CASE PRESENTATION

Fractured, Closed, Complete, Displaced Comminuted Sub Trochanteric Femur

Left, Avulsed Wound Posterolateral Aspect Right Leg secondary to MVA

Presented by:

Agustines, Hanzel

Naranjo, Ivy

Rosillon, Therese

Hole, Analyn

Tubelleja, Janine

Eraula, Kristian

Orate, Sergi

Dela Cruz, Cathy

Mahinay, Marnel

Evono, Hordon

McKnight, April

Ragusta, Mary

Hotingoy, Noe
General Objectives:
After the case presentation, the Level IV students will be able to gain knowledge,
understanding, and be able to apply skills in the care of the patient with Bone Fractures.
Specific Objectives:
On the completion of this case presentation, the listeners will be able to:
1. Define Fracture
2. Identify the causes of bone fracture
3. Recognize the contributing factors to the occurrence of the problem
4. Determine signs and symptoms
5. Illustrate the pathophysiology
6. Interpret the diagnostic tests used, its result and significance
7. Understand the role of drug therapy in managing client with bone fracture
8. Learn the basic and appropriate nursing interventions, treatment plan, and diagnosis of the
client
9. Understand the implement nursing roles in promoting health to the patient
 Introduction
A fracture is a complete or incomplete disruption in the continuity of bone structure and
is defined according to its type and extent. Fractures occur when the bone is subjected to stress
greater than it can absorb. Fractures may be caused by direct blows, crushing force, sudden
twisting motions, and 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 dislocations, ruptured tendons, severed nerves, and damaged blood vessels. Body
organs may be injured by the force that caused the fracture or by fracture fragments.
(Brunner & Suddarth’s Medical-Surgical Nursing, pg. 2084)

Patient’s Profile
A case of patient EB, 53 years old, male, born on September 02, 1965, married, Filipino,
Catholic, born and residing at Bongdo gua, Borbon, Cebu, working as a construction worker and
as a farmer, was admitted at Vicente Sotto Memorial Medical Center on June 05, 2019, due to
motor vehicular accident, with an admitting diagnosis of Fracture closed complete displaced
comminuted sub trochanteric femur left avulsed wound posterolateral aspect right leg
secondary to MVA.
History of Present Illness
Five days PTA, patient was hit by a dump truck while he was driving his motorcycle. The
accident happened not long after he got a phone call from his boss of where he needs to go to
his work site. While stopped at the traffic light, he did not noticed the go signal and the dump
truck behind him went through and unfortunately he fell off his motorcycle as the dump truck
ran off his left and right lower extremities. He had a surgery last June 21, 2019 for Debridement
and Application of VAC R leg & L thigh.
Past Medical History
Patient had no past admission from the hospital. This is his first time to be admitted.
Family History
He has a familial history of Hypertension from his mother side. His family does not have
any history of Diabetes Mellitus, Cancer or Heart Problem.
Allergy to Food and Drugs, Illicit Drug Use and Alcohol Consumption
The patient had no known allergies to food and drugs. He drinks alcohol occasionally. He
smokes 12 cigarette sticks a day but stopped. He had not use illegal drugs.
Course in the Ward
1st Day- endorsement done, received patient lying on bed, awake, and coherent, with no
IVF, with heplock at both arms, skeletal traction at left leg, with VAC at left thigh and
bandages at both legs, the patient noted facial grimace and verbalization of pail felt on
his right leg with a pain score of 8/10, had our vital signs taking (BP=120/80 mmhg,
PR=98 bpm, RR=20 cpm, T=37.5 degrees Celsius), on DAT, IV medications was given by
nurse in-charge, physical assessment and interview for the Gordon’s Functional Pattern
done
2nd Day- patient claimed to still have pain felt over his affected part, assessed done and
verbalized pain as 6/10, the patient was instructed to do gentle massage and do
diversional activities that may decrease the patient’s pain through reading, checked for
the capillary refill time as 1 second, encouraged to put small pillow at his foot to elevate
the legs
3rd Day- received patient lying on bed, awake and alert, seen having inability to do
physical activities due to condition, encouraged to participate to ROM exercise held by
the PT, assisted in ROM exercises, assisted patient in changing positions every 2 hours,
encouraged to raise slowly his right leg, the patient noted that he was able to raise his
right leg carefully
4th Day- patient seen changed his clothes and assisted in changing the linens, patient still
felt pain due to the fracture and was given pain medication by the in-charge nurse, the
patient was able to participate in assessment made by the student nurses and was
cooperative in answering questions
Medication given on Admission:
Tetanus Toxoid IM 0.5 ml
Current Medication:
Tramadol 500mg IVTT PRN
Clindamycin 300mg IVTT q 8hrs (-ANST)
Ciprofloxacin 200mg IVTT q 8hrs
Erythropoetin 4000 units x3 doses every 3 days SQ
Albumin 25% 50cc x3 OD IV
Genogram

Patient EB

Legend:

Hypertension