. The right femur (fractured bone) is then holed, so that the orthopedic surgeon would be able to put the reconstruction nail into the medullary canal. Then nail were attached to secure the femoral fracture. The screws were attached to fixate the rod.
X. HEALTH EDUCATION
1. Explain basis for fracture treatment and need for patient participation in therapeutic regimen. 2. Promote adjustment of usual lifestyle and responsibilities to accommodate limitations imposed by fracture. 3. Instruct the patient to actively exercise joints above and below the immobilized fracture at frequent intervals. 4. After removal of immobilizing device, have the patient start active exercises and continue with isometric exercises. 5. Instruct the patient on exercises to strengthen upper extremity muscles if crutch, walking is planned. 6. Instruct the patients in methods of safe ambulation-walker, crutches, and cane. 7. Emphasize instruction concerning amount of weight bearing that will be permitted on fractures extremity. 8. Discuss prevention of recurrent fracture; review safety consideration, avoidance of fatigue, proper foot wear. 9. Encourage follow-up medical supervision to monitor for bone union problems. 10. Teach the patient to recognize and report symptoms needing attention, such as numbness, decrease function, increase pain, or elevated temperature. 11. Encourage the patient to follow an adequate balance diet to promote bone and soft tissue healing.
XI. CONCLUSION
Towards the end of the case study or learning, the level 3 nursing students were able to, propose the overall assessment findings with the patient experiencing a Fracture, comminuted at the distal third right femur and expounded thoroughly and articulately the anatomy and physiology of the systems involved. They were able to illustrate and explain the pathophysiology of the Fracture, comminuted at the distal third right femur with regards to the patient, devised a well planned, with the principle of SMART a comprehensive nursing care plan that is applicable to the patient with Fracture, comminuted at the distal third right femur, inculcated health teachings and elucidated and discuss the rationale of the different nursing interventions to the patient and to the family as well. After proving the interventions, they evaluated the effectiveness and accuracy of the outcome.
