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FRACTUR E BSN III-B GROUP 1
I. PERSONAL DATA
Name: Ino Dulloog Address: Baay, Batac, Ilocos Norte Age: 56 Hospital number: 579012 Date and place of birth: July 27, 1953 Civil status: Married Religion: Roman Catholic Educational attainment: Highshool graduate Occupation: Farmer Date of admission: December 26, 2009 Admitting diagnosis: Fracture Close Tibia- fibula
proximal 3RD Admitting physician: Dr. Rasos and Dr. Agustin Final diagnosis: close tibia-fibula fracture11/26/10 proximal 3rd
II. ANATOMY AND PHYSIOLOGY
Physiologically, the musculoskeletal system enables changes in movement and position. The bony skeleton provides support, protection and movable parts while muscles facilitate movement. Structures of the Muscular System
Muscles They make up 40-50% of body weight. Skeletal Muscles • They are considered as the “living motor” which provides active movement of the skeleton. • These attaches to bones of the skeleton. • Exert force on bones or skin and moves them. • They are attached to the bones of the skeleton by very thin extensions of fascia or by tendons. Fascia are thin sheets of fibrous connective tissue. Tendons make strong connections to bones. • 11/26/10 Thousands of their fibers are bundled together by
Produces movement- mobility of the
body as a whole reflects the activity of skeletal muscles, which are responsible for all locomotion and manipulation.
Maintaining posture Stabilizing joints Generating heat- Generation of
body heat is a byproduct of muscle activity. As ATP is used to power
The skeletal system consists of two types of connective tissue: cartilage and bone. Each of this connective types consist of living cells, nonliving intercellular protein fibers, and an amorphous (shapeless0 ground substance. The tissue cells are responsible for secreting and maintaining the intercellular substances in which they are housed. These substances provide the structural characteristics of the tissue. Two main types of intercellular fibers are found in skeletal tissue: collagenous and elastic. Collagen is an inelastic and insoluble fibrous protein. Because of its molecular configuration, collagen has great tensile strength; the breaking point of collagenous fibers found in human tendons is reached with a force of several hundred kilograms per square centimeters. Fresh collagen is colorless, and tissues that contain large numbers of collagenous fibers generally appeared white. The collagen fibers in tendons and ligaments give these structure their white color. Elastin is the major component of elastic fiber 11/26/10
Bone The bone is a rigid connective tissue consisting of bone cells, calcified intracellular substances, bone marrow, and its chief organic constituents in collagen which is in CHON. It has a strength of cast iron. 2/3 of the adult bone is inorganic calcium salts(Ca-phosphate and Ca-carbonate). Ca Phosphate is the primary ingredient for proper bone density. It has its own blood vessel, lymphatic vessel and when fully developed has 20% water, organic material (CHON) of 30%-40%, Ca salts(inorganic substance)Ca phosphate and Ca carbonate of 40%-50%. Cartilage Cartilage is a firm but flexible type of connective tissue consisting of cells and intercellular fibers embedded in an amorphous, gel like material. It has a smooth and resilient surface and a weight-bearing capacity exceeded only by that of bone. It is a type of dense connective tissue that can withstand considerable tension. It is a semi opaque and has no nerve for blood supply of its own. Because cartilage has no 11/26/10 blood vessels, this tissue fluid allows the diffusion of gases,
Types of Bones According to Distribution of Spaces Between Cells
Compact bone- dense and with closely spaced lamellae-
concentric layers of mineral deposits.
Spongy/ Cancellous bone- with wide space lamellae. Arrange
in irregular network of thin plates of bones called trabeculae.
According to Shape
bones- length is greater than with. Found in extremities; in femur wich is the longest bone of the body. shape. (e.g. carpal and tarsal)
Short bones- equal in with and thickness but irregular in Flat bones- thin and flat composed of thin layers of compact
bones and spongy bone. (e.g. cranial bone, ribs, scapula and sternum) bones- bones not vertebrae, hip bone,mandible) classified in others.(e.g.
Anatomy of Bones Gross Anatomy of Long Bones
Diaphysis/Shaft- main portion of long bones; body of bones. Hollow cylinder of compact canal, which is field with bone, contains medullary yellow bone marrow in adult located bet. Epiphysis. covered by thin layer of compact bone, contains red marrow , where some RBC’s are manufactures during childhood and adolescence; erythropoietin activity in the adult mainly occurs in flat bones and vertebrae.
2. Epiphysis- the end of the diaphysis composed of spongy bone
3. Metaphysis- it is made up of epiphyseal plate(growth plate) and
the adjacent bony trabeculae.
4. Growth plate- a thick flat plate of hyaline cartilage that provides
the framework for construction of the cancellous bone tissue within the metaphysic.
5. Articular cartilage- covers the epiphysis. Thin layer of cartilage
covering epiphysis and forms articulation with another bones.
Types of Bone Cells
Osteogenic cells- found mostly in the deep
layer of periosteum and in bone marrow. Only bone cell that undergone mitosis and develop to an osteoblast during stress and healing. Unspecialized cells derived from mesenchyme
Osteoblast- cell responsible in bone
formation; bone forming, repairing and building. Usually found in the growing portion s of bones, including the periosteum. Secretes matrix mineralized ground substance called osteoids.
11/26/10 Osteocytes – mature osteoblasts. The
FUNCTIONS OF BONE AND THE SKELETAL SYSTEM
Support- serves as the structural framework for
the body by supporting soft tissues and providing attachment point for the tendons of most skeletal muscle
Protection- protects many internal organs from
in movement- because skeletal muscles attach to bones, when muscles contract, the pull on bones. Together, bones and muscles produce movement minerals, especially calcium and phosphorus. On 11/26/10 demand, bone releases minerals into the blood
Mineral homeostasis- bone tissue stores several
Blood cell production- within certain bones, a connective tissue called red bone marrow produces red blood cells, white blood cells, and platelets, a process called hemopoiesis. Red bone marrow consists of developing blood cells, adipocytes, fibroblasts, and macrophages within a network of reticular fibers. It is present in developing bones of the fetus and in some adult bones, such as pelvis, ribs, breastbones, backbones, skull, and ends of the arm bones and thighbones Triglyceride storage- triglycerides stored in the adipose cells of yellow bone marrow are an important chemical energy reserve. Yellow bone marrow consists mainly of adipose cells, which store triglycerides, and a few blood cells. In the newborn, all the bone marrow is red and is involved in 11/26/10 hemopoiesis. With increasing age, much of the bone
Fracture, or discontinuity of the bone, is the
most common type of bone lesion. Normal bone can withstand considerable compression and shearing forces and, to a lesser extent, tension forces. A fracture occurs when more stress is placed on the bone than it is able to absorb. one of the two bones of the lower leg. This fracture can occur anywhere between the knee and ankle. The tibia is the most commonly fractured long bone. Only the tibia bears weight, but fracture of the tibia is often associated with fracture of the fibula because force is transmitted via the interosseous membrane that connects the two bones. Isolated fracture of the 11/26/10 proximal or mid-shaft portions of the fibula is
A fracture of the tibia or fibula is a fracture of
The tibia is the major bone of the lower leg, commonly referred to as the shin bone. Tibia fractures can occur from many types of injuries. Tibia fractures come in different shapes and sizes, and each fracture must be treated with individual factors taken into account. When determining treatment of a tibia fracture, the following factors must be considered: § Location of the fracture, § Displacement of the fracture, § Alignment of the fracture, § Associated injuries, § Soft-tissue condition around the fracture, and
Sudden Injury- most common fractures;
the force causing the fracture may be direct, such as a fall or blow, or indirect, such as a massive muscle contraction or trauma transmitted along the bone.
Fatigue or stress fractures- fatigue
fracture results from repeated wear on a bone; stress fractures in the tibia may be confused with “shin splints,” a none specific term for pain in the lower leg from overuse in walking and running. Stress fractures result from repetitive force (eg, from overuse); they occur most often in 11/26/10
Classification Fractures are classified accdg. to location (proximal, midshaft, distal), the direction or fracture line (transverse, oblique, spiral), and type (comminuted, segmental, butterfly, or impacted). Location A long bone is divided into three parts: proximal, midshaft, and distal. A fracture of the long bone is described in relation to its position in the bone. Types The type of fracture is determined by its communication with the external environment, the degree of11/26/10 break in
Classification of fracture by communication with the environment
Open or compound fracture- when
the bone fragments have broken through the skin.
Closed fracture- no communication
with the outside skin.
It can be further divided into: Grade 1-
wound smaller than 1 cm with minimal contamination. Grade 2- wound larger than 1 cm with moderate contamination. Grade 3- wound larger 11/26/10
Classification by pattern
oblique-occurs at an oblique angle to the shaft. Linear- a fracture that is parallel to the bone's
Transverse- a fracture that is at a right angle to
the bone's long axis.
Spiral- a fracture that seems to spiral around the
bone like a stripe on a candy cane.
Classification by appearance Compression- common on the vertebrae. Comminuted- produced by high energy forces
(motor vehicle acccidennts) fragments are crushed.
Greenstick- one side of the bone 11/26/10 is broken and
Deformity- strong muscle spasm may
cause bone fragments to override; therefore alignment and contour changes occur. The deformity varies accdg. to the type of force applied, the area of the bone involved, the type of fracture produced, and the strength and balance of the surrounding muscles.
Swelling- due to localization of serous
fluids at the fracture site and extravagation of blood in to adjacent tissue.
11/26/10 Muscle spasm- involuntary muscle
HEALING Five stages of the healing process
hematoma formation- occurs during the first 48 to 72
hours after fracture. It develops as blood from torn vessels in the bone fragments and surrounding soft tissue leaks between and around the fragments of the fractured bone.
cellular proliferation- the bone-forming cells, multiply
and differentiate into a fibrocartilaginous callus. Cellular proliferation begins distal to the fracture, where there is greater supply of blood.
formation- fracture becomes ‘sticky’ as osteoblasts continue to move in and through the fibrin bridge to help keep it firm. This stage usu. occurs during the third to fourth week of fracture healing. remove the cast
ossification- the final laying down of bone; safe to remodeling- resorption of the excess 11/26/10 bony callus that
DIAGNOSIS AND TREATMENT Diagnosis is the first step in the care of fractures and is based on history and physical manifestations. A splint is a device for immobilizing the movable fragments of a fracture. Further treatment depends on the general condition of the patient, the presence of associated injuries, the location of the fracture and its displacement, and whether the fracture is open or closed.
11/26/10 Three objectives for treatment of
immobilization prevents movement of injured parts and is the single most important element in obtaining union of the fracture fragments. Immobilization can be accomplished through the use of:
o External devices:
metal splints or air splints may be used during transport to a health care facility as a temporary measure until the fracture has been reduced and another form of immobilization instituted commonly used to immobilize fractures of the extremities; they often are applied with a joint in partial flexion to prevent rotation of the fracture fragments. fixation devices - pins or screws are 11/26/10 inserted directly into the bone above and below
Preservation and Restoration of Function- exercises designed to preserve function, maintain muscle strength, and reduce joint stiffness should be started early. After the fracture has healed, a program11/26/10physical of
Traction- pulling force is applied to an extremity or part of the body while a counterforce, pulls in the opposite direction; used to maintain alignment of the fracture fragments and reduce muscle spasm. • Manual traction- steady, firm pull that is exerted by the hands • Skin traction- pulling force applied to the skin and soft tissues • Skeletal traction- pulling force applied directly to the bone Internal fixation devices inserted during surgical reduction of the fracture.
The goal of rehabilitation is to decrease pain and restore full function to the lower limb. Modalities such as heat and cold can be used to control pain and edema. Rehabilitation emphasizes restoring full range of motion, strength, proprioception and endurance of all adjacent joints while maintaining independence in all activities of daily living, if not contraindicated by the fracture stability. Gait training using appropriate assistive devices is indicated to promote independent ambulation. The individual may progress from walker to 11/26/10
PREDISPOSING FACTORS 1.Presence of underlying diseases- those with low bone density( osteoporosis), bone tumors, bone cancers or a brittle bone disease called osteogenesis imperferta results to bone fragility. 2.Age- highest injury rate occurs in persons between ages 15-24 because they are extremely active and participates in contact sports. In elderly, as a result of degenerative process, bones become fragile leading to easier breaking of bones. 3.Sex- Injury rates are high for 15 - 24 years old males. The risk in males is 2.5 times greater than females, due to the involvement of males in hazardous activities. However, during the menopausal stage, females have an increased risk to fracture because during this stage, ovaries stop producing estrogen, which normally protects against bone loss. 11/26/10
5.Diet low in Ca, Phosphorous, and Vit. DCalcium and phosphorous are necessary for strengthening the bones as well as maintenance of density. Vitamin D on the other hand hastens the reabsorption of Calcium. If the bones are insufficient of Ca, Phosphorous, and Vit. D, bones will become less dense and weaker, causing it to break easily. 6.Lifestyle- A sedentary lifestyle contributes to the moving of calcium out from the bones to the blood causing a decrease in the bone composition and strength. The bones will be depleted with calcium and demineralization process will occur making the bones to become spongy and may gradually deform and fracture 11/26/10 easily. Vehicular accident, fall, and even
RISK FACTORS 1.People who work with heights. These people are at high risk for fracture because of the nature of their job. 2. People who engages in high risk sports. These people are at high risk because the sports they play themselves is already risky and that it endangers their life too. OMPLICATIONS 1. Arterial damage- may consist of contused, thrombus, lacerated, severed or spastic arteries. arteries may also be constricted by casts that are too tight. Indications: - absent pulse - swelling - pallor - pain
11/26/10 - poor capillary feturns
-continuing blood loss
2. Shock- laceration of large vessels and can cause bleeding 3.Compartment syndrome- fascia lining each compartment (compartments are made of muscles, bones, nerves and blood vessels) can not expand. Therefore any increase in the compartment size due to bleeding or swelling will place pressure on pliable structures within the compartment, such as muscles, nerves and blood vessels. Compartment syndrome can also develop if external pressure is applied, such as from a cast or tight dressing. S/S: -uncontrollable pain - coolness -weak active movement - pallor -paresthesia – earliest sign - absent peripheral pulseslatest sign 4. Volkman’s Ischemic Contracture crippling condition of the hand or forearm arises from a complication of a fracture around the elbow joint or forearm bones if not relieved, pressure causes ischemia and results in a permanent, stiff, claw-like deformity of the arm and hand 11/26/10 S/S:
5. Fat Embolism- occurs 24- 48 hours after the injury develops when broken bones liberate fat from the marrow cavity that embolizes to the lungs and blood vessels which then causes occlusion. S/S: -altered mental status - tachypnea - tachycardia - hypoxemia 6. Infection
FACTORS THAT AFFECT BONE HEALING 1. Age- older people heal slower than younger people 2. Diabetics- decrease rate of healing because of blood viscosity therefore there is sluggish circulation which decreases the blood supply into the area 3. Infection
III. FAMILY BACKGROUND
The family is a group of persons united by ties of marriage, blood or adoption, constituting single household, interacting and communicating with each other in their respective social roles and creating and maintaining a common culture. It is composed of people who are emotionally involved with each other and live in close geographical proximity. The client is an extended family since the mother of Ino is with them. They are 9 in the family: Mang Ino(56) and his wife Mang Ada(54). They have 4 sons namely Aldo(32), Emy(31), Enie(29), and Nickanor(21), 2 11/26/10 daaughters Eve(29) and Evy(24), and the
Responsibilities at home are divided amongt the family members. During the visit, there were no conflicts observed between the family. However, like any other family, misunderstandings between them do arise sometimes. They solve it by open and peaceful conversations. In addition, Lola Maria also gives pieces advice to them so that they can avoid the same problem will not occur again. The family helps each other in doing household chores for the family’s welfare. In terms of rearing practices, both parents admitted that they seldom hit their child since they think that the child would just aggravate his tantrums. As much as possible they talk and deal with the child in a well-mannered way. The family owns a 200 sq. meter of land which they use for farming. The crops they harvest here are not sold but primarily for family consumption. They also have a vegetable garden at their backyard wherein they harvest tomato and chili which is also for their own benefit. They also own a deep well situated about 5 meters which they use for bathing, cooking and drinking purposes. To ensure its potability, the barangay health workers place chlorine at the deep well and they cover it during rainy seasons. 11/26/10
In relation to the family income, they earn about Php 6,000/month. Ino works a a farmer and stressed that, they have two cropping seasons with each season they are able to get 20 sacks of palay and each sack of palay is worth about Php 1800. Therefore, the family earns Php72,000 annually, making up Php 6000/ month. The family also receives foreign aid from their daughter in law amounting to Php 2000. Evy, Ino’s daughter, who works 11/26/10
Monthly Allocation of Family Expenses
All in all, the family allocates Php 9000 for their monthly budget. The breakdown of their monthly expenses is as follows. The family allocates Php 2000 for food which includes meat, poultry products and groceries like soy, cooking oil, fish paste, fish sauce and etc. They usually buy their foods and groceries at the public market Batac. Php 1000 is allotted for their electricity and Php 800 is for the gasoline of their kuliglig while Php of 50 is apportioned for their fertilizer and Php 300 is for the shellane they are using. They also allocate Pp 300 for miscellaneous that includes 11/26/10 toiletries and medicines. A fixed amount of
IV. HEALTH HISTORY
Family Health History Based from the genogram, the hereditary disease that runs in the family is hypertension. According to Ino, his mother Juana has a hypertension which was diagnosed when she was 50 y/o during her check up in the RHU. Eve and Nickanor also have hypertension which was both diagnosed during the consultation in a medical mission. Medicines were prescribed to them during the check-up however, due to financial restrictions at that time, they were not able to avail the said medicines and they eventually lost the prescriptions. The family manages their hypertension by increasing their intake of green leafy vegetables and chewing garlic and reducing intake of high-cholesterol foods. Gregorio, Ino’s father, had arthritis and died at the age of 80 because of a heart attack. According to Juana, Gregorio was not diagnosed to have a heart problem because they never went to a doctor for any consultation although he had experienced recurring chest pains before he died. She also claimed that Gregorio engages himself to cigarette smoking, consuming 5-10 sticks per day. He also drinks 2-3 bottles of 11/26/10 liquor for 1 week for relax and fatiguerelieve fatigue. Juana, 96
Marciano and Venabentura, Ino’s siblings, died at the ages of 62 and 57 respectively. Marciano had cataract and died because of a heart attack. He consumes 1 pack of cigarette/day. Venabentura died because he was stabbed by their neighbor due to a misunderstanding during a drinking session in their neighborhood. Nicholasa, 60 y/o and Ino is 56, y/o, have never experienced symptoms of hypertension. Only Nickanor and Eve inherited hypertension. The family is experiencing common illnesses such as cough, colds, fever and headache. These illnesses were managed through over-the-counter drugs—Solmux, 1 cap every 4 hours for adults and Ambroxol, 1 tsp every 4 hours for the children for cough, Neozep for colds, 1 tab every 4 hours both for children and adults. For fever, the children take Paracetamol 1 tsp every 4 hours and 1 tab every 4 hours for adults—both until the fever is gone. The family also considers the use of herbal medicines such as the use of oregano decoction and drinking of calamansi juice for cough. But when the condition of a family member is not relieved by the management aforementioned, they go to a 11/26/10 health center for consultation. The family goes to the RHU
The family members also suffered from chicken pox and managed it by avoiding the intake of poultry products due to their belief that eating such foods would only contribute to the itchiness of the skin. They also practice wearing black clothes to lessen the itchiness as claimed by Juana. They also suffered from measles and mumps. They managed their mumps by applying “anil” until it heals. With regards to the family’s immunization, Ada claimed that she was able to submit her children for immunizations and vaccinations. But when asked about the yellow cards, she said that she cannot remember where she kept it and she is not sure if all their children had a complete immunization. As with their vices, Gregorio used to smoke everyday and could consume 5-10 sticks of cigarette. They firmly believed that his cigarette smoking caused him to suffer from a heart disease that eventually led to his death. All of Ino’s children are fond of carbonated beverages and they usually consume 2 liters in a day. Their usual activities are doing household chores and farming. Ino 11/26/10 that he admits
Past Health History The patient suffered common childhood illnesses such as chickenpox, fever, mumps and measles. The patient said that when he was young they used to consult the “albularyo” since medical science was not popular or known then. Fever was managed by taking in paracetamol, coughs and colds were managed by Solmux and Ambroxol in which all medications are prescribed by the RHU physician of Batac City. They also use boiled oregano, drinks calamansi juice and have plenty of rest as a form of management for these conditions. When he had chickenpox when he was young, they used to cover him with black linen and put him near a smoke of onion. With regards to Ino’s immunizations, he told us that he cannot recall if he had immunizations and he also verbalize that “Idi ngamin panawen mi balasang ko ket han pay nga uso dagita ken meysa pay awan pay unay doctor idi isu nga albularyo lang ti papapanan mi kada nanang ko idi”. He has never been hospitalized until now. The patient does not have any allergic reactions to his environment, food, drinks, and medications. 11/26/10 Ino drinks alcoholic beverages thrice a week with his son
C. Present Health History It was the 26th of December at around 1:00 pm, the patient and his youngest son went to plow their land with their kuliglig. Suddenly the patient felt the kuliglig was moving wrongly to the left but still he kept on going so that they could finish earlier and then the kuliglig turned and dropped down on his left lower leg. His son came running to his side and helped him push away the kuliglig. When they finally pulled his leg out, his leg just bent downwards and he felt much pain. His son carried him home and rushed him to the hospital. He was admitted at the MMMH and MC with an admitting diagnosis of fractured tibiafibula proximal 3rd. 11/26/10
V. DEVELOPMENTAL DATA Erik Erikson’s Developmental Theory Erik Erickson, a German Psychoanalyst, proposed the psychosocial theory of development. This theory states that life is composed of sequence of levels of achievement and each stage indicates a certain task to be achieved. He believes that maturation of bodily functions is linked with expectations of society and culture in which the person lives. A successful resolution would indicate a support to the person’s ego while a failure to resolve the crises is damaging to the ego. When needs are met, a healthy or positive personality is developed and the individual moves to the future stages with particular strength; but if not, an unhealthy outcome occurs which will influence future relationships. According to Erickson’s developmental theory, the primary developmental task of the adulthood is to achieve Generativity. It is the willingness to care for and guide others. Generativity is being creative and productive and it 11/26/10 can be achieved with their children and the others through
A negative resolution would be evident by the person who is selfish and self-centered. The person is unable to share his potential to others which can serve as their guidance. This could develop due to a failure in the earlier tasks which resulted to the difficulty in achieving a higher developmental task. In the case of our client, Ino is able to achieve the developmental task completely. Positive indications of achieving the task include productivity and concern for others. Ino is productive in the sense that he can raise his 6 children well and that they have enough food to eat for their everyday living. He always see to it that all of them could eat their meals thrice a day and that he could support and sustain all his children’s needs and offer some help to his daughter who is already married but has a hard time raising her own family financially. Ino is also concerned to what is happening to his friends and neighbors as well as his relatives. He sees to it that he is able to talk to his friends and relatives even just once every two weeks to know how they are doing. He also attends wake and burials as a way of sympathizing to the bereaved family. He would also show his love and concern to his family by always talking to them and asking how the day has been and by telling that he loves them.
11/26/10 Analysis: Based on the cues presented, Ino was able to
Robert Havighurt’s theory Robert S. Havighurst theorized that there are developmental task one must accomplish all throughout life. He believes that learning is basic to life and that people continue to learn throughout life. According to him, developmental task is a task which arises at or about a certain period in the life of an individual, successful achievement of which leads to his happiness and to success with later tasks, while failure leads to unhappiness in the individual, disapproval by the society and difficulty with later task. Ino is 56 y/o and is under the middle age period. The following are his tasks: • Achieving adult civic and social responsibility • Establishing and maintaining an economic standard of living • Assisting teenage children to become responsible & happy adults • Developing adult leisure-time activities 11/26/10 • Relating oneself to one’s spouse as a person
Ino loves to mingle or interact with other people and he is always attentive and conversant to what the other person is saying. With regards to his social responsibilities, he always participate programs in their barangay like Clean & Green, and Fiestas. When it comes to economic standard of living, Ino together with his wife is involved in decision making. Ino sees to it that he could provide for the basic needs of his family although there are 7 of them living together in the same roof. He raised his children properly and responsibly. Ino’s leisure time is to go and have some talks with his friends and neighbors after his work. Whenever he faces any problem, he always talks to his wife and asks for pieces of advice on how to solve his problems. At his age, he already accepted the physiologic changes that he undergoes right now like his declining strength and he had already adjusted to the aging of his mother.
VI. LEVELS OF COMPETENCIES
Analysis: There was a significant change in the patient’s physical competency due to the immobility and weakness brought about by his condition. He was not able to perform the activities of daily living since his health requires ample rest.
Analysis: There is a significant change in our patient’s emotional level of competency during his hospitalization as brought about by the fear and anxiety of the result of his condition. His condition also affects his way of 11/26/10 communicating to others which makes him difficult to
Analysis: There is a significant change in Ino’s social level of competency because he cannot attend the barangay gatherings before as he used to as brought about by his condition because he easily gets tired and 11/26/10 this hinders him
Analysis: There is no change in the mental competency of the client. Although he was a bit disturbed about his condition, it did not alter his mental competency since he remained to be oriented and mentally competent by 11/26/10 answering appropriately all the questions asked to him.
Analysis: There spiritual aspect attended the hospitalization. despite of his
was no alteration with regards to of Ino except for not being able to Sunday mass during the His faith in God got stronger 11/26/10 illness because he sees it as a
VII. PATTERNS OF FUNCTIONING
Analysis: There is no change in the amount of food intake of the patient before the illness and during the hospitalization (before surgery) because the patient was ordered for a full diet. However, there is a decrease in the amount of food intake on the night before the surgery until the evening of the day of the surgery because the patient was ordered NPO post-midnight. This is indicated for the purpose of decreasing the workload of the stomach therefore preventing the stimulation of the vagal nerve which increases the hydrochloric secretion, thus neutralizing or buffering hydrochloric acid, inhibiting acid secretion, decreasing the activity of pepsin, and to eradicate helicobacter pylori. Then 11/26/10 the patient was ordered soft diet because
Before the accident theBefore Surgery: patient drinks 6-8During hospitalization glasses of water a daybefore surgery the approximately 1380-patient drinks 4-6 1840cc and drinks 1glasses of water a day bottle of Gin sharedapproximately 1000with his sons thrice 1200cc. every week. After Surgery:
During hospitalization after surgery the patient was on NPO then 4-6 glasses a day after the surgery. Analysis: there is a change in the amount of fluid intake of the patient before the illness and during the hospitalization because the patient was ordered for NPO before the surgery. Then he resumed his usual drinking pattern a day after the surgery for he is already in full diet.
Before Surgery: During hospitalization before surgery the patient voided 6-10 times at daytime and 2 times at night, estimated at 1000-1300 cc per day. Given from the patient’s chart he voided 1000 ml at 12/26/09; at 12/27/09 he voided 600ml and at 12/28/09 he voided 1000ml. the color of the urine on those given days was yellow and was slightly turbid. After Surgery:
During hospitalization after surgery the patient voided 3-7 times a day estimated at 600-1000 cc per day. Given from the patient’s chart he voided 800 ml at 12/30/09 and 500ml at 12/31/09. The patient’s urine was yellow and was characterized as slightly Analysis: There was a change in his urine elimination. Before turbid.
illness, the patient had normal bladder elimination but because of the decreased oral fluid intake after the surgery due to NPO, it resulted to the decreased in urine output. However, his bladder elimination resumed his normal 11/26/10 function a day after the surgery because of the change in the
During hospitalization before surgery he did not eliminate. After Surgery:
During hospitalization after surgery he eliminated once. The color was brown and it was hard and dry in Analysis: There is a decrease in the frequency consistency
of bowel elimination due to a decrease in activity and a change in the environment. 11/26/10
During hospitalization before surgery the patient slept at 10 pm with a length of 3-6 hours. At night before he slept he prayed. He took naps every afternoon. After Surgery:
During hospitalization after surgery the patient slept at 10pm with a length of 3-6 hours. At night before he slept he prayed. He took naps every afternoon.
Analysis: There is a change in the sleeping pattern of the patient in terms of duration because of the change in environment (noisiness), pain and
Before illnessBefore Surgery: the patientDuring hospitalization before takes a bath 2surgery the patient takes a bath times a day atonce a day at 8:00-9:00 in the 6:30-7:30 in themorning using sponge and morning andsoap, classified as partial bed dusk usingbath. shampoo and After Surgery: soap thus hospitalization after having aDuring complete bath. surgery the patient takes a bath once a day a 9:00-10:00 in the morning using sponge and soap, classified as partial bed Analysis: There bath. a change in the is
frequency and type of bathing pattern of 11/26/10 the patient because of his condition and
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