7. identify potential problems of patient 8. review the anatomy and physiology of the organ a!ective 9. discuss the pathophysiology of the condition. :. identify the clinical and classical signs and symptoms of the condition. ;. implement holistic nursing care in the care of patient utili
A#I(#)&(#'4 After 5 h ours of studen t nurse) patien t i nteracti on, t he pati ent and the sign i cant others will be able to2 6. explain the goals of the fre%uent position changes. 7. enumerate the position for proper body alignment. 8. discuss the di!erent therapeutic exercises. 9. practice the di!erent kinds of range of motion. :. participate attentively during the discussion.
III. (ursing Assessment 6. >ersonal ?istory6.6 >atient-s >role (ame2 /rs. #orralba, @ourdesAge2 5 years old $ex2 Female&ivil $tatus2 idow'eligion2 'oman &atholic 4ate and time of admissionB /arch 68, 7CC5 at 6C26C am 'oom (o.2 'oom 97:, Dicente sotto memorial medical center &omplaints2 >ain the right hip Impression or 4iagnosis2 Fracture &lose)&omminuted2 Femoral 'ight (eck >hysician2 4r. F. Dicuna, 4r. . @ee, 4r. (. 3y, 4r. 'amiro?ospital (o2 76; 97;6.7. Family and Individual Information, $ocial and ?ealth ?istory /rs. #orralba, @ourdes who resides in 5 Acacia $t. &uthaw @ahug, &ebu &ity, &ebu >rovince with successful children * ; boys and 8 girls+ was admitted to &ebu4octors- 3niversity ?ospital for further management of the condition./rs. #orralba is a college graduate and she-s previously working as an assistant of her husband * /r. 'odrigo #orrralba + a doctor.#he patient was diagnosed #wo days prior to admission, the patient was standing and was about to open uphe umbrella when she got out of balance and landed on her right hip.And had experiencedlimitation of movement on th e right hip. #he patient was then admitted due to the persistence of pain.#he patient was previously hospitalihysical 4evelopment>erception of well)being can dene %uality of life. 3nderstanding the older adults perception about health status is essential for accurate assessment and development of clinically relevant interventions. lder adults concepts of health generally depend on personal perceptions of functional ability. #herefore older adults engaged in activities of daily living usually consider themselves healthy, whereas those whose activities
arelimited by physical, emotional or social impairments may perceive themselves as ill.#here are fre%uently observed physiological changes in order adults that arecalled normal. Finding these normalG changes during and assessment is not an expected.#hese physiological changes are not always pathological processes in themselves, butthey may make older adults more vulnerable to some common clinical conditions anddiseases. $ome older adults experience all of these physiological changes, and others onlyexperience only a few. #he body changes continuously with age, and specic e!ects on particular older adults depend on health, lifestyle, stressors and environmental conditions.
&ognitive 4evelopmentIntellectual capacity includes perception, cognitive, memory, and learning.>erception, or the ability to interpret the environment, depends on the acuteness of thesenses. If the aging person-s senses are impaired, the ability to perceive the environmentand react appropriately is diminished. >erceptual capacity may be a!ected by changes inthe nervous system as well. &ognitive ability, or the ability to know, is related to the perceptual ability.&hanges in cognitive structure occur as a person ages. It is believe that there is a progressive loss of neurons. In addition, blood How to the brain decreases, the meanings appear to thicken, and brain metabolism slows. As yet, little is known about the e!ect of these physical changes on the cognitive functioning of the older adult. lder people need addition time for learning, largely because of the problem of retrieving information. /otivation is also important. lder adults have more di0culty than younger ones in learning information they do not consider meaningful. It is suggested that the older person mentally active to maintain cognitive ability at the highest possible level. @ifelong mental activity, particularly verbal activity, helps the older person retain the high level of cognitive function and may help maintain a long)term memory. &ognitive impairment that interferes with normal life is not considered part of normal aging. A decline in intellectual abilities that interferes with social or occupational functions should always be regarded as abnormal. >sychosocial 4evelopment According to rikson, the developmental task at this time is ego integrity versus despair. >eople who attain ego integrity view with a sense of wholeness and derive satisfaction from past accomplishment. #hey view death as an acceptable completion. According to rikson, people who develop integrity accept one-s one and only lifestyleG. "y contrast, people who despair often believe they have made poor choices during life and wish they have made poor choices during life and wish they could live life over. 'obert "utler sees integrity and bringing serenity and wisdom, and despair as resulting in the inability to accept one-s fate. 4espair gives rise of frustration, this couragement, and a sense that one-s life has been worthless. /oral 4evelopment According to ohlberg, moral development is completed in the early adult years. /ost old people stay at ohlberg-s conventional development, and some are at the preconventional level. An elderly person at the preconventional level obeys roles to avoid pain and the displeasure of others. At stage one, a person denes good and bad in relation to self, whereas older person-s at stage = may act to meet another-s need as well as their own. lderly people at the conventional level follow society-s rules of conduct to expectation of others. motional 4evelopment ell)adjusted aging couples usually thrive on companionship. /any couples rely increasingly on their mates for this company and may have few outside friends. 1reat bonds if a!ection and closeness can develop during this period of aging together and nurturing each
other. hen a mate dies, the remaining partner inevitably experiencesfeelings of loss, emptiness, and loneliness. /any are capable and manage to live aloneBhowever, reliance, on younger family members increases as age advances and in health occurs. $ome widows and widower remarry, particularly the latter, because the widowers are less inclined than widows to maintain a household. $piritual 4evelopment /urray and Jentner write that the elderly person with a mature religious outlook striver to incorporate views of theology and religious action into thinking. lderly people can contemplate new religious and philosophical views and try to understand ideas missed previously or interpreted di!erently. #he elderly person also derives a sense of worth by sharing experiences or views. In contrast, the elderly person who has not matured spiritually may not matured spiritually may feel impoverishment or despair as the drive for economic and professional success wares. >sychosexual 4evelopments drives persist into the =C-s, 5C-s, and C-s, provided that the health is good and an interested partner is available. Interest in sexual activity in old age depends, enlarge measure, on interest earlier in life. #hat is, people who are sexually active in young and middle adulthood will remain active during their later years. ?owever, sexual activity does become less fre%uent. /any factors may play a rate in the ability of an elderly person to engage in sexual activity. >hysical problems such as diabetes, arthritis, and respiratory conditions a!ect energy or the physical ability to participate in sexual activity. &hanges in the gonads of elderly women result from diminished secretion of the ovarian hormones. $ome changes, such as the shrinking of the uterus, and ovaries, go unnoticed. ther changes are obvious. #he breasts atrophy, and lubricating vaginalsecretions are reduced. 'educed natural lubrication is the cause of painful intercourse, which often necessities the use of lubricating jellies.8.6.7. Ill >erson at the >articular Age of >atient #he older fracture patients showed a higher prevalence of chronic brain syndrome, they were in poorer physical state and their skin old thickness was less. #hey also had more unrecogni
8. >resent >role of Functional ?ealth >atterns >role of Functional ?ealth >atterns 8.6. ?ealth >erception M ?ealth /anagement >attern #he patient described her usual health before to be fair and body is strong but now she considered it to be poor and weak. #his is because of the limited movements she felt, the inability to walk or stand and di0culty in moving the extremities due to the fracture of her right femoral neck. "efore the admission, the patient eats more foods rich in fats, sugar or glucose and cholesterol in their meals and she drinks plenty of water everyday. 4uring the patient-s hospitaliattern #he patient-s usual food intake before the hospitaliattern "efore, the patient can freely go to the &.'. to void or defecate but now that she-s hospitaliattern #he patient before hospitalierceptual >attern #he patient before, can hear, smell, taste and feel well and correctly but the patient cannot read her newspaper without her eyeglasses just the same as now. $he speaks slowly nglish, #agalong and "iscayan languages as of now but before she speaks Huently all of those languages. $he easily communicates, understands %uestions, instructions and be able to follow and answer them correctly. 8.;. 'estM $leep >attern "efore the hospitalierception >attern #he patient-s most concern about right now is her rehabilitation care. #he patient wants to stay at the hospital until she improves her mobility so she would be able to stand and walk all alone by herself. #he patient never loses the support of her
children even if they were not there physically and also her private nurses. #hrough this, she may be able to cope up easily from her unhealthy condition. #he treatment, managements, medications and all out care rendered by the hospital to the patient assured her for the improvement of her condition. 8.5. $exualityM 'eproduction #he patient-s husband just recently died. (ow, the patient does not allow anyone to see her getting undressed, changing diaper, changing clothes because she believes thetas a woman, it should be keep as private. 8.. &oping) $tress #olerance >attern #he patient usually makes her decision as for now since her children were busy in their work abroad, but they make sure they never forget to support and help their mother recover from illness. $ometimes, the patient usually shares her concerns to her private nurses and of course also to the student nurses. $he usually reads newspaper for her to bemire relaxed. 8.6C. Dalue)"elief >attern #he patient nd source strength and hope with 1od and her loved ones. 1od is very much important to the patient. "efore, she usually goes to church together with her other children. #hey were not involved in any religious organiattern #he patient understands more on nglish and "iscayan languages but a little only intaglio language. #he patient was living all by herself with her private nurses but sometimes, her grandchildren will come over to visit her. $he never uses the support of her children even if they were away from their mother they always make sure that their mother is safe and secure. #he patient can easily communicate, cooperate, listen and follow instructions easily. #he word skeleton comes from the 1reek word meaning dried) up bodyG, our internal framework is so beautifully designed and engineered and it puts any modern skyscraper to shame. $trong, yet light, it is perfectly adapted for its functions of body protection and motion. $haped by an event that happened more than one million years ago N when a being rst stood erect on hind legs N our skeleton is a tower of bones arranged so that we can stand upright and balance ourselves. #he skeleton is subdivided into three divisions2 the axial skeleton, the boned that form the longitudinal axis of the body, and the appendicle skeleton, the bones of the limbs and girdles. In addition to bones, the skeletal system includes joints, cartilages, and ligaments *brous cords that bind the bones together at joints+. #he joints give the body Hexibility and allow movement to occur. "esides contributing to body shape and form, or bones perform several important body functions such as support, protection, movement, storage and blood cell formation. &lassication of "ones #he diathesis, or shaft, makes up most of the bones length and is composed of compact bone. #he diathesis is covered and protected by a brous connective tissue membrane, the periosteum. ?undreds of connective tissue bbers, called $harpe-s bers,secure the periosteum to the underlying bone. #he epiphyses are the ends of the long bone. ach epiphyses consist of a thin layer of compact bone enclosing the area lled with spongy bone. >articular cartilage, instead of periosteum, covers its external surface."ecause the articular cartilage is glassy hyaline cartilage, it provides a smooth, slippery surface that decreases friction at joint surfaces. In adult bones, there is a thin line of bony tissue spanning the epiphyses that looks bit di!erent from the rest of the bone in that area. #his is the epiphysis line. #heepiphyseal line is a remnant of the epiphyseal plate *a Hat plate of hyaline cartilage+
seen in young, growing bone. piphyseal plates cause the lengthwise growth of the long bone. "y the end of puberty, when hormones stop long bone growth, epiphyseal plates have been completely replaced by bone, leaving the epiphyseal lines to mark their previouslocation.In adults, the cavity of the shaft is primarily a storage area for adipose *fat+ tissue. It is called the yellow marrow, or medullary, in infants this areas forms blood cells, and red marrow is found these. In adult bones, red marrow is conned to the cavities of spongy bone of Hat bones and the epiphyses some long bones. "one is one of the hardest materials in the body, and although relatively light in weight, it has a remarkable ability to resist tension and other forces acting on it. (ature has given us an extremely strong and exceptionally simple *almost crude+ supporting system without up mobility. #he calcium salts deposited in the matrix bone its hardness, whereas the organic parts *especially the collagen bbers+ provide for bone-s Hexibility and great tensile strength. #he femur, or thigh bone, is the only bone in the thigh. It is the heaviest, strongest bone in the body. Its proximal end has a ball)like head, a neck, and greater and lesser trochanters *separated anteriorly by the intertrochanteric line and posteriorly by theintertrochanteric crest+. #he trochanters, intertrochanteric crest and the gluteal tuberosity,located on the shaft, all serve us sites for muscle attachment. #he head of the femur articulates with acetabulum of the hip bone in a deep, secure socket. ?owever, the neck of the femur is a common fracture site, especially in old age. #he femur slants medially as it runs downward to joint with the leg bonesB this brings the knees in line which the body-s center of gravity. #he medial course of the femur is more noticeable in females because of the wider female pelvis. 4istally on the femur are the lateral and medial condytes, which articulates the tibia below. >osteriorly,these condytes are separated by the deep intercondylar notch. Anteriorly on the distal femur is the smooth patellar surface, which forms a joint with the patella, or kneecap.
4ening characteristics
(ursing diagnosis
$cientic basis
xpected outcome
(ursing intervention
'ationale
4i0culty in changing position while lying on bed.) 4i0cultyin movingtheextre mities.)Inability to walk or stand alone.) limitedrange of motion intheextremitie s.) $lowedmoveme nt.) 4i0cultyinitiati nggait.diligiha pon mulihok akongtiil dayG as verbali
Impaired physical mobility, inability to standalon e related to skeletal impairme nt to facture of the right femoral neck
Fractures occur when the bone is subjected to stress greater that it can absorb. hen the bone is broken, adjacent structures are also a!ected, resulting in soft tissue edema, hemorrhage in to the muscles and joints, joints dislocations, ruptured ten) dons, severed nerves, and damaged blood vessels. "ody organs maybe injured by the force that caused the fracture fragments. After a fracture, the extremities cannot function properly because normal functions of muscle depend on the integrity of the bones which they
After 5hours nurse) patient interventio n the patient will be able to2 4emonstra te increasing Function of the extremities
)>romote to avoid patients ade%uate from falling to mobility of sudden the client. movements
) instruct the to keep side rails up or raised.
) assist patient to do active '/ exercises on the lower extremities. )>rovides comfort measures such as backrub. )ncourage patient to stand or walk as tolerated using parallel bars. )$upport a!ected body parts or joints using pillows or rolls. )administer pain reliever such as areoxia as prescribe by the physician. )&onsult with physical or
)to improve muscle strength and joint mobility
)in order for the patient to become more relax and comfortable
)in order for the muscle to be more relax and relieves the pain )to relieve pain and motion sickness
)to develop individual exercise or mobility program and identify Appropriate adjunctive devices
are attached
4eni ng chara cteris tics
(ursing diagnosis
(ursing diagnosis
utcomes
occupational therapist as indicated
Intervention
'ationale
7. 'isk for alt ered blowH ow'is k Facto r2Imm obilit y
'isk for #he nhance altered extremitiescann circulation bloodHow ot rightimmo function properl bility y after tofracture afracture, of the thus,there rightfemo isimmobility bec ralneck ause normalfunction of themuscle dependson the integrityof the bones towhich they areattached.Im mobility of a body part may possiblyint errupt thecirculation of blood throughthe circuitousnetwor k of arteries andveins
4ening characteristi cs
(ursing diagnosis
$cientic basis
utcomes
blood
7. prevent, blood emboli)note signs of changes inrespiratory rate,depth use of accessorymus cles purled)lip breathingB (ote areas of pallor or cynosis.) auscultate breat h)sounds&heck if there isa decrease or adventitious b reath soundsas well asfremitus) monitor italsigns andcardiac rhythm)review risk factors) reinforce needfor ade%uaterest, whileencouragin gactivities withinclientslimit ation) encouragefre%ue nt positionchang es and4" or coughingexerc ise.)administer m edications asindicated
Interventions
to assessrespira tory in) su0ciency) serves as a baseline data)note for anychanges) to promote prev entionmanag ement of risk )to improvecircul ation of blood to the bodysystems. )to treatunderlyi ngconditions
'ationale
'isk for additiona l injury risk factors2 @oss of skeletal integrityO skeletal impartmentO Abnormal bl ood
'isk for additio nalinjuryri ght lossof skeletalint egrityto fractureof thefemor alneck
A fracture occurs when the stress placed on a bone is greater than a bone can absorb. /uscle, blood vessels,nerves , tendons, joints and other organs maybe injured when fracture occurs. #his condition may result to a loss of skeletal integrity that may possibly lead to further injury as a result of environmen tal conditions interacting with the individuals adaptive and defensive resources
to produce risk factors and protec t self from injury
for the patients to be free from injury )ascertain knowledge of safety needs or injury )assess muscles trength gross and ne motor coordination. )observe for signs of injury )identify interventions or safety devices. )encourage participati on in rehab programs, such as gaittraining >romote education programs geared to increasing the awareness of safety measures
to reinforce and import knowledge to the patient )to evaluate degree or source of risk. )for early detection. )to promote individual safety. )to improve skeletal integrity. )to promote wellness
