C. Medi Medica call His Histo tory ry 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 thigh bone 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 hip bone 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-O PRE-OP P MEDICA MEDICATIO TIONS NS 1) ketor ketorola olac c trome trometha thamin mine e Actio Action: n: Inhib Inhibit it prosta prostagla gland ndin in synthe synthesis sis,, to produ produce ce antianti-in infla flamma mmator tory, y, analg analges esic, ic, antipyretic effects. Indication: short-term management of moderately severe, acute pain (for single-dose treatment or multiple-dose treatment) 2) cefur furoxim oxime e Action: Action: Second Second-gen -generat eration ion cephalo cephalospor sporin in that that inhibits inhibits cell-wal cell-walll synthes synthesis, is, promotin promoting g osmotic instability; usually bactericidal. bactericidal. Indication: For bone or joint infection ; Perioperative prevention 3) ran raniti itidin dine Action: Competitively inhibits action of histamine on the H2 at receptor sites of parietal cells, decreasing gastric acid secretion. Indications: Indications: For active duodenal and gastric ulcer, maintenance maintenance therapy for duodenal duodenal or gastric gastric ulcer, ulcer, patholog pathologic ic hypersec hypersecreto retory ry conditio conditions, ns, GERD, GERD, erosive erosive esophag esophagitis itis and heartburn. 4) Metoc Metoclop loprom romide ide hydroc hydrochlo hlorid ride e 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) Para Parace ceta tamo moll 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 heatregulating center.
C. HEMA HEMATO TOLO LOGY GY 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, 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 (fract (fracture ured d bone bone)) is then then holed holed,, so that that the orthope orthopedi dic c surge surgeon on would would be able able to put 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
IX. Nursing Care Plan Assessment
Diagnosis
Inference
Planning
Interventions
Rationale
Subjective
Acute Pain Related to Surgery incision on R femur
Internal fixation devices to hold the bone fragment in position
Short-term Goal After 4 hours of nursing interventions, the patient:
Monitor vital signs Q15 until stable and check and change dressing if needed.
Internal bleeding
◊ verbalizes minimized feeling of pain
Alterations to normal may be a sign of infection. Moistened dressings are favorable site for microorganism to culture.
Encourage ambulation or even minimal movement of unaffected part.
◊ To divert attention on pain and increases circulation.
Adjust bandage if constricted and advise to elevate R leg.
◊This is to prevent Diminished circulatory & nerve function and to control swelling of the site.
Instruct and demonstrate of how to do a deep breathing exercise.
◊Help to promote circulation, relaxation of muscles.
“Sumasakit at kumikirot ang inoperahan sakin,” as Verbalized by the patient.
Objective
Pain scale: (?) – failed to get c incision on the R femur (ORIFtreated) c posterior bandage on R femur
Blood is associated to swelling
It cause Acute pain
◊ verbalizes methods that provide relief ◊demonstrates use of relaxation skills & diversional activities as indicated for his situation
-Unable to evaluate due to we were not able to handle and talk to the patient again.
Assessment Subjective ◊ “Medyo di pa ako makakilos ng gaya dati dahil sa nakakabit sa akin” as verbalized
Objective ◊ c internal fixator @ R leg
Diagnosis
Inference
Impaired ORIF physical procedur mobility of e the lower extremity Bleeding related to from internal damaged fixator @ ends of R femur bone & from surroundi ng tissue
Planning
Interventions
Short Term Goal
◊ Assist and demonstrate in doing ◊ After 3 days of exercises for nursing the interventions, unaffected the patient will lower demonstrate extremity. proper exercises of the ◊Encouraged unaffected progressive lower extremity activities according to level of fatigue
Stimulate s intense inflammat ory response
Pain
Impaired physical immobilit y of the lower R extremity
-Unable to evaluate due to we were not able to handle and talk to the patient again.
Rationale ◊Necessary to regain normal mobility of leg to speed recovery.
◊ Increase patient’s Use of affected leg.
Assessment
Diagnosis
Inference
Planning
Interventions
Rationale
Objective
Risk for infection related to inadequate primary defenses such as broken skin and traumatize d tissues.
ORIF procedure
Short Term Goal
◊ Stress proper hand hygiene by all caregivers between clients.
◊ It is a first line of defense against infections and help minimize cross contamination
◊ Educate to Maintain sterile technique
◊ To minimize accumulation of bacteria and to maintain asepsis.
◊ Emphasize necessity of taking antivirals / antibiotics antibiotics as directed.
◊ Premature discontinuatio n of treatment when client begins to feel well may result in return of infection and potentiate drug resistant strains.
◊ Portal of entry of microorganism because of surgical incision ◊ Another portal of entry via dressings is poorly dressed.
Internal & external bleeding Healing process of tissues will take quite a long time
Leaving the tissues partially open
There is a point of entry for the microorganism to enter
After 2 days of Nursing intervention s, the patient will be able to demonstrat e techniques to prevent risk of infections.
-Unable to evaluate due to we were not able to handle and talk to the patient again.
X. HEALTH EDUCATION
1. Explain basis for fracture treatment and need for patient participation in therapeutic regimen. 2. Promote Promote adjustm adjustment ent of usual usual lifestyle lifestyle and responsi responsibili bilities ties to accommod accommodate ate limitatio limitations ns 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, crutcher, and cane. 7. Emph Emphasi asize ze instr instruct uction ion conce concerni rning ng amou amount nt of weigh weightt beari bearing ng that that will will be permi permitte tted d 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, attention, such as numbness, 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, proposed the overall assessment findings with the patient experiencing a Fracture, comminuted comminuted at the distal third right femur and expounded expounded thoroughly thoroughly and articula articulately tely the anatomy 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 comprehensive nursing care plan that is applicable applicable to the patient patient with Fracture, Fracture, comminut comminuted ed at the distal third right femur, femur, inculcat inculcated ed health health teachings and elucidated and discuss the rationale of the different nursing interventions to the pati patien entt and and to the the fami family ly as well well.. Afte Afterr prov provin ing g the the inte interv rven enti tion ons, s, they they eval evalua uate ted d the the effectiveness and accuracy of the outcome.
