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.


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

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

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

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. 9 .

8 32.5 g/dL 41.5 % 150.5-33.10th Edition Volume 2.6-5 4.9x10^ g/uL 27.8 5. with excessive fluid intake. collagen and hemolytic disorders -Normal Source: Brunner and Suddarth’s.1 28.4-11.2 pg 80-96 fL 33.7 10 .5-50.4-35.6 32 387 67 0 4 09 20 .all anemias and leukemia.2. Diagnostic Test Diagnostic test April 10. when blood volume has been restored.000 40-70 % 0-1 % 0-5 % 0-8% 20-40% 9.32 2.4% 4.0-17. 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 14.5-5.000-450. -Normal -Increased-macrocytic anemia -Decrease-severe hypochronic anemia -Normal -Normal -Normal -Normal -Increase-viral infection. -Decreased-severe anemias -Normal -Decreased. Textbook of Medical-Surgical Nursing.0x10^ g/uL 4.Decreased-various anemias. page 2214-2215 -Normal Normal values Patient’s Result Significance Serum 3.7 103.

VII.8 65-110 8-35 u/mL 6.2 3.31 min.9 5. -Normal -Normal -Increased-deficiency of factors I. 96.page 2230. fat malabsorption -Normal Bleeding time-sim Clotting time Prothombin time % activity 2.10th Edition Volume 2. 10.2-2. Textbook of Medical-Surgical Nursing.2224.8 sec.5 5-15 10-13 70-120 6.5 4.41 min.10th Edition Volume 2. V.2233.page 2225.-sec.3-5. PBS 65-110 118 Uric acid 2. and X.5 2 6.0 2.page 2217.4-10.7-1.2221.2219. leukemia -Decreased-vitamin D. Textbook of Medical-Surgical Nursing.Potassium Creatinine Calcium Protein Albumen Globulin Total Protein GCT(50gms) 6. malnutrition -Decreased-no clinical significance -Increased-chronic infection.2 1. 13.3-9.6 8. anemia. deficiency -Decreased-anemia.2 % 11 .-sec.9 2.2232 -Increased-diabetes mellitus Source: Brunner and Suddarth’s. II. multiple myeloma -Decreased-malnutrition -Increased-diabetes mellitus -Normal Source: Brunner and Suddarth’s.8 145 20 -Decreased-Muscular atrophy.10th Edition Volume 2.2 1.2229. Textbook of Medical-Surgical Nursing.2230.4mg/dL -Normal Source: Brunner and Suddarth’s.5 8.5-7.

8 1.2 eu/dL -Normal -Normal -Normal -Normal -Glomerular disease. 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 4.2 1.010 Trace Trace Negative Negative Negative Negative Negative 0.029 Negative Negative Negative Negative Negative Negative Negative Normal Yellow Clear 6.0 1.10th Edition Volume 2.003-1.INR <1. Textbook of Medical-Surgical Nursing.03 -Normal Source: Brunner and Suddarth’s.5-7.

Amorphous Urates Blood cell Present Negative Few Few -Normal Indicates renal or urinary tract disease Source: Brunner and Suddarth’s. Textbook of Medical-Surgical Nursing.10th Edition Volume 2.page 2224.2225 13 .

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

taste and feel well and correctly but the patient cannot read her newspaper without her eyeglasses just the same as now.R. Elimination Pattern Before. Now. 3.3. She easily communicates. 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. can hear. 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.6.3. The patient usually stays in bed and read newspapers sometimes. She speaks slowly English. There is no burning sensation during ur4ination and her stool is brownish formed stool. 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. 3. Tagalog and Bisaya languages as of now but before she speaks fluently all of those languages. instructions and be able to follow and answer them correctly. she can’t take a nap in the afternoon due to her REHAB CARE. Rest/ Sleep Pattern Before the hospitalization. smell. but now. 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.5. 3. she’s just on bed lying assisted by her private nurses and CDUH health care providers. Cognitive/ Perceptual Pattern The patient before. 15 . the patient can freely go to the C. She usually guided her grandsons and granddaughters. understands questions.4.

Coping. medications and all out care rendered by the hospital to the patient assured her for the improvement of her condition. 3. The treatment.10.9. 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. but they make sure they never forget to support and help their mother recover from illness. Sometimes. she maybe able to cope up easily from her unhealthy condition. she usually goes to church together with her other children. changing diaper. The patient knows how to pray and praise God for all the nice things he had given. the patient usually shares her concerns to her private nurses and of course also to the student nurses. 3. it should be keep as private. Sexuality/ Reproduction The patient’s husband just recently died. the patient does not allow anyone to see her getting undressed.3. Through this. The patient never loses the support of her children even if they were not there physically and also her private nurses.Perception Pattern The patient’s most concern about right now is her rehabilitation care. managements. Self. 3.8. She usually reads newspaper for her to be more relaxed. 16 .Stress Tolerance Pattern The patient usually makes her decision as for now since her children were busy in their work abroad. Before. Now. God is very much important to the patient. changing clothes because she believes that as a woman. Value-Belief Pattern The patient find source strength and hope with God and her loved ones.7. They were not involved in any religious organizations or practices.

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

the bones of the limbs and girdles. and ligaments (fibrous cords that 18 . it is perfectly adapted for its functions of body protection and motion.4. cartilages. and the appendicular skeleton. In addition to bones. Strong. The skeleton is subdivided into three divisions: the axial skeleton. 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. Pathophysiology and Rationale 4. the skeletal system includes joints. yet light.up body”. the boned that form the longitudinal axis of the body. our internal framework is so beautifully designed and engineered and it puts any modern skyscraper to shame.1 Normal Anatomy and Physiology of Organ/ System Affected The word skeleton comes from the Greek word meaning “dried.

The calcium salts deposited in the matrix bone its hardness. instead of periosteum. 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. protection. secure the periosteum to the underlying bone. it provides a smooth. the cavity of the shaft is primarily a storage area for adipose (fat) tissue. This is the epiphyseal line. Classification of Bones The diaphysis. and red marrow is found these. Hundreds of connective tissue fibers. makes up most of the bones length and is composed of compact bone. the periosteum. in infants this areas forms blood cells. The epiphyseal line is a remnant of the epiphyseal plate (a flat plate of hyaline cartilage) seen in young. epiphyseal plates have been completely replaced by bone. 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. Articular cartilage.bind the bones together at joints). or medullary. when hormones stop long bone growth. and although relatively light in weight. called Sharpey’s fibers. In adult bones. Bone is one of the hardest materials in the body. Each epiphyses consist of a thin layer of compact bone enclosing the area filled with spongy bone. In adults. it has a remarkable ability to resist tension and other forces acting on it. leaving the epiphyseal lines to mark their previous location. or shaft. By the end of puberty. covers its external surface. Because the articular cartilage is glassy hyaline cartilage. growing bone. In adult bones. Besides contributing to body shape and form. 19 . The epiphyses are the ends of the long bone. red marrow is confined to the cavities of spongy bone of flat bones and the epiphyses some long bones. It is called the yellow marrow. slippery surface that decreases friction at joint surfaces. storage and blood cell formation. movement. The joints give the body flexibility and allow movement to occur. or bones perform several important body functions such as support. The diaphysis is covered and protected by a fibrous connective tissue membrane.

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

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

e. neurologic problems. malnutrition. impaired vision and balance.3 Pathophysiology Femoral neck fractures occur most commonly after falls. Particularly vulnerable to the development of ischemic are intracapsular fractures. The resulting stress fractures can be divided into fatigue fractures and insufficiency fractures. Fatigue fractures are a result of an increased or abnormal stress placed on a normal bone. Whereas insufficiency fractures are due to normal stresses placed on diseased bone. In fractures of the femoral neck.. Osteoporosis is the most important risk factor that contributes to hip fractures. This condition decreases bone strength and. such as an osteoporotic bone. bone scans have been recommended as diagnostic tools to determine the orability of the femoral need.Surgical Intervention: .Hip Hemiarthroplasty . therefore. Femoral neck fractures can also be related to chronic stress instead of a single traumatic event. the femoral neck in femoral fracture. In this location. Physical deconditioning. avascular (ischemic) necrosis may result. With seer circulatory compromise. the bones ability to resist trauma. than in those treated after that tine period. Trauma sufficient to produce a fracture can result in damage to the blood supply to an entire bone.Patients with hip osteonecrosis may require Hip Replacement Surgery 4. as occur in the hip. 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. 22 .g. 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. and shower reflexes all increase the risk of falls.Hip Pinning .

The pain is continuous and increases in severity until the bone fragment are immobilized.5 to 5 cm (1 to 2 inches) -When the extremity is examined 23 Shortening Crepitus Manifested . Rationale . In addition. because normal function of the muscles depends on the integrity of the bones to which they are attached. The fragments often overlap by as much as 2. the extremity cannot function properly. Not Manifested . abnormal movement (false motion) may be present. 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. Loss of function Deformity Manifested -Displacement.4 Classical and Clinical Sign’s and Symptoms Classical Symptoms Pain Clinical Symptoms Manifested .In fractures of long bones. limb is compared with the uninjured extremity.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. Pain contributes to the loss of function.unable to move extremities and unable to stand or walk without assistance. or . The muscle spasm that accompanies fracture is a type of natural splinting designed to minimize further movement of he fracture fragments.complains of pain on the right hip aggravated by sudden or too much movements of the extremities and relieved by elevation and resting. Deformity also results from soft tissue swelling.4. -After a fracture. Manifested . angulations.

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

Displaced femoral neck fractures may be treated as emergencies. or compression screw devices. with reduction and internal fixation performed within 12 to 24 hours after fracture. Adequate reduction is important for fracture healing (the better the reduction. After general or spinal anesthesia. A stable fracture is usually fixed with nails. 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). may be applied to reduce muscle spasm. and to relieve pain. This minimizes the effects of diminished blood supply and reduces the risk for avascular necrosis. Surgical intervention is carried out as soon as possible after injury. Buck’s extension. 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 25 . the hip fracture is reduced under x-ray visualization using an image intensifier. The orthopedic surgeon determines the specific fixation device based on the fracture site or sites. 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. The preoperative objective is to ensure that the patient is in as favorable a condition as possible for the surgery. multiple pins. the better the healing). a nail and plate combination. 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. Nursing Interventions 1. Medical and Surgical Management Temporary skin traction.IV.

Some modifications in the home maybe needed to permit safe use of walkers and crutches and for the patient’s continuing care. The standard method involves placing a pillow between the patient’s legs to keep the affected leg in an abducted position. toe touch. 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. shock proves fatal. 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. Monitoring and Managing Potential Complications Elderly people with hip fractures are particularly prone to complications that may require more vigorous treatment than the fracture. Physical therapists work with the patient on transfers. and the safe use of the walker and crutches. partial weight bearing).avoid complications of non-union and avascular necrosis of the head of the femur. In some instances. Promoting Strengthening Exercise The patient is encouraged to exercise as much as possible by means of the overbed trapeze. ambulation.g. This device helps strengthening the arms and shoulders in preparation for protected ambulation (e. The physician prescribes the degree of weight bearing and the rate at which the patient can progress to full weight bearing. Achievement of homeostasis after injury and surgery is accomplished through careful 26 . the patient transfers to a chair with assistance and begins assisted with ambulation. The amount of weight bearing that can be permitted depends on the stability of the fracture reduction. Total hip replacement may be used in selected patients with acetabular defects.. 2. On the first postoperative day. The patient is then turned onto the side white proper alignment and supported abduction are maintained.

Fall prevention is also important and maybe achieved through exercises to improve muscle tone and balance and through the elimination of environmental hazards. * Establish a supportive relationship to assist patient to deal with discomfort. Specific therapeutic interventions need to be initiated to retard additional bone loss and to build bone mineral density.evaluate patient for proper body alignment. throbbing. Encourage use of less potent drugs as severity of discomfort diseases.monitoring and collaborative management. lifestyle changes. makes the pain worse. pressure from equipment (casts. radiating.have patient describe the pain. aching and so forth) . and so forth. Relieving Pain * Secure data concerning pain . . 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. sharp. 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. continuous. and appliances) * Initiate activities to prevent or modify pain * Administer prescribed pharmaceuticals as indicated. Specific patient education regarding dietary requirements.ask patient what causes the pain. splints. traction. With dual-energy x-ray absorptiometry (DEXA) scan screenings the actual risk for additional fracture can be determined. boning. and exercise to promote bone3 health is needed. location characteristics (dull. Health Promotion Osteoporosis screening of patients who have experienced hip fracture is important for prevention of future fractures. relieves the pain. In addition. including adjustment of therapeutic interventions as indicated.

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

* Refer patient to psychiatric liaison nurse or refer for psychotherapy.* Teach relaxation techniques to decrease anxiety. Actual Patient Care 3. 3. * Encourages development of adaptive responses and participation in support groups.1 Physical Assessment PHYSIOLOGIC Palpation Body part Inspection Percussion Auscultation 29 . as needed.

few discharges seen. no tenderness. no wounds. . round. no scars. presence of wrinkles. wearing a clip. lesions. symmetrically aligned.Free from lumps.Symmetrical.Hair evenly distributed. pulse is at 82 bpm. black in . . not oily. no rashes present. no visible bulges.Firm. normocephalic. Scalp Forehead Face Eyes .Head . no protrusions and pond felt upon palpation. has a fine hair -No dandruff and .Palpable temporal pulse. no evidence of abnormal mass. . check bones are slightly prominent.No lesions.Small. pink. sides of the parietal bones. had wrinkles . evenly distributed. skin intact. without pimples . wounds present. behind the ears.No lumps and rashes. soft. with eyeglass . align with the ears. normal bond mobile prominences on the forehead.Forehead is free of lumps and nodes.Symmetrical. smooth and no tenderness Brows 30 . round head. no scales. -Tempera. Hair -Hair is short. white in color. no presence of scar.

short.turn outward. night displays at the same spot of the eyes -round. round smooth border. illuminated pupil constricts (pupil equally round reactive to light and decommodation) Cojunction Cornea Iris Pupil Muscle Function -eyes moves slowly as it follows my finger guiding the patient and assessing her 6 cardinal gazes -Move symmetrically the tremors Muscle Balance 31 .color. shiny and smooth. black -black in color but with white opacities near the lacrimal gland . free from sealing Lashes Lids-Upper Lids-Lower Sclearae .whitish in color but red capillaries are slightly seen .pink . black .sometimes cover the -Non tender whole sclerae .transparent.partially cover the eyelids -Non tender .

nontender Lips . septum is aligned in midline. deformities and deviations Nose Frontal Sinuses Maxillary Sinuses Mouth .no lesions. free from edema Gums Teeth -Yellow teeth with brownish discoloration.no palpable nodules 32 Tongue . -slightly pale in color. symmetry of contour. . .light color during transillumination -light color during transillumination .non-tender . no swelling or bleeding.no lumps. pink in color. air flows freely. long nose.no teeth Lower. and teeth are incomplete. open and close symmetrically and slowly. smooth in texture.non-tender -free from edema . no discharge/ flaring. -Intact.no lesions.Visual Acuity Peripheral Vision -260/20 -able to define correctly the number of fingers showed at the side of the patient nut sometimes its difficult for her. soft.nontender . lesions and tenderness upon palpation. the dentures. .4 -centrally positioned. moist. . Upper.White.

midline. with slight cerumen and hair. not visible -Carotid pulse palpable Neck Lymph nodes Thyroid -Not palpable -Not palpable. .Symmetrical.bony.muscular.Symmetrical. no lesions. . not enlarged . no swelling or lesions. no thickening/ pain. moist. discharges. upon palpation of pinna. pinna is in linewith the outer canthus of the ear. as masses/ bulges. align -Displays no with the eyes. align with the eyes.no lumps External . no inflammations . extension and rotation of neck. visible veins . free of lesions . -Muscles equal in size. slightly big. slightly pale .pinkish.no pain felt.no bulges.no visible bulges. midline. Frenulum Sublingual Area Hard Palate Self Palate Uvula Tonsils Ears . No swelling or lesions.pink.midline. free of nodules. . moves up and down as the 33 . whitish . head centered. . pinkish .slightly pale.Able to do flexion.

and stomach percussed. bulges .no nodules. equal chest expansion. symmetric excursion . -Lung sounds are clear.centrally located .flat. good turgor Skin Thorax Chest anterior . the ride and fall during respiratory is visible . non-palpable .full.no visible pulsations .white.vibrations are equal in both sides . nontender.slightly cold. with wrinkles. liver. flat over areas of heavy muscle and bone. Trachea .not enlarged .central placement in midline of neck. no dryness .apical pulse palpable -with breast CA ( R) ( 2006-2007 ) . soft. unblemished skin . dull on areas over the heart.resonate down to the 6th rib. spaces are equal in both sides. no rales and wheezes Lungs Heart .no nodules.non-tenderness -TR= 80 bpm -no murmurs Breast Abdomen .patient swallows.flat. retraction or nodules .audible bowel sound of 18 from the normal range of 5-35 34 .

no lumps palpated in the lungs .no tenderness. covered with cloth.white.capillary refill is 2 sec .80 bpm . equal in sizes. Dull sound at upper quadrant Spine Extremities .positive tenderness on the right hip Muscle strength 35 . fingers were curving downward -35.white. slightly cold .biceps and triceps reflex present .BP. .5 degrees Celsius .bowel sounds.has abnormal curvature -capillary refill time is 2 sec.no lesions. limited movement on lower extremities .difficulty in overcoming resistance Lower .120/80 mmHg Upper Muscle strength Muscle tone .brachial pulse palpable . equal in size.able to perform ROM exercises .radial pulse palpable.difficulty in performing ROM exercises .

with pain upon palpation .inability to overcome resistance .slightly cold.patellar reflex not present 36 . dry to touch .Muscle tone .


joints neck dislocations.Needs/ Problem / Cues I. -Encourage patient to stand or walk as tolerated using parallel bars. and damaged blood vessels.Difficulty in changing position while lying on bed.0 to keep siderails up or raised. -Provides comfort measures such as backrub. -Difficulty initiating gait. demonst rate increasi ng function of the extremit ies Measures to: 1. -Consult with physical or occupational therapist as indicated. -Inability to walk or stand alone. the extremities cannot function properly because normal functions of muscle depend on the integrity of the bones which they are attached. -administer pain reliever such as areoxia as prescribe by the physician. absorb. -limited range of motion in the extremities. -Support affected body parts or joints using pillows or rolls. alone adjacent related to structures are skeletal also affected.assist patient to do active ROM exercises on the lower extremities. . 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. Promote adequate mobility of the client. Body organs maybe injured by the force that caused the fracture fragments. -Slowed movement. severed nerves. -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. -Difficulty in moving the extremities. Deficit 1. ruptured tendons. impairmen resulting in soft t to facture tissue edema.instruct the 5. Rationale Fractures occur when the bone is subjected to Impaired stress greater physical that it can mobility. Physiologic A. . Impaired Physical Mobility Cues: . of the hemorrhage into right the muscles and femoral joints. When inability the bone is to stand broken. After a fracture. “dili gihapon mu lihok akong tiil day” as verbalized by the patient. 38 .

-to treat underlying conditions 39 . there is immobility because normal function of the muscle depends on the integrity of the bones to which they are attached. prevent. Note areas of pallor or cynosis. enhance blood circulati on 2. blood emboli -note signs of changes in respiratory rate. 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. -administer medications as indicated. depth use of accessory muscles purledlip breathing. -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.2. Immobility of a body part may possibly interrupt the circulation of blood through the circuitous network of arteries and veins 2. thus. -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.

B. blood vessels. -to promote wellness. Overload 3. -to promote individual safety. to produce risk factors and protect self from injury 3. tendons. 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. 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. -to improve skeletal integrity. -for early detection. Muscle. -encourage participation in rehab programs. joints and other organs maybe injured when fracture occurs. 40 . 3. nerves. A fracture occurs when the stress placed on a bone is greater than a bone can absorb. 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. for the patients to be free from injury -ascertain knowledge of safety needs or injury -assess muscle strength gross and fine motor coordination. -observe for signs of injury -identify interventions or safety devices.

-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 41 . influenza SE: Acute aspirin toxicity: hyperpnea . tab OD po Analgesic. and headache are common. attributable to cupirine ability to inhibit he synthesis of prostaglandins I. -give drug with fullglass of H2O to reduce risk or tablet or capsule lodging in the esophagus .estrogen receptorpositives breast cancer cell increased DRUG THERAPEUTIC RECORD Indication/ Principles of Contraindation/ Care Side effects I. tachypnea. depression. -elevate the leg of the patient. Tamoxifen therapy SE: C1: allergies.) Treatment Evaluation * Aspirin C: (aspilet) T Antipyriene. chicken pox. pregnancy and breastfeeding -25mg po everyday with meals. has anti. NSAID M: Analgesic and antirheumatic effect are. patient has not been through menopause yet. anxiety. antiinflammatory. -aoid use during premenopause or with renal or nepatic dysfunction.Drug/ Classification/ Dose/ Mechanism Frequency / Route * Aromasin 25 mg T tab-OD C: Antineoplastic M: Binds to estrogen receptors. hemorrhage -give drug with food or after meals if GI upset occurs. mild to moderate pain fever Inflammatory conditions Rheumatic fever rheumatoid arthritis. treatment of advanced breast cancer in postmenopaural women whose decreased has progressed FF. -assist client in doing ROM exercises -provide comfort measures such as back rub. .platelet salicylate. anti.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. Antirheumatic . osteoarthritis CI: Allerge use continuously with impaired renal function.(ho flashes. GI upset.

. dizziness tinnitus like odor -take extra precautions to keep this drug out of the reach of children 42 . 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. 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 . Inhibition of platelet aggregation is attributable to the inhibition of platelet synthesis of thromboxane A21 a potent vasoconstricto r and inducer of platelet aggregation. dyspnea. occult blood loss.

colorless to pale yellow -can be taken with or without food. preventing the formation of clots. C: lowmolecular weight heparin antithrombotic M: lowmolecular weight heparin that inhibits thrombus and clot formation by checking factor XA. -divert patient’s attention -guide imagery -encourage -further complicatio ns were prevented. Of age -severely to liver function SE: headache. chills. CI: hypersensitivity use cautiously with pregnancy or lactation history of GI blood. factor II a. dizziness -give deep subcutaneous injections. prevention of deep vein thrombosis. a patient vasodilator and inhibitor of platelet aggregation. *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. Monitor blood test -provide a safety and comfortable environment -provide rest periods -avoid patient from dying strenuous activities -position client in a comfortable position.*Clexane 0-4 cc SQ OD prostaglandin. pain. Do not give clexane by IM injection -patient should be lying down. local irritation. fever. spinal top SE: Bruishing. but may start to work quicker if taken without food. Acute and chronic treatment of asteoarthritis and RA CI: Children and adolescent under 16 yrs. 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. -there is an improvemen t of patient’s gait and the patient was able to slightly move her extremities 43 . who is at risk of bleeding -check patient for signs of bleeding. -do not exceed the prescribed dose -maybe taken with low dose -provide for safety measures (electric razor. soft toothbrush) to prevent injury to patient. thrombocytopenia . which may lead to pulmonary embolism following hip replacement. I. Prevention of ischemic complications.

liver cirrhosis and fatty liver. cause pain or swelling and inflammation. but as catalysts. -provide rest periods -avoid client to perform strenuous activities -provide a safety environment I. -initially 1 capsule every 8 hours.* vitamin B complex (sangubio n) T tab OD involved on producing prostaglandins in response to injury or certain diseases. they serve as essential link and regulators in metabolic reaction that release energy from food. -best to take after meals. 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 44 . dry mouth. 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. flatulence (76 mg daily) aspirin. indigestion. lactation SE: sedation. They contain no useful energy. vomiting. Control the processes of Constipation. For liver protection eases of intoxication (alcohol abuse) CI: hypersensitivity. dizziness. nausea. treatment of chronic liver disease . Follow up treatment 1 capsule daily DBE -hot compress is applied to the affected site or area. 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. nausea. There prostaglandins .

hypercalcemia. lactation.encourage client to exercise regularly. and pain dry mouth. . maintenance of health metabolism C: electrolyte Antacid M: Essential element of the body.encourage client to eat foods rich in calcium such as milk. dysfunction pregnancy. thirst. neutralizes or reduces gastric acidity. dry mouth.. I: Acute and long treatment of RA and osteoarthritis. heat waves.do not administer oral drugs within 12 hour of antacid administration. cheese. use cautiously withdrawal.relief of mild to moderate pain. .impart [atient the importamce of takiln adequate amount of nutritious foods. If .provide rest periods . nausea. CI: Allergy. blood coagulation: is an enzyme cofactor and affects the secretom activity of endocrine and exocrine glands.there was an improvemen t of patient’s gait and the 45 . . .report loss of appetite. assist growth. vomiting. .*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. local irritation. . helps maintain cardiac function. helps maintain the functional integrity if nervous and muscular system. tingling.the strength of patient’s bones were improved as evidenced by standing or walking with assistance. C: NSAID Non-opioid analgesics M: Antiinflammatory foods I: Dietary supplement when calcium intake is in adequate. abdominal pain. . treatment of calcium deficiency. . prevention of hypocalcemia during exchange transfusions. For over-thecounter Use: Do not take for more than 10 days. Se: Slowed heart rate. increase voiding.assist client be expose to sunlight for 5-15 minutes.elevate the leg of the patient . constipation.

. dyspepsia. . SE: Headache. urinary and fecal incontinence. peripheral edema.promote a quite.thigh and right knee twice a day.liver functions should be assessed before and regularly during treatment. CI: Significant renal impairment. *Calmose ptine ointment appky to affected C: Topical antivirals M: Protects. . . .maintain general well-being and hygiene of the . I: Poor appetite in adult. dizziness.the patient was able to improve her appetite as evidenced by eating her meals an time and avoiding to skip meals.the dosage must be reduced to patient’s with liver damage. rash.instruct patient to eat adequate nutritious foods. patient was able to slightly move her extremities. pat dry and apply once daily or as necessary . inhibits prostaglandin and has antibradykinin and lysosomal or membrane stabilizing actions. nausea.encourage client to do DBE . lactation allergy to ketoprofen. soothes and helps promote I: Wound drainage. dysuria.provide small frequent feelings . and other chronic ailments. . and analgesic activity. dyspnea. relaxing and comfortable environment . . use cautiously the impaired hearing allergies hepatic.provide comfort measures . pruritus.offer foods that are attractive or presentable enough to stimulate appetite. pregnancy. *Dibencos ide (heraclene ) Mg tav T tab HD C: Appetite stimulants M: Improes appetite and preents faulty nutrition and other chronic ailments.patient’s wound was easily healed and bedsores 46 . . renal impairment. CV and GI conditions.cleanse skin. convalescence from acute infection: CI: Hypersensitivity symptoms persist contact your HC provider. adjuvant to the treatment of TB.should be used with caution in patient’s with diabetes mellitus as their management may become more difficult.impart to patient the importance of taking adequate nutritious foods. bedsores. ileo .

dime thicone.call your doctor if you have any signs of redness and warmth or oozing skin lesions. .avoid getting this medication in your mouth or eyes.encourage client to do regular exercise assisted by the SO. mineral oil or wax.inform patient of likelihood of abdominal pain and flatulence. . reservoirs. . . lanolin.site BID healing in those with impaired skin integrity. abdominal pain. patients. parabens. .monitor serum glucose level frequently to determine drug effectiveness and dosage. flatulence.give drug TID with the first bite of each meal. 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. were . .do not discontinue this drug without consultation from health care provider. 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.impart to client the . use cautiously with renal impairment pregnancy and lactation.further complicatio ns were being prevented and appearance of signs and symptoms slowly diminished 47 . cod liver oil. SE: Hypoglycemia. .meticulous skin care . .promote proper environment al sanitation. clean and comfortable environment . jelly. .do not use this medication if you are allergic to zinc. .impart to patient to eat a nondiabetic diet. petroleum. CI: Hypersensitivity. anal.provide a prevented. .consult with a dietician to establish weight loss program and dietary control.

diarrhea. CI: Hypersensitivity.avoid the client from eating foods rich in fats and cholesterol. tachycardia. insulin.*Ranitidin e (ulcin) 75 mg tab PC 3x a day 6 am – 6 pm hemoglobin. in controlling blood glucose. use cautiously the impaired renal or hepatic function pregnancy.if you are using antacid. SE: Headache. thrombocytopenia . does not enhance insulin secretion. leucopenia.encourage client to ear adequate nutritious foods at a regular meal time. rash. histamine. C: Histanine. being careful of the time administered. sour stomach. bradycardia. malaise. . acid ingestion. gastrin and pentagastrin. take it exactly as prescribed.impart to client not to skip meals. . dizziness. . cholinergic agonists. .the patient was able to feel more comfortable as evidenced resting and sleeping comfortably. .administered oral drug with meals and hours. constipation. .decrease doses in renal and liver failure. . 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.provide rest periods . 48 .have regular medical follow up care to evaluate your response.position client into a comfortable position. importance of taking nutritious foods. treatment of heart burn. . anemia. so its effects are addictive to those of the sulfonyl areas. I: Short term treatment of active duodenal ulcer. .

P= To promote adequate mobility of the client. provided comfort measures such as backrub. difficulty initiating in gait. E= The patient was able to demonstrate increasing function of the extremities as evidenced by standing and walking between parallel bars with assistance. assisted patient upon doing gait training. I= Introduced name to the patient. has difficulty in moving the extremities. A= Impaired physical mobility. supported affected body parts/ joints using pillows/ rolls. R= 20 bpm and BP= 120/70 mmHg. communicative. P= 86 pm. monitored v/s. of the patient. has difficulty in changing position while lying on bed.“ Dili gehapon ayu malihuk akong tiil day”. 49 . limited range of motion in the extremities. awake. the patient is reading a newspaper.5 degree Celsius. coherent. documented the v/s and I and O of the patient. slowed movement. set siderails up. inability to walk or stand alone. conscious.5 SOAPIE SOAPIE #1 S. consulted with physical or occupational therapist as indicated. encouraged patient to do DBE. assessed the condition.Received patient lying on bed with head elevated to 30 degrees.3. without IV. with the following v/s T= 35. inability to stand alone related to skeletal impairment 2 degrees to fracture on the right femoral neck. assisted patient in doing ROM exercises. O.

documented the v/s.SOAPIE #2 S= “Naproblema man ko sa akong tiil day kay pila na ni ka adlaw walay lihok. monitored cardiac rhythm. reinforced need for adequate rest while encouraging activity within client’s limitations. noted signs of changes in respiratory rate. P= 76 bpm. swelling on the area and demonstrates calm breathing. monitored v/s. O= Received patient sitting up on bed. no verbalization of pain. with the following v/s T= 35. pursed top breathing. depth. . A= Risk for altered blood flow r/t immobility 2 degrees to fracture of the right femoral neck. remains intact. check the CRT of the patient. E= The client’s extremities are warm and pink. murag lain na kaayu akong feeling”. communicative. CRT results of 2 seconds.lihok. as verbalized by the patient. limited movement of the lower extremities.7 degrees Celsius. reviewed risk factors. BP= 120/70 with feet supported by rolled towels. conscious. use of accessory muscles. without IV. 50 . encouraged frequent position changes and DBE / coughing exercises. areas or pallor/ cyanosis. administered medications. I and O and medications taken by the patient. assessed the condition of the patient. auscultated breath sounds if there is a decrease or adventitious breath sounds as well as fremitus. coherent. R= 19 bpm. P= To enhance blood circulation I= Introduced name to the patient.

and preferably more frequently in patients who have no spontaneous movement. 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 51 . the patients as well as the significant other or family will be able to: 1. *the recommendation is to change body position at least every 2 hours. HEALTH TEACHING PLAN Content Methodology Evaluation Positioning (Goals) * to prevent contractures * stimulate circulation and prevent pressure sores * prevent thrombophiebitis and pulmonary embolism. * 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. attitude and skills in preventing complications of immobility. the patient as well as the significant others or family will be able to acquire knowledge. Specific Objectives: After 45 minutes of teaching. explain the goals of frequent position changes.

Prone position a. The Arms are flexed at the elbow with the hands resting against the lateral abdomen. trochanter tons are place under the greater trochanter in the hip joint areas. f. Side lying or lateral position a. the trunk is positioned so traction of the hips is minimized to prevent hip contractive. the elbow are fexed Informal discussion -the patient was able to verbalize the different proper positions for proper body alignment 52 . b. the body is an alignment and is not twisted c. a pillow supports the arm which is flexed of both the elbow and shoulder joints. Dorsal or Supine Position. e. d. the neels are suspended in a space between the mattress and the footboard to prevent neel pressure. 2. c. the head is turned laterally and is in alignment with the rest of the body b. d. the arms are abducted and externally rotated at the shoulder joint. the head is in line with the spine both laterally and anteroposteriority. the uppermost hip joint silently forward and supported by a pillow in a position of slight abduction. a. the head is in line with the spine b. the legs are extended in a neutral position with the toes pointed towards the ceiling. enumerate the positions for proper body alignment Proper Body Alignment 1.2. 3.

Resistive exercise 5. 3. discuss the different therapeutic exercises Therapeutic Exercises 1. * Flexion-hyperextension. * Adduction-abduction and opposition of thumb * Adduction-abduction. adduction-abduction of toes * Adduction-abuction. active range of motion 4. Eversion of the ankle. Range of motion * Flexion extension of shoulder. flexion-hyper extension of fingers. d. * Pronation-supination of elbow. Isometric or muscle settings exercise.c. 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 53 . the lower extremities remain in a neutral position. * Dorsiflexion and palmar flexion of wrist. 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. * Ulnar-radial deviation of wrist. Positive range of motion exercise 2. * Fexion extension of elbow * adduction-abduction of shoulder. active assistive range of motion 3. *Dorsiflexion-Plantarflexion. * Flexion-extension. internal rotation or external rotation of the hip. a small flat support is placed under the pelvis extending from the level of the umbilicus to the upper third of the thigh.

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. 5.* Lateral bending of cervical spine. 54 .

teaches symptoms needing attention. the student nurse observed certain changes from the patient. 55 . increased pain and elevated temperature and explains basis for fracture treatment and need for patient participation in therapeutic regimen. The patient reports decreased pain with elevation. reports working through feelings about trauma. urine output adequate and no calf pain reported: Homan’s sign negative. methods of safe ambulation – walker. crutches. The patient also exhibits unlabored respirations. decreased function. The patient is instructed about exercises to strengthening upper extremity muscles If crutch walking is planned. The patient and the family were also informed that the patient must have an adequate balanced diet to promote bone and soft tissue healing. v/s stable. Evaluation and Recommendation Prognosis of the patient After 3 days of intervention. such as numbness. ice and analgesic. no signs of neurovascular compromise. hygiene and dressing practices with minimal assistance and denies acute symptoms of stress. using affected extremity for light activity as allowed. 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. a febrile. avoidance of fatigue and proper footwear. The patient also performs active ROM correctly.V. emphasizes instructions concerning amount of weight bearing that will be permitted on fractured extremity. Recommendation As a researcher in this case study. care. alert and oriented.

This study would help the student nurse in providing a higher quality of care of patients with the same condition. people. causes. Hopefully. Evaluation and Implication of this case study to: Nursing Practice The result of this case study would provide the student nurse with sufficient knowledge. and nursing management.oriented and having a commitment to the organization. nurses are accountable to their patients to promote a maximum level of health. Nursing Education Education can promote enhancement of professionalism through an on.going learning process. signs and symptoms. More specifically. Through this case study. Nursing Research Nursing research is essential for the development of scientific knowledge that enables nurses to provide evidenced-based health care. 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. nurses are likely to become well respected through the formal educational programs. this 56 . cost effective care and for seeking ways to improve that care. This would ensure the timely healing of injury and the prevention of complications.motivated. Broadly nursing is accountable to society for providing quality. attitude and skills towards the management of patients with fracture on the right femoral neck. This could contribute to the development of the case study of fracture – its prevention. This case study would contribute more information and facts about fracture on the right femoral neck. whether self.VI. 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.

VII – Referral and Follow-Up The patient was informed to have a continuous appointment with the Rehabilitation Care Program Health Care providers after discharge. 6th Edition Baltimore: C. Elaine N.F. M. A. “ Nurses Pocket Guide”. I. Manual of nursing Practice. Anne. 2001. Brenda I. 2004. interventions and rationales. . 1998. Potter. 9th Edition (2004). M. Fundamentals of Nursing. 5th Edition. The patient was encouraged for follow-up medical supervision to monitor for union problems. Moorhouse. Patricia and Perry. Fundamentals of Nursing. 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. Barbara et al. Incorporated. 7th Edtion.B. Pearson Education South Asia Pte. Textbook of Medical-Surgical Nursing. Lippincott Company. 10th Edition Philadelphia: I. Ltd. Mosby and Company. 7th Edition. Nettina.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. Singapore. VIII – Bibliography Bare... 2004. Marleb. Sandra M. Essential of Human Anatomy and Physiology. 57 . and Smeltzer.B Lippincott Company. Doenges. 2005.. Diagnosis.V. Rozler. Geissler – Murr. Newyork: AddisonWeatleylongman.

Geissler – Murr. A. “ Nursing Care Plans”... Guidelines for Individualizing Patient Care. M. . F. 58 . Davis Company.Doenges. 6th Edition.F. Moorhouse. 2002.A. M.

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