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.

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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.

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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.

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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.

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

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

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

when blood volume has been restored.4-11. 2008 Complete Blood Count Hemoglobin Hematocrit WBC RBC Normal values Significance 14.6 -Increased-macrocytic anemia 33.4% 4.5-5.9x10^ g/uL 9.7 10 . -Normal Mean Corpuseular Hemoglobin Mean Cell Volume (MCA) Mean Corpuseular Hemoglobin Platelet 27. collagen and hemolytic disorders -Normal Source: Brunner and Suddarth‘s. Diagnostic Test Patient‘s Result Diagnostic test April 10.7 80-96 fL 103.2 pg 32.5 % 32 -Decrease-severe hypochronic anemia 150.8 5.000-450. page 2214-2215 -Normal Serum 3.1 28. with excessive fluid intake.Decreased-various anemias.000 387 -Normal Differential Count Neutropihl Basophil Eosinophil Monocyte Lympocyte 40-70 % 0-1 % 0-5 % 0-8% 20-40% 67 0 4 09 20 -Normal -Normal -Normal -Increase-viral infection.6-5 4.2.all anemias and leukemia.5-33.5-50.4-35. -Decreased-severe anemias -Normal -Decreased.10th Edition Volume 2.0-17. Textbook of Medical-Surgical Nursing.5 g/dL 41.8 .0x10^ g/uL 4.32 2.

3-9.2229.-sec.Potassium Creatinine Calcium Protein Albumen Globulin Total Protein GCT(50gms) 6. deficiency -Decreased-anemia.page 2217. malnutrition -Decreased-no clinical significance -Increased-chronic infection.8 145 20 -Decreased-Muscular atrophy.7-1.2224.41 min.2 1.-sec.0 2.page 2230. multiple myeloma -Decreased-malnutrition -Increased-diabetes mellitus -Normal Source: Brunner and Suddarth‘s. anemia. Clotting time 5-15 -Normal Prothombin time 10-13 -Increased-deficiency of factors I.10th Edition Volume 2. VII.page 2225. leukemia -Decreased-vitamin D.5 2 6.6 8. 10. II.9 5.5 6.10th Edition Volume 2.3-5. Textbook of Medical-Surgical Nursing.2232 -Increased-diabetes mellitus Source: Brunner and Suddarth‘s.5-7.2221.2 1.8 sec. 13.8 65-110 8-35 u/mL 6.4-10.5 4.10th Edition Volume 2. fat malabsorption -Normal % activity 70-120 96. -Normal Bleeding time-sim 2. PBS 65-110 118 Uric acid 2.2 % 11 .4mg/dL -Normal Source: Brunner and Suddarth‘s.5 8.2219. V.9 2. Textbook of Medical-Surgical Nursing.2 3.31 min. and X.2230. Textbook of Medical-Surgical Nursing.2233.2-2.

8 1.2 1.003-1. Textbook of Medical-Surgical Nursing.029 Negative Negative Negative Negative Negative Yellow Clear 6.03 -Normal Source: Brunner and Suddarth‘s.010 Trace Trace Negative Negative Negative -Normal -Normal -Normal -Normal -Glomerular disease.INR <1.page 2214 Urinalysis Macroscopic Examination Color Appearance Plt Specific gravity Protein Glucose Ketones Blood Leukocytes Yellow Clear 4.5-7. nephritic syndrome -Diabetes mellitus -Normal -Normal -Normal Nitrite Bilirubin Urohilinogen Negative Negative Normal Negative Negative 0.0 1.10th Edition Volume 2.2 eu/dL -Normal -Normal -Normal 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 12 .

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

Nutritional / Metabolic Pattern The patient‘s usual food intake before the hospitalization includes fish. the patient eats more foods rich in fats. vegetables. chicken and especially foods rich in fats. Fosamax. Now the patient was advised by her attending physician to restrict foods that can aggravate her condition. The patient is non-smoker and non-alcoholic drinker and she has no known allergies. meat. There is a change in her appetite now. She consumes more than 8 glasses of water a day. Present Profile of Functional Health Patterns Profile of Functional Health Patterns 3.2.3. 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 maintenance meds were Aromasin. fruits. During the patient‘s hospitalization. The patient doesn‘t smoke or drink alcoholic beverages. The patient‘s attending physician encourages her to take more of calcium and Vitamin D in order for her bones to become stronger. 14 . This is because of the limited movements she felt. sugar or glucose and cholesterol in their meals and she drinks plenty of water everyday. Before the admission. The patient was also encourage to take more of Calcium and Vitamin D in order for her bones to become stronger. sugar/glucose and cholesterol. the inability to walk or stand and difficulty in moving the extremities due to the fracture of her right femoral neck. she often eats a little only each meal. has no known allergies. 3. her diet was changed to low fat and low cholesterol diet because she was diagnosed of having diabetes mellitus type II. Centrum and Caltrate.1.

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. Now. The patient usually stays in bed and read newspapers sometimes. 3. 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.R.3. 3. instructions and be able to follow and answer them correctly. 15 .3.6. can hear.4. she can‘t take a nap in the afternoon due to her REHAB CARE. There is no burning sensation during ur4ination and her stool is brownish formed stool. 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. but now. She speaks slowly English. smell. understands questions. Elimination Pattern Before.5. the patient can freely go to the C. Cognitive/ Perceptual Pattern The patient before. she‘s just on bed lying assisted by her private nurses and CDUH health care providers. 3. She easily communicates. She usually guided her grandsons and granddaughters. Rest/ Sleep Pattern Before the hospitalization. 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. Tagalog and Bisaya languages as of now but before she speaks fluently all of those languages. taste and feel well and correctly but the patient cannot read her newspaper without her eyeglasses just the same as now.

3.10.Stress Tolerance Pattern The patient usually makes her decision as for now since her children were busy in their work abroad. but they make sure they never forget to support and help their mother recover from illness. 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. the patient usually shares her concerns to her private nurses and of course also to the student nurses. changing diaper. Self. Value-Belief Pattern The patient find source strength and hope with God and her loved ones. Sexuality/ Reproduction The patient‘s husband just recently died.9. Now. God is very much important to the patient.3. 3.8. it should be keep as private. Through this. 3. She usually reads newspaper for her to be more relaxed. Sometimes.Perception Pattern The patient‘s most concern about right now is her rehabilitation care. she usually goes to church together with her other children. changing clothes because she believes that as a woman. They were not involved in any religious organizations or practices. managements. The patient knows how to pray and praise God for all the nice things he had given. the patient does not allow anyone to see her getting undressed. medications and all out care rendered by the hospital to the patient assured her for the improvement of her condition. she maybe able to cope up easily from her unhealthy condition.7. The patient never loses the support of her children even if they were not there physically and also her private nurses. 16 . Before. The treatment. Coping.

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

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

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

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

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

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

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 fractures of long bones. abnormal movement (false motion) may be present. angulations. Pain contributes to the loss of function. -After a fracture.4 Classical and Clinical Sign‘s and Symptoms Classical Symptoms Pain Clinical Symptoms Manifested . the extremity cannot function properly.4.unable to move extremities and unable to stand or walk without assistance. It is caused by the rubbing of the bone fragments against each other. -localized swelling and discoloration 23 Shortening Crepitus Manifested Swelling and Manifested . can be felt. Manifested . The fragments often overlap by as much as 2.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. Loss of function Deformity Manifested -Displacement.5 to 5 cm (1 to 2 inches) -When the extremity is examined with the hands.The pain is continuous and increases in severity until the bone fragment are immobilized. or . limb is compared with the uninjured extremity. because normal function of the muscles depends on the integrity of the bones to which they are attached. The muscle spasm that accompanies fracture is a type of natural splinting designed to minimize further movement of he fracture fragments. In addition. Rationale . 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. called crepitus. a grating sensation. Not Manifested .

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

Buck‘s extension. The preoperative objective is to ensure that the patient is in as favorable a condition as possible for the surgery. may be applied to reduce muscle spasm. 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. Surgical intervention is carried out as soon as possible after injury. Nursing Interventions 1. with reduction and internal fixation performed within 12 to 24 hours after fracture. 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). 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. 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. multiple pins. Displaced femoral neck fractures may be treated as emergencies. to immobilize the extremity. Adequate reduction is important for fracture healing (the better the reduction. and to relieve pain. or compression screw devices. After general or spinal anesthesia. Total hip replacement may be used in selected patients with acetabular defects. 25 . The orthopedic surgeon determines the specific fixation device based on the fracture site or sites. the better the healing). the hip fracture is reduced under x-ray visualization using an image intensifier.IV. or (3) closed reduction with pereutaneous stabilization for an intracapsular fracture. a nail and plate combination. Medical and Surgical Management Temporary skin traction. This minimizes the effects of diminished blood supply and reduces the risk for avascular necrosis. A stable fracture is usually fixed with nails.

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

Health Promotion Osteoporosis screening of patients who have experienced hip fracture is important for prevention of future fractures. makes the pain worse. splints. * Establish a supportive relationship to assist patient to deal with discomfort. boning. lifestyle changes. aching and so forth) . and appliances) * Initiate activities to prevent or modify pain * Administer prescribed pharmaceuticals as indicated. and so forth. 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. Specific therapeutic interventions need to be initiated to retard additional bone loss and to build bone mineral density. and exercise to promote bone3 health is needed. Encourage use of less potent drugs as severity of discomfort diseases. Relieving Pain * Secure data concerning pain . traction.have patient describe the pain. continuous. With dual-energy x-ray absorptiometry (DEXA) scan screenings the actual risk for additional fracture can be determined. radiating.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. pressure from equipment (casts. * Encourage patient to become an active participant in rehabilitative plans. throbbing. sharp. 27 . relieves the pain. In addition.ask patient what causes the pain. 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. Specific patient education regarding dietary requirements. location characteristics (dull. .

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

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

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

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

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

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

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

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

BRUNSWICK LENS MODEL 36 .

Needs/ Problem / Cues I. and damaged blood vessels. Physiologic A. ruptured tendons. -Support affected body parts or joints using pillows or rolls. of the hemorrhage into right the muscles and femoral joints. -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. -Slowed movement. -Provides comfort measures such as backrub. Deficit 1. the extremities cannot function properly because normal functions of muscle depend on the integrity of the bones which they are attached. . severed nerves. -Consult with physical or occupational therapist as indicated. -limited range of motion in the extremities. alone adjacent related to structures are skeletal also affected. ―dili gihapon mu lihok akong tiil day‖ as verbalized by the patient. 37 . joints neck dislocations. impairmen resulting in soft t to facture tissue edema. -administer pain reliever such as areoxia as prescribe by the physician.assist patient to do active ROM exercises on the lower extremities. demonst rate increasi ng function of the extremit ies Measures to: 1. After a fracture. -Difficulty in moving the extremities. -Inability to walk or stand alone. absorb. 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.instruct the 5. Promote adequate mobility of the client. -Encourage patient to stand or walk as tolerated using parallel bars. Body organs maybe injured by the force that caused the fracture fragments. When inability the bone is to stand broken. .Difficulty in changing position while lying on bed. Rationale Fractures occur when the bone is subjected to Impaired stress greater physical that it can mobility. -Difficulty initiating gait.0 to keep siderails up or raised. Impaired Physical Mobility Cues: .

enhance blood circulati on 2. while encouraging activities within clients limitation -encourage frequent position changes and DBE or coughing exercise. 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. prevent. -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.2. -administer medications as indicated. Note areas of pallor or cynosis. blood emboli -note signs of changes in respiratory rate. thus. there is immobility because normal function of the muscle depends on the integrity of the bones to which they are attached. 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. -to treat underlying conditions 38 .

3. -for early detection. -to promote individual safety. blood vessels. Overload 3. 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. tendons.B. -to promote wellness. for the patients to be free from injury -ascertain knowledge of safety needs or injury -assess muscle strength gross and fine motor coordination. A fracture occurs when the stress placed on a bone is greater than a bone can absorb. -observe for signs of injury -identify interventions or safety devices. 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. nerves. joints and other organs maybe injured when fracture occurs. to produce risk factors and protect self from injury 3. -to improve skeletal integrity. 39 . Muscle. -encourage participation in rehab programs. 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.

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

dyspnea. occult blood loss. 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 .. 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. Inhibition of platelet aggregation is attributable to the inhibition of platelet synthesis of thromboxane A21 a potent vasoconstricto r and inducer of platelet aggregation. dizziness tinnitus like odor -take extra precautions to keep this drug out of the reach of children 41 .

CI: hypersensitivity use cautiously with pregnancy or lactation history of GI blood. dizziness -give deep subcutaneous injections. fever. local irritation. which may lead to pulmonary embolism following hip replacement. thrombocytopenia . soft toothbrush) to prevent injury to patient. C: lowmolecular weight heparin antithrombotic M: lowmolecular weight heparin that inhibits thrombus and clot formation by checking factor XA. spinal top SE: Bruishing. but may start to work quicker if taken without food. -there is an improvemen t of patient‘s gait and the patient was able to slightly move her extremities 42 . Of age -severely to liver function SE: headache. *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. factor II a. I. preventing the formation of clots. a patient vasodilator and inhibitor of platelet aggregation. Do not give clexane by IM injection -patient should be lying down.*Clexane 0-4 cc SQ OD prostaglandin. -do not exceed the prescribed dose -maybe taken with low dose -provide for safety measures (electric razor. chills. colorless to pale yellow -can be taken with or without food. 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. pain. Acute and chronic treatment of asteoarthritis and RA CI: Children and adolescent under 16 yrs. Prevention of ischemic complications. -divert patient‘s attention -guide imagery -encourage -further complicatio ns were prevented. prevention of deep vein thrombosis. who is at risk of bleeding -check patient for signs of bleeding.

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

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

ileo . inhibits prostaglandin and has antibradykinin and lysosomal or membrane stabilizing actions.liver functions should be assessed before and regularly during treatment.provide comfort measures . bedsores. relaxing and comfortable environment . pregnancy. CI: Significant renal impairment. I: Poor appetite in adult. . convalescence from acute infection: CI: Hypersensitivity symptoms persist contact your HC provider.offer foods that are attractive or presentable enough to stimulate appetite.the patient was able to improve her appetite as evidenced by eating her meals an time and avoiding to skip meals. . dysuria. . rash. and analgesic activity.the dosage must be reduced to patient‘s with liver damage.provide small frequent feelings . pat dry and apply once daily or as necessary . dizziness. urinary and fecal incontinence. pruritus.instruct patient to eat adequate nutritious foods. adjuvant to the treatment of TB.thigh and right knee twice a day. CV and GI conditions.promote a quite.impart to patient the importance of taking adequate nutritious foods. renal impairment. . . lactation allergy to ketoprofen. dyspepsia. peripheral edema. soothes and helps promote I: Wound drainage. *Dibencos ide (heraclene ) Mg tav T tab HD C: Appetite stimulants M: Improes appetite and preents faulty nutrition and other chronic ailments. dyspnea.encourage client to do DBE .patient‘s wound was easily healed and bedsores 45 .should be used with caution in patient‘s with diabetes mellitus as their management may become more difficult. patient was able to slightly move her extremities. . nausea.maintain general well-being and hygiene of the . *Calmose ptine ointment appky to affected C: Topical antivirals M: Protects.cleanse skin. use cautiously the impaired hearing allergies hepatic. . and other chronic ailments. SE: Headache. .

inform patient of likelihood of abdominal pain and flatulence.site BID healing in those with impaired skin integrity. . jelly.provide a prevented. If it does rinse with water right away. . 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. parabens. 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.give drug TID with the first bite of each meal.monitor serum glucose level frequently to determine drug effectiveness and dosage. . patients.consult with a dietician to establish weight loss program and dietary control.do not use this medication if you are allergic to zinc.further complicatio ns were being prevented and appearance of signs and symptoms slowly diminished 46 . flatulence. SE: Hypoglycemia.impart to client the . . . lanolin.impart to patient to eat a nondiabetic diet.encourage client to do regular exercise assisted by the SO.meticulous skin care . use cautiously with renal impairment pregnancy and lactation. petroleum. . abdominal pain. CI: Hypersensitivity.promote proper environment al sanitation. dime thicone. . . reservoirs. were .avoid getting this medication in your mouth or eyes. cod liver oil.call your doctor if you have any signs of redness and warmth or oozing skin lesions. . . . clean and comfortable environment .do not discontinue this drug without consultation from health care provider. . mineral oil or wax. anal.

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

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

7 degrees Celsius. limited movement of the lower extremities. monitored cardiac rhythm. A= Risk for altered blood flow r/t immobility 2 degrees to fracture of the right femoral neck.lihok. pursed top breathing. BP= 120/70 with feet supported by rolled towels. areas or pallor/ cyanosis. swelling on the area and demonstrates calm breathing. without IV. encouraged frequent position changes and DBE / coughing exercises. CRT results of 2 seconds.SOAPIE #2 S= ―Naproblema man ko sa akong tiil day kay pila na ni ka adlaw walay lihok. depth. O= Received patient sitting up on bed. use of accessory muscles. with the following v/s T= 35. as verbalized by the patient. reinforced need for adequate rest while encouraging activity within client‘s limitations. . noted signs of changes in respiratory rate. P= To enhance blood circulation I= Introduced name to the patient. R= 19 bpm. documented the v/s. coherent. 49 . no verbalization of pain. reviewed risk factors. communicative. monitored v/s. remains intact. P= 76 bpm. murag lain na kaayu akong feeling‖. I and O and medications taken by the patient. conscious. administered medications. E= The client‘s extremities are warm and pink. auscultated breath sounds if there is a decrease or adventitious breath sounds as well as fremitus. check the CRT of the patient. assessed the condition of the patient.

Specific Objectives: After 45 minutes of teaching.Objective General Objectives: After 3 day of varied learning activities. the patient as well as the significant others or family will be able to acquire knowledge. the patients as well as the significant other or family will be able to: 1. attitude and skills in preventing complications of immobility. explain the goals of frequent position changes. HEALTH TEACHING PLAN Content Methodology Evaluation Positioning (Goals) * to prevent contractures * stimulate circulation and prevent pressure sores * prevent thrombophiebitis and pulmonary embolism. *the recommendation is to change body position at least every 2 hours. * 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. 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 50 .

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

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

5.* Lateral bending of cervical spine. 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.

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

Broadly nursing is accountable to society for providing quality. Through this case study.motivated. 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. cost effective care and for seeking ways to improve that care. Evaluation and Implication of this case study to: Nursing Practice The result of this case study would provide the student nurse with sufficient knowledge. causes. nurses are likely to become well respected through the formal educational programs. Nursing Education Education can promote enhancement of professionalism through an on. This study would help the student nurse in providing a higher quality of care of patients with the same condition. More specifically. Nursing Research Nursing research is essential for the development of scientific knowledge that enables nurses to provide evidenced-based health care.VI. 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. attitude and skills towards the management of patients with fracture on the right femoral neck. whether self. people. Hopefully. signs and symptoms.oriented and having a commitment to the organization. nurses are accountable to their patients to promote a maximum level of health. this 55 . 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. and nursing management.

Textbook of Medical-Surgical Nursing. Doenges.F. Pearson Education South Asia Pte. Marleb. Patricia and Perry. Ltd. 1998. ― Nurses Pocket Guide‖. 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. A. Diagnosis. Newyork: AddisonWeatleylongman. Fundamentals of Nursing. 7th Edtion. Lippincott Company. Essential of Human Anatomy and Physiology.. and Smeltzer. 2004.. M. Brenda I. Incorporated. Geissler – Murr. Moorhouse. The patient was encouraged for follow-up medical supervision to monitor for union problems. 2004. 2005.. M. VIII – Bibliography Bare. Manual of nursing Practice.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. Sandra M.V. Fundamentals of Nursing. Rozler. Elaine N. Anne. 56 . interventions and rationales. Singapore. 5th Edition. Potter. VII – Referral and Follow-Up The patient was informed to have a continuous appointment with the Rehabilitation Care Program Health Care providers after discharge. Barbara et al. 10th Edition Philadelphia: I. 7th Edition. Suzzane C. Mosby and Company. Nettina.B Lippincott Company.B. 6th Edition Baltimore: C. 9th Edition (2004). I. . 2001.

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

58 .