Nursing Case Study (FRACTURE

)

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Fracture
Fracture is a medical condition in which there is a break in the continuity of the
bone. A bone fracture can be the result of high force impact or stress, or trivial
injury as a result of certain medical conditions that weaken the bones, such as
osteoporosis, bone cancer, or osteogenesis imperfecta, where the fracture is then
properly termed a pathological fracture.

Closed (simple) fractures are those in which the skin is intact, while open
(compound) fractures involve wounds that communicate with the fracture, or where
fracture hematoma is exposed, and may thus expose bone to contamination. Open
injuries carry a higher risk of infection.

Comminuted fracture: A fracture in which the bone has broken into a number of
pieces.Other considerations in fracture care are displacement (fracture gap) and
angulation. If angulation or displacement is large, reduction (manipulation) of the
bone may be required and, in adults, frequently requires surgical care. These injuries
may take longer to heal than injuries without displacement or angulation.

Although bone tissue itself contains no nociceptors, bone fracture is very painful for
several reasons. Breaking in the continuity of the periosteum, with or without similar
discontinuity in endosteum, as both contain multiple nociceptors. Edema of nearby
soft tissues caused by bleeding of torn periosteal blood vessels evokes pressure
pain. Muscle spasms trying to hold bone fragments in place

Orthopedic surgeons treat fractures throughout the skeletal frame, except for the
skull (neurosurgeon) and face (ENT, or ear, nose, and throat, surgeon). Extremity
fractures are most common, and usually occur in men younger than age 45, and
then become more common in women over age 45. The reason for the difference is
when women go through menopause, and stop producing estrogen, the rate of bone
loss increases. Incidence rate of fractures in the Philippines is 475, 597 over
86,241,697 million estimated population, according to US Census Bureau,
International Data Base, 2004.

Spongy bone occurs in most bones. the sites of anterior cruciate and posterior cruciate ligament attachment.The intercondylar fossa is present between the condyles at the distal end of the femur. tibia. hard. The bones of the upper and lower extremities (ex.84 cm (1. Irregular bones are all others that do not fall into the previous categories. or cancellous.6 million red blood cells are produced each second by the bone marrow to replace those worn out and destroyed by the liver. Short bones are short. They have varied shapes. in the human femur: the head. and can support up to 30 times the weight of an adult. Initially. flat bones. Most bones contain both types. The average adult male femur is 48 centimeters (18. cube-shaped. femur. the lesser trochanter. When the supply of these minerals within the blood is low.) are of this type. and storing minerals. short bones. and surfaces features and include the bones of the vertebrae and a few in the skull. Its 206 bones form a rigid framework to which the softer tissues and organs of the body are attached. bones of shoulder girdle). which is located above. the greater trochanter. The bones of the body fall into four general categories: long bones. and collagenous fibers and ground substance to give the bone flexibility. Spongy bone is inside the compact bone and is very porous (full of tiny holes). and irregular bones. bone. respectively. The shaft of femur is cylindrical with a rough line on its posterior surface (linea aspera).12in) in diameter at the midshaft. Blood cells are produced by the marrow located in some bones. or dense bone. it will be withdrawn from the bones to replenish the supply. and found in the wrists and ankles. sizes. they are joined to the main body of the femur with cartilage. or protuberances. Bones serve as a storage area for minerals such as calcium and phosphorus. etc. An average of 2. humerus. and the lower extremity. buildup will occur within the bones. In addition to the intercondylar eminence on the tibial plateau.9 in) in length and 2. When an excess is present in the blood. usually in early adulthood. producing blood for the body. and forms the protective exterior portion of all bones.Anatomy And Physiology The Skeletal System serves many important functions. and spongy. Compact bone is dense. protecting. the femur is the longest and largest bone. ribs. allowing bodily movement. it provides the shape and form for our bodies in addition to supporting. cranial bones. ulna. metacarpals. The skeletal system is divided into 2. . Long bones are longer than they are wide and work as levers. They appear at various times from just before birth to about age 14. It forms part of the hip joint (at theacetabulum) and part of the knee joint. there is both an anterior and posterior intercondylar fossa (area). The axial and the appendicular skeleton. which gradually becomes ossified until the protuberances become an integral part of the femur bone. Compact. There are four eminences. Flat bones have broad surfaces for protection of organs and attachment of muscles (ex. Bones are composed of tissue that may take one of two forms. The bone tissue is composed of several types of bone cells embedded in a web of inorganic salts (mostly calcium and phosphorus) to give the bone strength.

O Once daily Contraindication: %u2022 Hypersensitivity to drug Side Effects: . ant antipyretic action due to inhibition of COX-2 Enzyne Indications and Usage: -Osteoarthritis Adults: 100 mg P.i.i.Pathophysiology PLAYING OF SPORT CAUSES STRESS ON THE FEMUR------------------>TWISTED LEG OF THE PATIENT (POSSIBLE PHYSICAL CONTACT AND LEANED TO MUCH WEIGHT ON THE TWISTED LEG) ------->FRACTURE (Fracture Close Middle/ 3rd. analgesics. Comminuted Left Femur)----------------> SKELETAL TRACTION (12lbs) ---------> (OPEN REDUCTION INTERNAL FIXATION) Drug study Name of Drug : GN: CELECOXIB BN: CELEBRIX Classification and Mechanism of Action: -NSAID'S (Non-steroidal anti inflammatory drugs) -Exhbits anti-inflammatory. b.d .Acute pain and Dysmenorrhea Adults: 400 mg P.d -Rheumatoid arthritis Adults: 100mg to 200 mg b.O.

leg cramps Respiratory: upper respiratory tract infection SKIN: rash Nursing Responsibilities: -Advise patient to immediately report bloody stools.Acute pain Adults: 75-150 mg P. headache. neutropenia Musculoskeletal: back pain. vomiting.CNS: dizziness. abdominal pain dyspepsia. -Instruct patient to take drug with food or milk -Advise the S. peripheral edema EENT: tinnitus.Inhibit cyclooxygenase an enzyme needed for prostaglandin synthesis this inhibition stimulates the anti- inflammatory response and blocks pain impulses Indication and Usage: . diarrhea. dry mouth Hepatic: Hepatoxicity Hematologic: ecchymosis. drowsiness.O to accompany the patient in going to the comfort room Name of Drug: GN: MEFENAMIC ACID BN: DOLFENAL Classification and Mechanism of ACtion: . constipation. sinuisitis GI: nausea. insomnia.d .O b. epistaxis.i. vomiting of blood.NSAID'S (Non-steroidal anti inflammatory drugs) . tachycardia. Fatigue CV: angina.

O to accompany the patient in going to the comfort room -Advise patient to report immediately persistence or failure to relieve pain. sinuisitis GI: nausea. constipation. peripheral edema EENT: tinnitus. epistaxis. drowsiness. One term is not better or worse than another. The nerve endings that surround bones contain pain fibers and and these fibers become irritated when the bone is broken or bruised. tachycardia. Nursing Care Plan Scientific Analysis Fractures occur when bone cannot withstand those outside forces. neutropenia Musculoskeletal: back pain. diarrhea. vomiting. or crack all mean the same thing. insomnia. joint pain Metabolic: dehydration SKIN: rash. Fracture. abdominal pain dyspepsia. break. . and the blood and associated swelling (edema) causes pain. Broken bones bleed. The integrity of the bone has been lost and the bone structure fails. diaphoresis Nursing Responsibilities: -Assess patient's pain before giving the medication -Instruct patient to take drug with food or milk -Advise the S. headache.Contraindication: %u2022 Hypersensitivity to drug Side Effects: CNS: dizziness. dry mouth Hepatic: Hepatoxicity Hematologic: ecchymosis. Fatigue CV: angina.

when indicated.psu. . -Observe wounds for formation of bronze discoloration of skin frothy/fruity smelling drainage. reflexes. b. be free of purulent drainage or erythema. c.htm Objectives After an hour of nurse -patient interaction the client will be able to: a.Provide information/ involve in appropriate community and national education programs.hmc.) Identify interventions to prevent/ reduce risk of infection. .) Verbalize understanding of individual causative/ risk factor(s). -Monitor vital signs. d.Administer medication as indicated: Tetanus toxoid .Recommend routine or preoperative body showers/ scrubs.) Achieve timely wound healing. .Maintain adequate hydration. Nursing Interventions: .edu/healthinfo/b/bonefracture.Monitor patients visitor's/ caregivers for respiratory illnesses .Provide wound/bone irrigation and apply warm soak as indicated. -Provide sterile pin/wound care according to protocol and exercise meticulous hand washing . be afebrile.Assess muscle tone.Inspect the skin for preexisting irritation or breaks in continuity. . Hershly Medical Center. and ability to speak. (2006). Bone Fracture.Instruct patient not to touch the insertion sites.) Demonstrate techniques. . retrieved by http://www. lifestyle changes to promote safe environment. .Referrence: Penn State Milton S.

A physical therapy program usually begins with range-of-motion and resistive exercises. Do every day up to 3 times a day. Define the causative factors of the current condition of the patient b. the patient will be able to: a. TEACHING STRATEGIES: Lecture Method . Hold for 5 to 15 minutes.Health Teaching Plan GOALS/OBJECTIVES Following a 30 minute nurse-client interation.to verbally transmit information directly to the learner. Display positive attitude while health teachings are provided CONTENTS COMMINUTED FRACTURE -A fracture in which bone is broken. Gently push the raised knee toward the floor using only leg muscles. Demonstrate proper exercises of the unaffected lower extremity c. for the purpose of instruction . and it strengthens the muscles surrounding the joints. a. splintered or crushed into a number of pieces. Lecture Method provides a background information as basis for presentation on the particular topic. then rest a minute. Lecture Method . edge of bed). making movement easier and reducing pain.) Unloading the knee Put a light weight (5 to 10 pounds) on your ankle and sit in a position that allows the leg to dangle (on a bench. Hold the stretch for 5 to 10 seconds. flexibility. 1 to 3 times a day. aerobic and muscular endurance. . REHABILITATION EXERCISES -to improve the strength of the leg and gradually increase pain-free range of motion. Strong muscles provide needed support. Lecture Method provides a background information as basis for presentation on the particular topic. Repeat 10 times.to verbally transmit information directly to the learner. for the purpose of instruction . and coordination drills. then incorporates power. Exercise will keep your joints from becoming stiffer. b. tall stool. A fracture is considered comminuted when there are atleast 3 bone fragments.) Knee extension Sit in a chair and rest your foot on another chair across from you so that the knee is slightly raised. %u2022 Rehabilitation after surgery Keep in mind that if your femoral fracture requires surgery the soft tissue needs time to heal before exercise can begin.

abnormal breath sounds (e. 2. cough productive of purulent. pleural friction rub. introduction of pathogens associated with an indwelling catheter if present. WBC count declining toward normal 8. 3. Nursing Actions and Selected Purposes/Rationales 1. Desired Outcome The client will not develop pneumonia as evidenced by: 1. cough productive of clear mucus only 5. 2. wound infection related to: A. administer oxygen as ordered . Implement measures to prevent pneumonia: A. If signs and symptoms of pneumonia occur: A. increased growth and colonization of microorganisms associated with urinary stasis B. bronchial breath sounds. absence of tachypnea 4. increase in respiratory rate D. crackles [rales]. action b) B. persistent elevation of or increase in WBC count H. resonant percussion note over lungs 3. pleuritic pain G.g. absence of pleuritic pain 7. action b) C. abnormal oximetry and blood gas results I. encourage and assist client to perform frequent oral hygiene in order to remove pathogens and secretions that could be aspirated D. or rust-colored sputum E. pneumonia related to stasis of pulmonary secretions and aspiration (if it occurs). chills and fever F. diminished or absent breath sounds) B. afebrile status 6. negative sputum culture. replace or cleanse equipment used for respiratory care as often as needed E. Assess for and report signs and symptoms of pneumonia: A. protect client from persons with respiratory tract infections.NURSING DIAGNOSIS: Risk for infection 1. urinary tract infection related to: A. chest x-ray results indicative of pneumonia. blood gases within normal range for client 9. wound contamination associated with introduction of pathogens during or following surgery B. perform actions to maintain an effective breathing pattern and airway clearance (see Diagnoses 2. normal breath sounds 2. 3. green. dull percussion note over affected lung area C. perform actions to reduce risk for aspiration (see Diagnosis 19. action b and 3. positive sputum culture results J. decreased resistance to infection associated with factors such as diminished tissue perfusion of wound area and inadequate nutritional status.

g. and burning on urination 3. and increased pain in wound area. absence of frequency. unusual wound drainage. instruct client to avoid touching incisions. foul odor from wound area. chills. fever. absence of chills and fever 4. positive results of wound drainage cultures). perform actions to promote wound healing (see Diagnosis 10) B. Assess for and report signs and symptoms of wound infection (e. 2. dressings. administer antimicrobials if ordered. redness. Desired Outcome The client will remain free of wound infection as evidenced by: 1. and increased pain in wound area 3. administer antimicrobials if ordered. 3. maintain a closed system for wound drains whenever possible VII. heat. Implement measures to prevent wound infection: A. Consult appropriate health care provider if signs and symptoms of infection are present. use sterile technique during all dressing changes and wound care IV. Desired Outcome The client will remain free of urinary tract infection as evidenced by: 1. swelling. Nursing Actions and Selected Purposes/Rationales 1. urgency. clear urine 2. drainage tubings. negative cultures of wound drainage. use good handwashing technique and encourage client to do the same II. B. heat. fewer than 5 WBCs and absence of nitrites and . persistent elevation of WBC count and significant change in differential. anchor wound drainage tubings securely to reduce in-and-out movement of the tubes VI. swelling. replace equipment and solutions used for wound care according to hospital policy in order to reduce the risk of colonization of microorganisms V. and open wounds III. protect client from others with infections C. absence of chills and fever 2. absence of redness. usual drainage from wounds 4. WBC and differential counts returning toward normal 5. perform actions to reduce the introduction of pathogens into the wound: I.

instruct female client to wipe from front to back after urinating or defecating C. remove catheter as soon as allowed (the risk for urinary tract infection increases the longer the catheter is in place). Assess for and report signs and symptoms of urinary tract infection (e. urinalysis showing a WBC count greater than 5 or the presence of nitrites or bacteria. increase activity as allowed and tolerated to decrease urinary stasis F. bacteria in urine 5. Implement measures to prevent urinary tract infection: A. if an indwelling urinary catheter is present: I. perform actions to prevent urinary retention (see Diagnosis 14. which flushes pathogens from the bladder and urethra E. positive urine culture). Nursing Actions and Selected Purposes/Rationales 1. secure the catheter tubing to lower abdomen or thigh on males or to thigh on females to minimize risk of accidental traction on the catheter and subsequent trauma to the bladder and urethra II. actions c- e) B. anchor tubing securely to reduce the amount of in-and-out movement of the catheter (this movement can result in the introduction of pathogens into the urinary tract and can cause tissue trauma. perform catheter care as often as needed to prevent accumulation of mucus around the meatus III. If signs and symptoms of urinary tract infection are present. maintain a closed drainage system whenever possible to reduce the risk of the introduction of pathogens into the urinary tract V. 2. .g. reports of frequency. cloudy urine. chills. elevated temperature. administer antimicrobials if ordered. keep urine collection container lower than level of the bladder at all times to prevent reflux or stasis of urine VI. negative urine culture. maintain fluid intake of at least 2500 ml/day unless contraindicated to promote urine formation and subsequent voiding. or burning on urination. assist client with perineal care routinely and after each bowel movement D. maintain sterile technique during urinary catheterizations and irrigations G. 3. urgency. which can result in colonization of microorganisms) IV.