CASE STUDY

Pneumo Hemoperitoneum secondary to Stab Wound Right Subcostal Area, Midclavicular Line

INTRODUCTION: The severity of stab wounds is based exclusively on the location and depth of penetration. Important considerations include the type of weapon used (knife length, shape, straight or serrated), and manner of assault (overhand vs.underhand). The gender of the assailant may have some importance, in that women tend to stab "overhand." Penetration tends to be deeper with the "underhand" thrust. ALL STAB WOUNDS REQUIRE IMMEDIATE PHYSICIAN MANAGEMENT. All stab wounds require a tetanus vaccination within the past 5 years. Stab wounds to the CHEST should always be considered LETHAL until proven otherwise. Chest wounds can result in rupture of the lung (pneumothorax) or marked bleeding within the chest cavity (hemothorax). Central stab wounds, below the collar bones (clavicles) and to either side of the breastbone (sternum), can result in penetration of the heart. Remember,

the ability to penetrate the heart is limited by the length of the knife and the force exerted by the assailant. Stab wounds to the ABDOMEN always require EMERGENCY evaluation. These injuries will often result in an exploratory laparotomy (operation) to rule out serious damage. Slow bleeding inside the abdomen is extremely difficult to diagnose, and should be considered a possibility in every case. Wounds that have internal organs passing through the opening (evisceration) require prompt surgical intervention. Peritoneal lavage and CT-scanning are helpful diagnostic tools in these situations. Stab wounds to the upper back can involve the lung or heart. Stab wounds to the lower and middle back can involve the kidneys and/or ureters. Evaluation of stab wounds to the back that may have punctured the kidney will require intravenous pyelography for evaluation. The presence of blood in the urinalysis indicates injury to the kidney, bladder, or ureter. Stab wounds to the EXTREMITIES that do not lacerate nerves, blood vessels, or tendon structures, often can be sutured closed loosely, or left open to heal on their own. Cases where vascular injury is a possibility, may require angiography to determine if operative intervention is necessary. Examination for sensation, movement, and pulses must be performed. Watch for SIGNS OF INFECTIONS: increase in pain at the site, discharge from the wound, redness, swelling, or fever. In short, all stab wounds are potentially SERIOUS injuries that require the evaluation by a qualified Emergency Physician.Consultation to the General Surgeon will be made where appropriate.

Why we chose this case We choose this Case: a. To have an additional knowledge about stab wound in order for us to disseminate information to our patient and to other people. b. To know the possible intervention or teachings when we encounter this case somewhere, especially to those place who doesnt have a health care provider. General Objectives: To conduct a thorough and comprehensive study about the condition according to data through the use of data gathered from extensive research.

Specific Objectives: to give different definitions about stab wound for better understanding of unfamiliar terms To elaborate on the anatomy and physiology of different systems involved and affected during this condition To establish whether several factors, signs and symptoms are present or absent in a patient with this condition. To list the different medical management for stab wound To present the different results of our patients diagnostic exams together with comparisons with normal values for the understanding of what changes during this condition To list the different drugs together with their specific purposes for the better understanding of the treatment for stab wound To show the nursing care plans used by the group to administer nursing care to the patient during our exposure To present the discharge plan for a patient with stab wound

NURSING HEALTH HISTORY A. BIOGRAPHIC DATA Name: MR. T R Address: 76 Ruben St. Don Mariano Subd. Cainta, Rizal Age: 38 yrs old Sex: M

Race: Filipino Marital Status: Married Occupation: Jeepney Driver Religious Orientation: Roman Catholic

B. CHIEF COMPLAINT Abdominal Stab wound C. HISTORY OF PRESENT ILLNESS Prior to admission patient was having a rest on his jeepney and suddenly a man stabbed him with an ice pick. D. PAST HISTORY OF ILLNESS The client commonly had cough and fever. The childhood diseases that he acquired are mumps, measles, and chicken pox and sore eyes .There were no known food or medication allergy.. He does smoke and drink alcohol E. FAMILY HISTORY OF ILLNESS The clients father has a history of hypertension. F. ADMITTING DIAGNOSIS: Punctured Wound Costal margin Clavicular line Right

DISCHARGE PLANNING MEDICATION - Instruct patient and family to follow the home medications as prescribed by the

physician. Treatment regimen is important to have faster recovery. Explain the purpose of each medication To provide information to the client as to why she needs to take as prescribed the medications. And to inform the patient that each drug has its own action and indication. Educate the patient and family about the side effects of the medication. Instruct the family or significant others to remind the patient to follow the prescribed dosage and frequency and be cautious about those things to be contraindicated while taking the medication. This is to prevent occurrence of complications. Never administer any drug not prescribed by the physician. Non-prescribed drugs may have an antagonistic effect or synergistic effect in any drug therapy. Let patient complete the whole medication treatment.

EXERCISE Encourage early ambulation Walking is good exercise and could promote circulation, hence, proper healing Advise patient to have adequate rest and sleep To gain back the lost strength and be able to return to its normal state thus allow ample time for healing Practice deep breathing exercise
Periodic deep breathing aerate the lungs and help prevent stasis of lung mucus. Because stasis always has the potential for causing infection, it must be prevented as much as possible.

TREATMENT Explain the purpose of treatment to be at home.

To make the client and family aware that the treatment is a continuous process Inform the client to avoid taking any medication that is not prescribed by the physician. To have a good recovery

HYGIENE - Encourage proper hygiene like taking a bath, meticulous hand washing, perineal care, and brushing of teeth every after meal. Hygiene promotes comfort and cleanliness to the patient. It also increases the sense of wellness, which is very much needed in the therapeutic process Encourage patient to continue hygienic measures practiced at present such as changing clothes everyday and changing of underwear as often as necessary, keeping the nails neatly trimmed, maintaining own supplies/items for personal necessities. Provide a calm, clean, and accepting environment Calm, clean and non threatening environment may lessen the occurrence of possible infection and would be a good place for healing. OUTPATIENT ORDER Inform the patient that follow-up check-up is important to have continuous monitoring and care. Through constant visits as out patient, the physician would check on the wound of the patient. Encourage client to carry out and follow up diagnostic treatments This is to alleviate the condition of the patient Instruct the family to report for any unusual signs and symptoms experienced by the patient This will help detect early signs and symptoms experienced by the patient. DIET Encourage client to eat a variety nutritious food like fruits and vegetables

To maintain and promote healthy body and as well as regain the strength after the crisis. Instruct the client to take vitamins or food supplements as ordered. To boost the bodys defense mechanism Encourage patient to increase oral fluid intake. This is to replace all the lost fluids. Regular interval of meals is the basic principle of a good dietary plan Tell patient not to eat foods contraindicated by the physician. To prevent the occurrence of complications