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Frectal XD

Frectal XD

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Published by: Jeremiash Noblesala Dela Cruz on Jun 09, 2013
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I- Introduction A fracture is a break in the continuity of bone and is defined according to its type and extent.

Fractures occur when the bone is subjected to stress greater that it can absorb. Fractures are caused by direct blows, crushing forces, sudden twisting motions, and even extreme muscle contractions. When the bone is broken, adjacent structures are also affected, resulting in soft tissue edema, hemorrhage into the muscles and joints, joint dislocation, ruptured tendons, severed nerves, and damaged blood vessels. Body organs maybe injured by the force that cause the fracture or by the fracture fragments. There are different types of fractures and these include, complete fracture, incomplete fracture, closed fracture, open fracture and there are also types of fractures that may also be described according to the anatomic placement of fragments, particularly if they are displaced or nondisplaced. Such as greenstick fracture, depressed fracture, oblique fracture, avulsion, spinal fracture, impacted fracture, transverse fracture and compression fracture. A comminuted fracture is one that produces several bone fragments and a closed fracture or simple fracture is one that not cause a break in the skin. Comminuted fracture at the Right Femoral Neck is a fracture in which bones of the Right Femoral Neck has splintered to several fragments. By choosing this condition as a case study, the student nurse expects to broaden her knowledge understanding and management of fracture, not just for the fulfillment of the course requirements in medical-surgical nursing. It is very important for the nurses now a day to be adequately informed regarding the knowledge and skill in managing these conditions since hip fracture has a high incidence among elderly people, who have brittle bones from osteoporosis (particularly women) and who tend to fall frequently. Often, a fractured hip is a catastrophic event that will have a negative impact on the patient’s life style and quality of life. There are two major types of hip fracture. Intracapsular fractures are fractures of the neck of the femur, Extracapsular fracture are fractures of the trochanteric region and of the subtrocanteric region. Fractures of the neck of the femur may damage the vascular system that supplies blood to the head and the neck of the femur, and the bone may die. Many older adults experience hip fracture that 1

student nurse need to insure recovery and to attend their special need efficiently and effectively. True the knowledge of this condition, a high quality of care will be provided to those people suffering from it.


II. Objectives General Objectives: After three day of student nurse-patient interaction, the patient and the significant others will be able to acquire knowledge, attitudes and skills in preventing complications of immobility. Specific Objectives: A. STUDENT-NURSE CENTERED After 8 hours of student nurse-patient interaction, the student nurse will be able to: 1. state the history of the patient. 2. identify potential problems of patient 3. review the anatomy and physiology of the organ affective 4. discuss the pathophysiology of the condition. 5. identify the clinical and classical signs and symptoms of the condition. 6. implement holistic nursing care in the care of patient utilizing the nursing process. 7. impart health teachings to patient and family members to care of patient with fracture. B. PATIENT-CENTERED After 8 hours of student nurse-patient interaction, the patient and the significant others will be able to: 1. explain the goals of the frequent position changes. 2. enumerate the position for proper body alignment. 3. discuss the different therapeutic exercises. 4. practice the different kinds of range of motion. 5. participate attentively during the discussion.


III. Nursing Assessment 1. Personal History 1.1 Patient’s Profile Name: Mrs. Torralba, Lourdes Age: 89 years old Sex: Female Civil Status: Widow Religion: Roman Catholic Date and time of admission; March 13, 2008 at 10:10 am Room No.: Room 425, Cebu Doctors’ University Hospital Complaints: Pain the right hip Impression or Diagnosis: Fracture Close-Comminuted: Femoral Right Neck General Osteoporosis Breast Cancel (Right) Diabetes Mellitus Type II Physician: Dr. F. Vicuna, Dr. E. Lee, Dr. N. Uy, Dr. Ramiro Hospital No: 216 426 1.2. Family and Individual Information, Social and Health History Mrs. Torralba, Lourdes who resides in 8 Acacia St. Camputhaw Lahug, Cebu City, Cebu Province with 9 successful children ( 6 boys and 3 girls) was admitted to Cebu Doctors’ University Hospital for further management of the condition. Mrs. Torralba is a college graduate and she’s previously working as an assistant of her husband ( Mr. Rodrigo Torrralba ) a doctor. The patient was diagnosed to have Breast Cancer (Right) last 2006 with bone metastasis and on chemotherapy with aromasin.


Two days prior to admission, the patient was standing and was about to open up he umbrella when she got out of balance and landed on her right hip.And had experienced limitation of movement on the right hip. The patient was then admitted due to the persistence of pain. The patient was previously hospitalized due to infected wound at the right ankle last 2002. No familial history of hypertension and bronchial asthma but is positive to diabetes mellitus of paternal side. Has no known food and drug allergies. The patient is non-smoker non-alcoholic beverages drinker. 1.3. Level of Growth and Development 1.3.1. Normal Growth and Development at particular stage Older Adult ( 65 Years old to death) Physical Development Perception of well-being can define quality of life. Understanding the older adults perception about health status is essential for accurate assessment and development of clinically relevant interventions. Older adults concepts of health generally depend on personal perceptions of functional ability. Therefore older adults engaged in activities of daily living usually consider themselves healthy, whereas those whose activities are limited by physical, emotional or social impairments may perceive themselves as ill. There are frequently observed physiological changes in order adults that are called normal. Finding these “normal” changes during and assessment is not an expected. These physiological changes are not always pathological processes in themselves, but they may make older adults more vulnerable to some common clinical conditions and diseases. Some older adults experience all of these physiological changes, and others only experience only a few. The body changes continuously with age, and specific effects on particular older adults depend on health, lifestyle, stressors and environmental conditions.


Robert Butler sees integrity and bringing serenity and wisdom. If the aging person’s senses are impaired. and learning. little is known about the effect of these physical changes on the cognitive functioning of the older adult.Cognitive Development Intellectual capacity includes perception. is related to the perceptual ability. As yet. or the ability to interpret the environment. In addition. helps the older person retain the high level of cognitive function and may help maintain a long-term memory. According to Erikson. Psychosocial Development According to Erikson. and brain metabolism slows. memory. or the ability to know. Perceptual capacity may be affected by changes in the nervous system as well. People who attain ego integrity view with a sense of wholeness and derive satisfaction from past accomplishment. Older adults have more difficulty than younger ones in learning information they do not consider meaningful. Life long mental activity. They view death as an acceptable completion. Cognitive impairment that interferes with normal life is not considered part of normal aging. By contrast. depends on the acuteness of the senses. Motivation is also important. cognitive. the meaninges appear to thicken. the developmental task at this time is ego integrity versus despair. Changes in cognitive structure occur as a person ages. 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. the ability to perceive the environment and react appropriately is diminished. and despair as resulting in 6 . largely because of the problem of retrieving information. people who develop integrity accept “one’s one and only life style”. blood flow to the brain decreases. A decline in intellectual abilities that interferes with social or occupational functions should always be regarded as abnormal. Older people need addition time for learning. Perception. Cognitive ability. particularly verbal activity. It is believe that there is a progressive loss of neurons. It is suggested that the older person mentally active to maintain cognitive ability at the highest possible level.

moral development is completed in the early adult years. Great bonds if affection and closeness can develop during this period of aging together and nurturing each other. Many couples rely increasingly on their mates for this company and may have few outside friends. the remaining partner inevitably experiences feelings of loss. and some are at the preconventional level. the elderly person who has not 7 . on younger family members increases as age advances and in health occurs. Some widows and widower remarry. and a sense that one’s life has been worthless. however. An elderly person at the preconventional level obeys roles to avoid pain and the displeasure of others. this couragement. In contrast. Moral Development According to Kohlberg. and loneliness. emptiness. Elderly people can contemplate new religious and philosophical views and try to understand ideas missed previously or interpreted differently. Elderly people at the conventional level follow society’s rules of conduct to expectation of others. When a mate dies. Despair gives rise of frustration. particularly the latter. because the widowers are less inclined than widows to maintain a household. Most old people stay at Kohlberg’s conventional development.the inability to accept one’s fate. reliance. whereas older person’s at stage 7 may act to meet another’s need as well as their own. Many are capable and manage to live alone. The elderly person also derives a sense of worth by sharing experiences or views. Spiritual Development Murray and Zentner write that the elderly person with a mature religious outlook striver to incorporate views of theology and religious action into thinking. Emotional Development Well-adjusted aging couples usually thrive on companionship. At stage one. a person defines good and bad in relation to self.

However. sexual activity does become less frequent. on interest earlier in life. Interest in sexual activity in old age depends. Changes in the gonads of elderly women result from diminished secretion of the ovarian hormones. and respiratory conditions affect energy or the physical ability to participate in sexual activity.2. Those who were younger had a higher prevalence of stroke than comparable controls. They also had more unrecognized visual disorders. 3. in large measure.matured spiritually may not matured spiritually may feel impoverishment or despair as the drive for economic and professional success wares. provided that the health is good and an interested partner is available.1. and ovaries. and 90’s. go unnoticed. That is. such as the shrinking of the uterus. they were in poorer physical state and their skinfold thickness was less. people who are sexually active in young and middle adulthood will remain active during their later years. The type of fall leading to the fracture varied with age—tripping was the commonest cause in the younger patients and ‘drop attacks’ in the older. Some changes. 8 . Psychosexual Development Sex drives persist into the 70’s. Many factors may play a rate in the ability of an elderly person to engage in sexual activity. arthritis. Reduced natural lubrication is the cause of painful intercourse. 80’s. The older patients had a very high prevalence of pyramidal tract abnormality associated with chronic brain syndrome—and it appears that these demented patients fall not because of mental confusion but because of associated motor abnormalities. Ill Person at the Particular Age of Patient The older fracture patients showed a higher prevalence of chronic brain syndrome. Both stroke and partial sightedness were associated with falls due to loss of balance. The breasts atrophy. and lubricating vaginal secretions are reduced. Physical problems such as diabetes. Other changes are obvious. which often necessities the use of lubricating jellies.

9 .Ertra-capsular fractures occur in older patients. They are more likely to have a history of falls but previous fracture is equally common at this age in the fracture and control series.

5-5. Diagnostic Test Diagnostic test April 10. -Normal -Increased-macrocytic anemia -Decrease-severe hypochronic anemia -Normal -Normal -Normal -Normal -Increase-viral infection. -Decreased-severe anemias -Normal -Decreased.Decreased-various anemias.8 32.000-450.6 32 387 67 0 4 09 20 .1 28. page 2214-2215 -Normal Normal values Patient’s Result Significance Serum 3.10th Edition Volume 2. Textbook of Medical-Surgical Nursing.32 2.8 5.000 40-70 % 0-1 % 0-5 % 0-8% 20-40% 9.0x10^ g/uL 4.5-33.5-50.7 10 .4-11.2 pg 80-96 fL 33.7 103.5 g/dL 41.4% 4.4-35.2.6-5 4. when blood volume has been restored. 2008 Complete Blood Count Hemoglobin Hematocrit WBC RBC Mean Corpuseular Hemoglobin Mean Cell Volume (MCA) Mean Corpuseular Hemoglobin Platelet Differential Count Neutropihl Basophil Eosinophil Monocyte Lympocyte 14.all anemias and leukemia.0-17. with excessive fluid intake.9x10^ g/uL 27.5 % 150. collagen and hemolytic disorders -Normal Source: Brunner and Suddarth’s.

5 5-15 10-13 70-120 6. 10.5 2 6.2233. 13.2221.31 min. leukemia -Decreased-vitamin D.8 145 20 -Decreased-Muscular atrophy. V.page 2217. PBS 65-110 118 Uric acid 2. 96.10th Edition Volume 2.2-2. deficiency -Decreased-anemia.10th Edition Volume 2. and X. multiple myeloma -Decreased-malnutrition -Increased-diabetes mellitus -Normal Source: Brunner and Suddarth’s.2 3. -Normal -Normal -Increased-deficiency of factors I.4mg/dL -Normal Source: Brunner and Suddarth’s.2 1. Textbook of Medical-Surgical Nursing.3-5.3-9.page 2230.2230. VII.2232 -Increased-diabetes mellitus Source: Brunner and Suddarth’s.5 4.6 8.9 2. Textbook of Medical-Surgical Nursing.-sec.2229.2 1.Potassium Creatinine Calcium Protein Albumen Globulin Total Protein GCT(50gms) 6. anemia.41 min.5-7. II. Textbook of Medical-Surgical Nursing.2 % 11 .5 8.-sec. malnutrition -Decreased-no clinical significance -Increased-chronic infection.0 2.2224.4-10.10th Edition Volume 2.9 5.page 2225.7-1. fat malabsorption -Normal Bleeding time-sim Clotting time Prothombin time % activity 2.8 65-110 8-35 u/mL 6.2219.8 sec.

2 1.2 eu/dL -Normal -Normal -Normal -Normal -Glomerular disease.5-7.03 -Normal Source: Brunner and Suddarth’s.8 1.029 Negative Negative Negative Negative Negative Negative Negative Normal Yellow Clear 6.INR <1. Textbook of Medical-Surgical Nursing.10th Edition Volume 2.0 1. nephritic syndrome -Diabetes mellitus -Normal -Normal -Normal -Normal -Normal -Normal 12 .page 2214 Urinalysis Macroscopic Examination Color Appearance Plt Specific gravity Protein Glucose Ketones Blood Leukocytes Nitrite Bilirubin Urohilinogen Microscopic Examination RBC/hpf WBC/hpf Bacteria Mucus threads 0-5 0-5 Present Present 0-2/hpf 0-2/hpf Few Few -Normal -Normal -Normal -Normal Yellow Clear 4.003-1.010 Trace Trace Negative Negative Negative Negative Negative 0.

Textbook of Medical-Surgical Nursing.2225 13 .10th Edition Volume 2.Amorphous Urates Blood cell Present Negative Few Few -Normal Indicates renal or urinary tract disease Source: Brunner and Suddarth’s.page 2224.

Fosamax. she often eats a little only each meal.3. During the patient’s hospitalization. She consumes more than 8 glasses of water a day. 3. fruits. meat. The patient was also encourage to take more of Calcium and Vitamin D in order for her bones to become stronger. The patient’s attending physician encourages her to take more of calcium and Vitamin D in order for her bones to become stronger.2. The patient is non-smoker and non-alcoholic drinker and she has no known allergies. chicken and especially foods rich in fats. There is a change in her appetite now. 14 . vegetables. has no known allergies. Centrum and Caltrate. The patient doesn’t smoke or drink alcoholic beverages. Before the admission. Nutritional / Metabolic Pattern The patient’s usual food intake before the hospitalization includes fish. Health Perception / Health Management Pattern The patient described her usual health before to be fair and body is strong but now she considered it to be poor and weak. the inability to walk or stand and difficulty in moving the extremities due to the fracture of her right femoral neck. Her maintenance meds were Aromasin. This is because of the limited movements she felt. Now the patient was advised by her attending physician to restrict foods that can aggravate her condition. sugar or glucose and cholesterol in their meals and she drinks plenty of water everyday. Present Profile of Functional Health Patterns Profile of Functional Health Patterns 3. her diet was changed to low fat and low cholesterol diet because she was diagnosed of having diabetes mellitus type II. the patient eats more foods rich in fats. sugar/glucose and cholesterol.1.

Cognitive/ Perceptual Pattern The patient before. 3. she usually sleeps early at night (8-9 o’clock pm) and wakes up at around 7 o’clock am with an hour of sleep of 10 hours. she can’t take a nap in the afternoon due to her REHAB CARE.5. She speaks slowly English. she’s just on bed lying assisted by her private nurses and CDUH health care providers.6. to void or defecate but now that she’s hospitalized she was advised to wear diaper for her to have difficulty in standing and walking. can hear. 3. Elimination Pattern Before. 15 . She easily communicates.3. understands questions.3.R. Rest/ Sleep Pattern Before the hospitalization. Activity-Exercise Pattern The patient before hospitalized wakes up early in the morning for her to have fine walking around their house as her exercise. The patient usually stays in bed and read newspapers sometimes. Tagalog and Bisaya languages as of now but before she speaks fluently all of those languages. There is no burning sensation during ur4ination and her stool is brownish formed stool. Now. smell. instructions and be able to follow and answer them correctly. the patient usually sleeps late at night at around 10 o’clock pm and wakes up early in the morning at 6 o’clock am with an hour of sleep of 8 hours.4. but now. the patient can freely go to the C. She usually guided her grandsons and granddaughters. taste and feel well and correctly but the patient cannot read her newspaper without her eyeglasses just the same as now. 3.

Sometimes.8. changing clothes because she believes that as a woman. the patient usually shares her concerns to her private nurses and of course also to the student nurses. it should be keep as private.Perception Pattern The patient’s most concern about right now is her rehabilitation care. She usually reads newspaper for her to be more relaxed. the patient does not allow anyone to see her getting undressed. 3.Stress Tolerance Pattern The patient usually makes her decision as for now since her children were busy in their work abroad. she usually goes to church together with her other children. Now. but they make sure they never forget to support and help their mother recover from illness. The treatment. medications and all out care rendered by the hospital to the patient assured her for the improvement of her condition. God is very much important to the patient. 3. The patient never loses the support of her children even if they were not there physically and also her private nurses. she maybe able to cope up easily from her unhealthy condition. changing diaper. Coping.10. Through this. They were not involved in any religious organizations or practices. Value-Belief Pattern The patient find source strength and hope with God and her loved ones. 3.7. Self. managements. Sexuality/ Reproduction The patient’s husband just recently died. The patient knows how to pray and praise God for all the nice things he had given.9. 16 . Before.3. The 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.

Relationship Pattern The patient understands more on English and Bisaya languages but a little only in Tagalog language. listen and follow instructions easily.11. The patient can easily communicate.3. The patient was living all by herself with her private nurses but sometimes. She 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. cooperate. her grandchildren will come over to visit her. 17 .

our internal framework is so beautifully designed and engineered and it puts any modern skyscraper to shame.4. Strong. and ligaments (fibrous cords that bind the bones together at joints).1 Normal Anatomy and Physiology of Organ/ System Affected The word skeleton comes from the Greek word meaning “dried. the bones of the limbs and girdles. the skeletal system includes joints. The joints give the body flexibility and allow 18 .up body”. Shaped by an event that happened more than one million years ago – when a being first stood erect on hind legs – our skeleton is a tower of bones arranged so that we can stand upright and balance ourselves. The skeleton is subdivided into three divisions: the axial skeleton. and the appendicular skeleton. cartilages. Pathophysiology and Rationale 4. it is perfectly adapted for its functions of body protection and motion. In addition to bones. yet light. the boned that form the longitudinal axis of the body.

Classification of Bones The diaphysis. covers its external surface. The epiphyseal line is a remnant of the epiphyseal plate (a flat plate of hyaline cartilage) seen in young. in infants this areas forms blood cells. It is called the yellow marrow. Because the articular cartilage is glassy hyaline cartilage. Articular cartilage. The diaphysis is covered and protected by a fibrous connective tissue membrane. Hundreds of connective tissue fibers. In adult bones. there is a thin line of bony tissue spanning the epiphyses that looks a bit different from the rest of the bone in that area. red marrow is confined to the cavities of spongy bone of flat bones and the epiphyses some long bones. the cavity of the shaft is primarily a storage area for adipose (fat) tissue. Nature has given us an extremely strong and exceptionally simple (almost crude) supporting system without up mobility. Epiphyseal plates cause the lengthwise growth of the long bone.movement to occur. or medullary. In adults. Besides contributing to body shape and form. it has a remarkable ability to resist tension and other forces acting on it. This is the epiphyseal line. By the end of puberty. The calcium salts deposited in the matrix bone its hardness. slippery surface that decreases friction at joint surfaces. and red marrow is found these. storage and blood cell formation. called Sharpey’s fibers. leaving the epiphyseal lines to mark their previous location. instead of periosteum. when hormones stop long bone growth. growing bone. protection. In adult bones. the periosteum. Each epiphyses consist of a thin layer of compact bone enclosing the area filled with spongy bone. whereas the organic parts (especially the collagen fibers) provide for bone’s flexibility and great tensile strength. The epiphyses are the ends of the long bone. it provides a smooth. or bones perform several important body functions such as support. epiphyseal plates have been completely replaced by bone. Bone is one of the hardest materials in the body. secure the periosteum to the underlying bone. and although relatively light in weight. movement. 19 . makes up most of the bones length and is composed of compact bone. or shaft.

strongest bone in the body. Distally on the femur are the lateral and medial condytes. Its proximal end has a ball-like head. or thigh bone. the neck of the femur is a common fracture site. this brings the knees in line which the body’s center of gravity. is the only bone in the thigh. intertrochanteric crest and the gluteal tuberosity. which forms a joint with the patella. 20 . The medial course of the femur is more noticeable in females because of the wider female pelvis. or kneecap. a neck. The femur slants medially as it runs downward to joint with the leg bones. The head of the femur articulates with acetabulum of the hip bone in a deep. these condytes are separated by the deep intercondylar notch. especially in old age. Anteriorly on the distal femur is the smooth patellar surface. secure socket. all serve us sites for muscle attachment. However. and greater and lesser trochanters (separrsted anteriorly by the intertrochanteric line and posteriorly by the intertrochanteric crest). Posteriorly. The trochanters. which articulates the tibia below. located on the shaft.The femur. It is the heaviest.

Open or closed reduction of the fracture and .Buck’s extension .Malnutrition -neurologic problems .Comorbidity .Health promotion internal fixation .Patients with hip osteonecrosis may require Hip Replacement Surgery 21 .Temporary skin traction .Patient teaching Surgical Intervention: .Crepitus .Promoting positive psychological response to .Pain (right up) .Promoting physical mobility (hemiarthrmoplasty) .Tenderness Nursing Management: Medical Management: .Closed reduction with pereutaneous stabilization trauma for an intracapsular fracture.Loss of function .4. .Hip Pinning .osteoporosis -functional disability .Deformity .Replacement of the femoral head with prosthesis .Monitoring and managing complications .Promoting strengthening exercise .Relieving pain .Hip Hemiarthroplasty .2 Schematic Diagram Predisposing Factors: -Elderly people (85 years or older) .Paresthesia .impaired vision and balance Damage to the blood supply to an entire bone.Trauma .Obesity -slower reflexes Precipitating Factors: -Fall .Swelling and discoloration . Severe circulatory compromise Avascular (ischemic) necrosis may result Clinical Manifestations: .Repositioning the patient .

impaired vision and balance. Physical deconditioning. therefore. bone scans have been recommended as diagnostic tools to determine the orability of the femoral need.4. the femoral neck in femoral fracture. In fractures of the femoral neck. Whereas insufficiency fractures are due to normal stresses placed on diseased bone. With seer circulatory compromise. malnutrition. avascular (ischemic) necrosis may result. In this location. such as an osteoporotic bone. as occur in the hip. Fatigue fractures are a result of an increased or abnormal stress placed on a normal bone. Particularly vulnerable to the development of ischemic are intracapsular fractures.g. Femoral neck fractures can also be related to chronic stress instead of a single traumatic event. the bones ability to resist trauma. Trauma sufficient to produce a fracture can result in damage to the blood supply to an entire bone. The resulting stress fractures can be divided into fatigue fractures and insufficiency fractures. 22 . Osteoporosis is the most important risk factor that contributes to hip fractures. Factors that increase the risk of injuries are related to conditions that increase the probability of falls and those that decrease the intrinsic ability of the person to with stand the trauma. neurologic problems. blood supply is marginal ad damage to surrounding soft tissues may be a critical factor since better results are obtained in cases of hip fracture reduced with in 12 hr. This condition decreases bone strength and.. and shower reflexes all increase the risk of falls. than in those treated after that tine period. e.3 Pathophysiology Femoral neck fractures occur most commonly after falls.

unable to move extremities and unable to stand or walk without assistance.4. the extremity cannot function properly.complains of pain on the right hip aggravated by sudden or too much movements of the extremities and relieved by elevation and resting. a grating sensation. or .In fractures of long bones. there is actual shortening of the extremity because of the contraction of the muscles that are attached above ad below the site of the fracture.5 to 5 cm (1 to 2 inches) -When the extremity is examined with the hands. limb is compared with the uninjured extremity. Pain contributes to the loss of function. It is caused by the rubbing of the bone fragments against each other. Not Manifested . angulations. because normal function of the muscles depends on the integrity of the bones to which they are attached. Manifested . The fragments often overlap by as much as 2. Loss of function Deformity Manifested -Displacement.Bones of the right rotation of the fragments in a fracture femoral neck are of the right femoral neck causes a splintered into small deformity that is detectable when the fragments. In addition. abnormal movement (false motion) may be present. -After a fracture. Rationale . Deformity also results from soft tissue swelling.4 Classical and Clinical Sign’s and Symptoms Classical Symptoms Pain Clinical Symptoms Manifested . -localized swelling and discoloration 23 Shortening Crepitus Manifested Swelling and Manifested .The pain is continuous and increases in severity until the bone fragment are immobilized. The muscle spasm that accompanies fracture is a type of natural splinting designed to minimize further movement of he fracture fragments. called crepitus. can be felt.

These often fluctuate according to such influences as posture. -Mostly. congestion. Manifested -After fracture. Paresthesia Tenderness Manifested 24 .Discoloration of the skin (ecehymosis) occurs after a fracture as a result of trauma and bleeching into the tissues. These signs may not develop for several hours after the injury. or a “pins and needles” may be felt. activity. any subjective sensation. rest. edema. it is sometimes identified as acroparesthesia. experienced as numbness. the affected part responds with a sensation of pain to pressure or touch that would not normally cause discomfort. or underlying disease. tingling. This happens due to the bones splintered into fragments.

Total hip replacement may be used in selected patients with acetabular defects. or (3) closed reduction with pereutaneous stabilization for an intracapsular fracture. Hemiarthroplasty (replacement of the head of the femur with prosthesis) is usually reserved for fractures that cannot be satisfactorily reduced or securely nailed or o avoid complications of non-union and avascular necrosis of the head of the femur. A stable fracture is usually fixed with nails. or compression screw devices. Nursing Interventions 1. The goal of surgical treatment of hip fractures is to obtain a satisfactory fixation so that the patient can be mobilized quickly and avoid secondary medical complications. to immobilize the extremity. 25 . may be applied to reduce muscle spasm. Displaced femoral neck fractures may be treated as emergencies. and to relieve pain. The findings of a recent study suggested that there is no benefit to the routine use of preparative skin traction for patients with hip fractures and that the use of skin traction should be based as evaluation of the individual patient. multiple pins. This minimizes the effects of diminished blood supply and reduces the risk for avascular necrosis. Surgical treatment consists of (1) open or closed reduction of the fracture and internal fixation (2) replacement of the femoral head with a prosthesis (hemiarthroplasty). After general or spinal anesthesia. a nail and plate combination. the better the healing). the hip fracture is reduced under x-ray visualization using an image intensifier. Medical and Surgical Management Temporary skin traction. Buck’s extension. The orthopedic surgeon determines the specific fixation device based on the fracture site or sites. Surgical intervention is carried out as soon as possible after injury. with reduction and internal fixation performed within 12 to 24 hours after fracture. Adequate reduction is important for fracture healing (the better the reduction. The preoperative objective is to ensure that the patient is in as favorable a condition as possible for the surgery.IV.

The physician prescribes the degree of weight bearing and the rate at which the patient can progress to full weight bearing. Physical therapists work with the patient on transfers. including adjustment of therapeutic interventions as indicated. 26 . shock proves fatal. partial weight bearing). Monitoring and Managing Potential Complications Elderly people with hip fractures are particularly prone to complications that may require more vigorous treatment than the fracture. Achievement of homeostasis after injury and surgery is accomplished through careful monitoring and collaborative management. Care Guide of Patient with the Condition (fracture of the right femoral neck) Repositioning the Patient The nurse may turn the patient onto the effected or unaffected extremity as prescribed by the physician. The standard method involves placing a pillow between the patient’s legs to keep the affected leg in an abducted position. the patient transfers to a chair with assistance and begins assisted with ambulation. and the safe use of the walker and crutches. The patient is then turned onto the side white proper alignment and supported abduction are maintained. This device helps strengthening the arms and shoulders in preparation for protected ambulation (e. In some instances. Promoting Strengthening Exercise The patient is encouraged to exercise as much as possible by means of the overbed trapeze.. The patient who has experienced a fractured hop can anticipate discharge to home or to an extended care facility with the use of an ambulating aid. The amount of weight bearing that can be permitted depends on the stability of the fracture reduction. On the first postoperative day.g. toe touch.2. ambulation. Some modifications in the home maybe needed to permit safe use of walkers and crutches and for the patient’s continuing care.

lifestyle changes. Specific therapeutic interventions need to be initiated to retard additional bone loss and to build bone mineral density. location characteristics (dull. continuous. Encourage use of less potent drugs as severity of discomfort diseases. 27 . the use of hip protectors that absorb or shunt impact forces may help to prevent an additional hip fracture if the patient were to fall. and so forth.Health Promotion Osteoporosis screening of patients who have experienced hip fracture is important for prevention of future fractures. . traction. aching and so forth) . Specific patient education regarding dietary requirements. sharp. With dual-energy x-ray absorptiometry (DEXA) scan screenings the actual risk for additional fracture can be determined. * Encourage patient to become an active participant in rehabilitative plans. and exercise to promote bone3 health is needed. boning. * Establish a supportive relationship to assist patient to deal with discomfort. throbbing. In addition. Studies have shown that health care providers caring for patient with hip fractures fail to diagnose or treat these patients for osteoporosis despite the probability that hip fractures are secondary to osteoporosis.evaluate patient for proper body alignment. Fall prevention is also important and maybe achieved through exercises to improve muscle tone and balance and through the elimination of environmental hazards. Relieving Pain * Secure data concerning pain . splints. radiating.ask patient what causes the pain. and appliances) * Initiate activities to prevent or modify pain * Administer prescribed pharmaceuticals as indicated. relieves the pain. pressure from equipment (casts.have patient describe the pain. makes the pain worse.

* Establish trusting therapeutic relationship with patient. maintaining supports to fracture during position changes. * Encourages patient participation in frequent position changes. denied. * Modify activities to facilitate maximum independence within prescribed limits. * Allow time for patient to accomplish task. 28 . * Teach family how to assist patient while promoting independence in self-care Promoting Physical Mobility * Perform active and passive exercises to all nonimonobilized joints. completion). * Arrange patient area and personal items for patient convenience to promote independence. * Minimize prolonged periods of physical inactivity. * Assist patient to more through phases of post-trammatic stress (outery.omtrusiveness. working through.Promoting Self-Care Activities * Encourage participation in care. * Administer prescribed analogies judiciously to decrease pain associated with movement. * Teach relaxation techniques to decrease anxiety. * Encourages patient to express thoughts and feelings about traumatic event * Encourages patient to participate in decision making to reestablish control and overcome feelings of helplessness. Promoting Positive Psychological Response to Trauma * Monitor patient for symptoms of post from a stress disorder. encouraging ambulation when prescribed.

* Refer patient to psychiatric liaison nurse or refer for psychotherapy. . no wounds. behind the ears. normal bond mobile prominences on the forehead. white in color. no rashes present. has a fine hair -No dandruff and . no protrusions and pond felt upon palpation. without pimples . not oily. no evidence of abnormal mass. no scars. Percussion Auscultation Hair -Hair is short. Body part Head Inspection . pink. 3. round head.* Encourages development of adaptive responses and participation in support groups. check bones are slightly prominent. wearing a clip. had wrinkles .Firm. no presence of scar. -Tempera. no scales. Actual Patient Care 3. soft. no visible bulges. lesions. presence of wrinkles. as needed.No lesions.Palpable temporal pulse.Symmetrical. evenly distributed. sides of the parietal bones. no tenderness. pulse is at 82 bpm.Small. . normocephalic.Free from lumps. Scalp Forehead Face 29 . wounds present.Forehead is free of lumps and nodes.1 Physical Assessment PHYSIOLOGIC Palpation .

transparent.whitish in color but red capillaries are slightly seen . black -black in color but with white opacities near the lacrimal gland . with eyeglass . illuminated pupil constricts (pupil equally round reactive to light and decommodation) 30 Cojunction Cornea Iris Pupil . align with the ears. shiny and smooth. round.turn outward. black . round smooth border.pink . black in color. smooth and no tenderness Brows Lashes Lids-Upper Lids-Lower Sclearae . skin intact.partially cover the eyelids -Non tender . night displays at the same spot of the eyes -round.sometimes cover the -Non tender whole sclerae . free from sealing .Eyes . short. symmetrically aligned.Symmetrical. few discharges seen.Hair evenly distributed.No lumps and rashes.

no swelling or bleeding.nontender .non-tender -free from edema . soft. moist.no lesions. lesions and tenderness upon palpation.no lumps.nontender Lips .White. . . free from edema Gums . no discharge/ flaring. -slightly pale in color. deformities and deviations Muscle Balance Visual Acuity Peripheral Vision Nose Frontal Sinuses Maxillary Sinuses Mouth . -Intact. symmetry of contour.Muscle Function -eyes moves slowly as it follows my finger guiding the patient and assessing her 6 cardinal gazes -Move symmetrically the tremors -260/20 -able to define correctly the number of fingers showed at the side of the patient nut sometimes its difficult for her.light color during transillumination -light color during transillumination . air flows freely. open and close symmetrically and slowly. 31 . pink in color. long nose. smooth in texture.non-tender .no lesions. septum is aligned in midline.

as masses/ bulges.midline. no inflammations .Symmetrical. slightly pale.Teeth -Yellow teeth with brownish discoloration.muscular. pinna is in linewith the outer canthus of the ear. Upper.Symmetrical. . the dentures.no lumps . slightly pale .bony. no swelling or lesions.no palpable nodules Tongue Frenulum Sublingual Area Hard Palate Self Palate Uvula Tonsils Ears External . no thickening/ pain. 32 . whitish . no lesions. align -Displays no with the eyes.no teeth Lower. midline. align with the eyes. No swelling or lesions. pinkish .no pain felt. upon palpation of pinna. moist. and teeth are incomplete. with slight cerumen and hair. visible veins .pinkish. .pink. slightly big.midline. . discharges. free of lesions .4 -centrally positioned.

equal chest expansion. flat over areas of heavy muscle and bone.no bulges. moves up and down as the patient swallows.vibrations are equal in both sides . non-palpable .flat. nontender. -Muscles equal in size. retraction or nodules . and stomach percussed. free of nodules. liver. good turgor Trachea . .not enlarged .central placement in midline of neck.Neck .white.slightly cold. no rales and wheezes Lungs 33 . not enlarged . spaces are equal in both sides.no nodules.no visible bulges. with wrinkles. . extension and rotation of neck. no dryness . -Lung sounds are clear. dull on areas over the heart. head centered. the ride and fall during respiratory is visible .resonate down to the 6th rib.centrally located Skin Thorax Chest anterior .Able to do flexion. not visible -Carotid pulse palpable Lymph nodes Thyroid -Not palpable -Not palpable. symmetric excursion .full.

Dull sound at upper quadrant Spine Extremities . no lumps palpated in the lungs .flat.BP.no tenderness. bulges .80 bpm . fingers were curving downward -35.apical pulse palpable -with breast CA ( R) ( 2006-2007 ) . slightly cold .able to perform ROM exercises .no nodules. unblemished skin .radial pulse palpable.biceps and triceps reflex present .brachial pulse palpable .5 degrees Celsius .non-tenderness -TR= 80 bpm -no murmurs Breast Abdomen .difficulty in overcoming resistance 34 . equal in sizes.no visible pulsations .white. soft.has abnormal curvature -capillary refill time is 2 sec.audible bowel sound of 18 from the normal range of 5-35 bowel sounds.Heart . .no lesions.120/80 mmHg Upper Muscle strength Muscle tone .

inability to overcome resistance .difficulty in performing ROM exercises .patellar reflex not present 35 . with pain upon palpation .positive tenderness on the right hip Muscle strength Muscle tone . equal in size.white. dry to touch .slightly cold.Lower . covered with cloth. limited movement on lower extremities .capillary refill is 2 sec .


absorb. -Support affected body parts or joints using pillows or rolls. When inability the bone is to stand broken. -administer pain reliever such as areoxia as prescribe by the physician. Rationale Fractures occur when the bone is subjected to Impaired stress greater physical that it can mobility. . Deficit 1.0 to keep siderails up or raised. joints neck dislocations. ruptured tendons. -Consult with physical or occupational therapist as indicated. Promote adequate mobility of the client. of the hemorrhage into right the muscles and femoral joints. -Difficulty in moving the extremities. alone adjacent related to structures are skeletal also affected. Body organs maybe injured by the force that caused the fracture fragments. and damaged blood vessels. “dili gihapon mu lihok akong tiil day” as verbalized by the patient.assist patient to do active ROM exercises on the lower extremities. the extremities cannot function properly because normal functions of muscle depend on the integrity of the bones which they are attached. Impaired Physical Mobility Cues: .instruct the 5. -Slowed movement. severed nerves. 37 . After a fracture. Physiologic A. -Difficulty initiating gait.Needs/ Problem / Cues I.Difficulty in changing position while lying on bed. demonst rate increasi ng function of the extremit ies Measures to: 1. . impairmen resulting in soft t to facture tissue edema. -Encourage patient to stand or walk as tolerated using parallel bars. -Inability to walk or stand alone. -to avoid patients from falling to sudden movements -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. -Provides comfort measures such as backrub. Nursing Diagnosis NURSING CARE PLAN Scientific Basis ObjecNursing Action tives of Care After 8 hours of holistic nursing caring care the patient will be able to: 1. -limited range of motion in the extremities.

enhance blood circulati on 2. -to assess respiratory insufficiency -serves as a baseline data -note for any changes -to promote prevention management of risk -to improve circulation of blood to the body systems. depth use of accessory muscles purledlip breathing.2. there is immobility because normal function of the muscle depends on the integrity of the bones to which they are attached. -auscultate breath-sounds Check if there is a decrease or adventitious breath sounds as well as fremitus -monitor ital signs and cardiac rhythm -review risk factors -reinforce need for adequate rest. Immobility of a body part may possibly interrupt the circulation of blood through the circuitous network of arteries and veins 2. Risk for altered blow flow Risk Factor: Immobility Risk for altered blood flow right immobilit y to fracture of the right femoral neck The extremities cannot function properly after a fracture. while encouraging activities within clients limitation -encourage frequent position changes and DBE or coughing exercise. -to treat underlying conditions 38 . thus. prevent. Note areas of pallor or cynosis. -administer medications as indicated. blood emboli -note signs of changes in respiratory rate.

to produce risk factors and protect self from injury 3. Risk for additional injury risk factors: *Loss of skeletal integrity * skeletal impartment *Abnormal blood profile *Impaired or altered mobility Risk for additional injury right loss of skeletal integrity to fracture of the femoral neck. Muscle. -to promote wellness. -encourage participation in rehab programs. Overload 3. -to promote individual safety. 39 . joints and other organs maybe injured when fracture occurs. This condition may result to a loss of skeletal integrity that may possibly lead to further injury as a result of environmental conditions interacting with the individuals adaptive and defensive resources. blood vessels. such as gait training -promote 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. A fracture occurs when the stress placed on a bone is greater than a bone can absorb. 3. -observe for signs of injury -identify interventions or safety devices. nerves. for the patients to be free from injury -ascertain knowledge of safety needs or injury -assess muscle strength gross and fine motor coordination.B. tendons. -to improve skeletal integrity. -for early detection.

tachypnea. attributable to cupirine ability to inhibit he synthesis of prostaglandins I. anxiety. . GI upset.Drug/ Dose/ Frequency / Route * Aromasin 25 mg T tab-OD Classification/ Mechanism DRUG THERAPEUTIC RECORD Indication/ Principles of Contraindation/ Care Side effects I. osteoarthritis CI: Allerge use continuously with impaired renal function. influenza SE: Acute aspirin toxicity: hyperpnea . and headache are common. NSAID M: Analgesic and antirheumatic effect are. chicken pox. -assist client in doing ROM exercises -provide comfort measures such as back rub. mild to moderate pain fever Inflammatory conditions Rheumatic fever rheumatoid arthritis. has anti.estrogen receptorpositives breast cancer cell increased * Aspirin C: (aspilet) T Antipyriene.(ho flashes. -aoid use during premenopause or with renal or nepatic dysfunction.platelet salicylate. pregnancy and breastfeeding -25mg po everyday with meals. Antirheumatic .do not crush and ensure that patient does not chew SR preparation -Do not use aspirin that has a strong vinegar -provide rest periods -mpnitor for any side effects that may occur -provide a quite and comfortable environment -maintain client’s general well-being and hygiene -provide safety and comfort measures to the client. treatment of advanced breast cancer in postmenopaural women whose decreased has progressed FF. Tamoxifen therapy SE: C1: allergies.) Treatment Evaluation C: Antineoplastic M: Binds to estrogen receptors. patient has not been through menopause yet. -give drug with fullglass of H2O to reduce risk or tablet or capsule lodging in the esophagus . -provide rest periods -do not allow client to do strenuous activities -growth of tumor cells were inhabit -there is al improvemen t of patients gout ant the patient was able to slight move her extremities 40 . hemorrhage -give drug with food or after meals if GI upset occurs. depression. -elevate the leg of the patient. antiinflammatory. tab OD po Analgesic. anti.

dizziness tinnitus like odor -take extra precautions to keep this drug out of the reach of children 41 . This effects occurs at low doses and last for the life of the platelet(8 days) These doses inhibit the synthesis of Aspirin intolerance: -shinitis exacerbation of broncho spasm -nausea. dyspnea.. important mediators of inflammation antipyretic effects are not fully understood but aspirin probably acts in the thermoregulat ory center of the hypothalamus to block effects of endogenous purogen by inhibiting synthesis of the prostaglandin intermediately . occult blood loss. Inhibition of platelet aggregation is attributable to the inhibition of platelet synthesis of thromboxane A21 a potent vasoconstricto r and inducer of platelet aggregation.

Prevention of ischemic complications. but may start to work quicker if taken without food. Monitor blood test -provide a safety and comfortable environment -provide rest periods -avoid patient from dying strenuous activities -position client in a comfortable position. CI: hypersensitivity use cautiously with pregnancy or lactation history of GI blood. factor II a. thrombocytopenia . -do not exceed the prescribed dose -maybe taken with low dose -provide for safety measures (electric razor. Do not give clexane by IM injection -patient should be lying down. colorless to pale yellow -can be taken with or without food. -there is an improvemen t of patient’s gait and the patient was able to slightly move her extremities 42 . a patient vasodilator and inhibitor of platelet aggregation. spinal top SE: Bruishing. fever. preventing the formation of clots. I. pain. local irritation. -divert patient’s attention -guide imagery -encourage -further complicatio ns were prevented. dizziness -give deep subcutaneous injections. chills. Activities between the left and right anterolateral and posterolateral abdomen wall -apply pressure to all injection sites after needle is withdrawn -do not mix with other injections or infusions -store at room temperature fluid should be clear. soft toothbrush) to prevent injury to patient. prevention of deep vein thrombosis. which may lead to pulmonary embolism following hip replacement. who is at risk of bleeding -check patient for signs of bleeding. Acute and chronic treatment of asteoarthritis and RA CI: Children and adolescent under 16 yrs. *lericoxib (arcoxta) 90mg T tab OD C: nonsteroidal anti inflammatory drug (NSAID) M: work DY blocking the action of a substance in the body called cyclooxygenare is I. C: lowmolecular weight heparin antithrombotic M: lowmolecular weight heparin that inhibits thrombus and clot formation by checking factor XA. Of age -severely to liver function SE: headache.*Clexane 0-4 cc SQ OD prostaglandin.

dizziness. dry mouth. -initially 1 capsule every 8 hours. indigestion. but as catalysts. They contain no useful energy. For liver protection eases of intoxication (alcohol abuse) CI: hypersensitivity. constipation -encourage client to eat foods rich in vitamins and minerals -instruct client to minimize the intake of fatly foods -lifestyle modificatio n -exercise regularly -impart to patient the importance of taking adequate amount of nutritious -the patient was able to gain more energy and increase its function 43 . lactation SE: sedation. liver cirrhosis and fatty liver. Control the processes of Constipation. treatment of chronic liver disease . There prostaglandins . nausea. Because NSAIDS block the production of prostaglandins they are effective at relieving pain and inflammation C: Phospholipid + multivitamins M: mainly function as eatalysts for reactions within the body.* vitamin B complex (sangubio n) T tab OD involved on producing prostaglandins in response to injury or certain diseases. However the combination may carry an increased risk of ulceration or bleeding in the stomach or intestine -it is important to tell your doctor or pharmacist what medicine you are already taking including those bought with out prescription and herbal medicine -maybe taken with meals if GI discomforts occurs. they serve as essential link and regulators in metabolic reaction that release energy from food. nausea. -provide rest periods -avoid client to perform strenuous activities -provide a safety environment I. cause pain or swelling and inflammation. -best to take after meals. flatulence (76 mg daily) aspirin. Follow up treatment 1 capsule daily DBE -hot compress is applied to the affected site or area. vomiting.

nausea. treatment of calcium deficiency. blood coagulation: is an enzyme cofactor and affects the secretom activity of endocrine and exocrine glands.. maintenance of health metabolism C: electrolyte Antacid M: Essential element of the body.assist client be expose to sunlight for 5-15 minutes.encourage client to eat foods rich in calcium such as milk. CI: Allergy.*CaCo3 (Calvit) T tab OD every 6pm *Ketoprof en (fortum) Gel apply to right tissue synthesis and aid in protecting the integrity of the cells plasma membrane. constipation. . cheese.impart [atient the importamce of takiln adequate amount of nutritious foods. vomiting. . helps maintain the functional integrity if nervous and muscular system. C: NSAID Non-opioid analgesics M: Antiinflammatory foods I: Dietary supplement when calcium intake is in adequate. prevention of hypocalcemia during exchange transfusions. For over-thecounter Use: Do not take for more than 10 days. and pain dry mouth. Se: Slowed heart rate.the strength of patient’s bones were improved as evidenced by standing or walking with assistance. use cautiously withdrawal. dysfunction pregnancy.provide rest periods . dry mouth. abdominal pain. I: Acute and long treatment of RA and osteoarthritis. If . increase voiding. lactation. tingling.there was an improvemen t of patient’s gait and the 44 . . neutralizes or reduces gastric acidity. . thirst.relief of mild to moderate pain. local irritation. . assist growth.do not administer oral drugs within 12 hour of antacid administration.encourage client to exercise regularly. .report loss of appetite. . hypercalcemia. .elevate the leg of the patient . helps maintain cardiac function. heat waves.

soothes and helps promote I: Wound drainage. pat dry and apply once daily or as necessary . CI: Significant renal impairment. adjuvant to the treatment of TB. . renal impairment. inhibits prostaglandin and has antibradykinin and lysosomal or membrane stabilizing actions.provide comfort measures . . dizziness.patient’s wound was easily healed and bedsores 45 .maintain general well-being and hygiene of the . .instruct patient to eat adequate nutritious foods. . SE: Headache. CV and GI conditions.thigh and right knee twice a day. dyspnea. . relaxing and comfortable environment .should be used with caution in patient’s with diabetes mellitus as their management may become more difficult. dysuria.the patient was able to improve her appetite as evidenced by eating her meals an time and avoiding to skip meals. lactation allergy to ketoprofen. urinary and fecal incontinence. *Calmose ptine ointment appky to affected C: Topical antivirals M: Protects.the dosage must be reduced to patient’s with liver damage.liver functions should be assessed before and regularly during treatment. rash. peripheral edema. and analgesic activity. convalescence from acute infection: CI: Hypersensitivity symptoms persist contact your HC provider.provide small frequent feelings .impart to patient the importance of taking adequate nutritious foods. bedsores. nausea.encourage client to do DBE . pruritus.promote a quite. *Dibencos ide (heraclene ) Mg tav T tab HD C: Appetite stimulants M: Improes appetite and preents faulty nutrition and other chronic ailments. use cautiously the impaired hearing allergies hepatic. pregnancy. . patient was able to slightly move her extremities. and other chronic ailments. . I: Poor appetite in adult.cleanse skin. dyspepsia. ileo . .offer foods that are attractive or presentable enough to stimulate appetite.

. abdominal pain. flatulence.do not discontinue this drug without consultation from health care provider. mineral oil or wax. patients. . dime thicone. parabens. anal. . jelly. were .monitor serum glucose level frequently to determine drug effectiveness and dosage.promote proper environment al sanitation.site BID healing in those with impaired skin integrity.impart to client the .encourage client to do regular exercise assisted by the SO. cod liver oil. SE: Hypoglycemia.avoid getting this medication in your mouth or eyes.consult with a dietician to establish weight loss program and dietary control. . . .inform patient of likelihood of abdominal pain and flatulence. . .provide a prevented. delays the digestion of ingested carbohydrates heading to a smaller increase in blood glucose following meals and in glycosylated I: Adjunct to diet to lower blood glucose in those patient’s with tipe2 (non-insulin dependent) DM whose hypercalcemia cannot be managed alone.give drug TID with the first bite of each meal. CI: Hypersensitivity.meticulous skin care . . use cautiously with renal impairment pregnancy and lactation.impart to patient to eat a nondiabetic diet. If it does rinse with water right away. moistures of perspirations CI: Hypersensitivity *Acarbose (glucobay) 50 mg tab TID with meals C: Antidiabetic M: Alphaglucosidase inhibitorobtained from the fermentation process of a microorganis m. . petroleum. .further complicatio ns were being prevented and appearance of signs and symptoms slowly diminished 46 .call your doctor if you have any signs of redness and warmth or oozing skin lesions.do not use this medication if you are allergic to zinc. reservoirs. clean and comfortable environment . . lanolin.

decrease doses in renal and liver failure. acid ingestion. anemia. . cholinergic agonists. malaise.administered oral drug with meals and hours. leucopenia. . rash.impart to client not to skip meals.*Ranitidin e (ulcin) 75 mg tab PC 3x a day 6 am – 6 pm hemoglobin. CI: Hypersensitivity. insulin.provide rest periods . 47 .encourage client to ear adequate nutritious foods at a regular meal time. constipation. tachycardia.the patient was able to feel more comfortable as evidenced resting and sleeping comfortably. gastrin and pentagastrin. importance of taking nutritious foods. . histamine.avoid the client from eating foods rich in fats and cholesterol. does not enhance insulin secretion. take it exactly as prescribed. . antagonists M: Competitively inhibits the action of histamine At h2 receptors of the parietal cells of the stomach inhibiting basal gastric acid secretion that is stimulated by food. . . use cautiously the impaired renal or hepatic function pregnancy. dizziness.have regular medical follow up care to evaluate your response. SE: Headache. .if you are using antacid. treatment of heart burn. diarrhea. being careful of the time administered. . so its effects are addictive to those of the sulfonyl areas. sour stomach. I: Short term treatment of active duodenal ulcer. in controlling blood glucose. bradycardia. C: Histanine. thrombocytopenia . .position client into a comfortable position.

consulted with physical or occupational therapist as indicated. assisted patient in doing ROM exercises. provided comfort measures such as backrub. R= 20 bpm and BP= 120/70 mmHg. I= Introduced name to the patient. A= Impaired physical mobility. supported affected body parts/ joints using pillows/ rolls. 48 . of the patient.3. has difficulty in changing position while lying on bed. awake. limited range of motion in the extremities. P= To promote adequate mobility of the client. inability to walk or stand alone. without IV. assisted patient upon doing gait training. difficulty initiating in gait. conscious.5 SOAPIE SOAPIE #1 S.Received patient lying on bed with head elevated to 30 degrees. P= 86 pm. E= The patient was able to demonstrate increasing function of the extremities as evidenced by standing and walking between parallel bars with assistance.5 degree Celsius. set siderails up. monitored v/s. documented the v/s and I and O of the patient. assessed the condition. has difficulty in moving the extremities. the patient is reading a newspaper. slowed movement. inability to stand alone related to skeletal impairment 2 degrees to fracture on the right femoral neck. communicative. coherent. O. encouraged patient to do DBE. with the following v/s T= 35.“ Dili gehapon ayu malihuk akong tiil day”.

auscultated breath sounds if there is a decrease or adventitious breath sounds as well as fremitus. without IV. use of accessory muscles. assessed the condition of the patient. monitored v/s. E= The client’s extremities are warm and pink. conscious. areas or pallor/ cyanosis. P= To enhance blood circulation I= Introduced name to the patient. CRT results of 2 seconds. . BP= 120/70 with feet supported by rolled towels. I and O and medications taken by the patient. noted signs of changes in respiratory rate. remains intact. administered medications.SOAPIE #2 S= “Naproblema man ko sa akong tiil day kay pila na ni ka adlaw walay lihok. reinforced need for adequate rest while encouraging activity within client’s limitations. P= 76 bpm. no verbalization of pain. monitored cardiac rhythm. 49 . R= 19 bpm. communicative. swelling on the area and demonstrates calm breathing. encouraged frequent position changes and DBE / coughing exercises. documented the v/s. A= Risk for altered blood flow r/t immobility 2 degrees to fracture of the right femoral neck. pursed top breathing. murag lain na kaayu akong feeling”. with the following v/s T= 35. as verbalized by the patient. reviewed risk factors. depth.lihok.7 degrees Celsius. limited movement of the lower extremities. coherent. O= Received patient sitting up on bed. check the CRT of the patient.

attitude and skills in preventing complications of immobility. and preferably more frequently in patients who have no spontaneous movement. Specific Objectives: After 45 minutes of teaching. explain the goals of frequent position changes. Informal discussion -the patients was able to explain the goal of frequent position changes and she was motivated to perform the different positions to become at ease from pain or any discomfort felt 50 . the patient as well as the significant others or family will be able to acquire knowledge. *the recommendation is to change body position at least every 2 hours. the patients as well as the significant other or family will be able to: 1. * promote lung expansion and prevent pneumonia * decrease edema of the extremities * changing position from lying to sitting several times a day can help prevent changes in the CVS known as deconditioning.Objective General Objectives: After 3 day of varied learning activities. HEALTH TEACHING PLAN Content Methodology Evaluation Positioning (Goals) * to prevent contractures * stimulate circulation and prevent pressure sores * prevent thrombophiebitis and pulmonary embolism.

2. f. the head is in line with the spine both laterally and anteroposteriority. 3. Side lying or lateral position a. 2. b. Dorsal or Supine Position. d. the head is turned laterally and is in alignment with the rest of the body b. the head is in line with the spine b. the elbow are fexed Informal discussion -the patient was able to verbalize the different proper positions for proper body alignment 51 . the arms are abducted and externally rotated at the shoulder joint. the uppermost hip joint silently forward and supported by a pillow in a position of slight abduction. enumerate the positions for proper body alignment Proper Body Alignment 1. The Arms are flexed at the elbow with the hands resting against the lateral abdomen. the neels are suspended in a space between the mattress and the footboard to prevent neel pressure. a. the trunk is positioned so traction of the hips is minimized to prevent hip contractive. the legs are extended in a neutral position with the toes pointed towards the ceiling. c. e. trochanter tons are place under the greater trochanter in the hip joint areas. a pillow supports the arm which is flexed of both the elbow and shoulder joints. the body is an alignment and is not twisted c. Prone position a. d.

* Dorsiflexion and palmar flexion of wrist. * Pronation-supination of elbow. discuss the different therapeutic exercises Therapeutic Exercises 1. * Ulnar-radial deviation of wrist. *Dorsiflexion-Plantarflexion. rotation of cervical spine Informal discussion and demonstration -the patient was able to discuss the different therapeutic exercises and was able to demonstrate them with assistance 4. * Fexion extension of elbow * adduction-abduction of shoulder. Isometric or muscle settings exercise.c. Resistive exercise 5. Positive range of motion exercise 2. Eversion of the ankle. the lower extremities remain in a neutral position. practice the different kinds of range of motion Informal discussion and demonstration The patient was able to practice the different kinds of ROM exercise with assistance 52 . 3. d. * Flexion-hyperextension. active range of motion 4. Range of motion * Flexion extension of shoulder. internal rotation or external rotation of the hip. flexion-hyper extension of fingers. adduction-abduction of toes * Adduction-abuction. a small flat support is placed under the pelvis extending from the level of the umbilicus to the upper third of the thigh. active assistive range of motion 3. * Flexion-extension. * Adduction-abduction and opposition of thumb * Adduction-abduction.

5. 53 . participate attentively to the discussion Informal discussion and demonstration -the patient was able to listen attentively and asked some question related to the discussion and she was also able to participate during demonstration.* Lateral bending of cervical spine.

the student nurse observed certain changes from the patient. hygiene and dressing practices with minimal assistance and denies acute symptoms of stress. 54 . a febrile. alert and oriented. the student nurse recommends the patient to adjust in usual lifestyle and responsibilities to accommodate limitations imposed by fracture and to prevent recurrent fractures – safety considerations. methods of safe ambulation – walker. Evaluation and Recommendation Prognosis of the patient After 3 days of intervention. increased pain and elevated temperature and explains basis for fracture treatment and need for patient participation in therapeutic regimen. ice and analgesic. The patient and the family were also informed that the patient must have an adequate balanced diet to promote bone and soft tissue healing. reports working through feelings about trauma. no signs of neurovascular compromise. v/s stable. avoidance of fatigue and proper footwear. crutches. teaches symptoms needing attention. The patient also performs active ROM correctly. The patient reports decreased pain with elevation. urine output adequate and no calf pain reported: Homan’s sign negative. decreased function.V. such as numbness. Recommendation As a researcher in this case study. care. using affected extremity for light activity as allowed. emphasizes instructions concerning amount of weight bearing that will be permitted on fractured extremity. The patient also exhibits unlabored respirations. The patient is instructed about exercises to strengthening upper extremity muscles If crutch walking is planned.

It is important that the proper and ideal managements and interventions are done in order to give a more holistic approach and optimum care to clients with fracture on the right femoral neck.oriented and having a commitment to the organization. and nursing management. Hopefully. causes. nurses are accountable to their patients to promote a maximum level of health. this 55 . This could contribute to the development of the case study of fracture – its prevention. This would ensure the timely healing of injury and the prevention of complications.going learning process. it is important to know all areas of patient are both knowledge and skills to manage effectively in all aspects of their professional nursing practice. Nursing Research Nursing research is essential for the development of scientific knowledge that enables nurses to provide evidenced-based health care. This case study would contribute more information and facts about fracture on the right femoral neck. people. attitude and skills towards the management of patients with fracture on the right femoral neck. nurses are likely to become well respected through the formal educational programs. More specifically. Through this case study. whether self. Evaluation and Implication of this case study to: Nursing Practice The result of this case study would provide the student nurse with sufficient knowledge. This study would help the student nurse in providing a higher quality of care of patients with the same condition. Nursing Education Education can promote enhancement of professionalism through an on.motivated. signs and symptoms. Broadly nursing is accountable to society for providing quality. cost effective care and for seeking ways to improve that care.VI.

Singapore. and Smeltzer.F. 7th Edtion. 1998. 6th Edition Baltimore: C.B. This case study could also as basis for related study and will provide facts for further research in aiming for the improvement of these patients. interventions and rationales. Nettina. 2005. M. I. 2004. Anne. Ltd. Elaine N. Doenges.B Lippincott Company. Diagnosis. Mosby and Company. . 56 . “ Nurses Pocket Guide”. 10th Edition Philadelphia: I. Rozler. Essential of Human Anatomy and Physiology. Geissler – Murr. 2004. Manual of nursing Practice. A. VII – Referral and Follow-Up The patient was informed to have a continuous appointment with the Rehabilitation Care Program Health Care providers after discharge.. 7th Edition.. M.case study will lead to development of new skills and new approaches to the care of patient’s with fracture on the right femoral neck. Suzzane C. Incorporated. Fundamentals of Nursing. Newyork: AddisonWeatleylongman.. 5th Edition. Brenda I. Sandra M. 9th Edition (2004). Textbook of Medical-Surgical Nursing. Potter. Patricia and Perry.V. Barbara et al. Lippincott Company. Fundamentals of Nursing. Marleb. VIII – Bibliography Bare. Pearson Education South Asia Pte. The patient was encouraged for follow-up medical supervision to monitor for union problems. 2001. Moorhouse.

. 6th Edition..A. “ Nursing Care Plans”. M. 2002. F. 57 . Guidelines for Individualizing Patient Care..F. Geissler – Murr. A. Davis Company. M. Moorhouse.Doenges.

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