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 causes a break in the skin. Comminuted fracture at the Left
Proximal Middle 3rd Femur is a fracture in which bones has splintered into several fragments.
Often, a fractured bone is a catastrophic event that will have a negative impact on the patient’s
life style and quality of life.

As we apply this condition to my patient, she has fracture in the proximal part of the
femur caused by vehicular accident. She is Raiza Marie Tungol Nuque, a 4 years old child from
44-A-Reyes P-3 Lower Bicutan, Taguig City. She was admitted at Philippine Orthopedic Center
last March 5, 2011 with a chief complaint of pain in the thigh and leg. The patient was under the
supervision of Dra. Apalisoc.

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OBJECTIVES

General Objectives:

After student nurse-patient interaction, the patient and the significant others will be able
to acquire knowledge, attitudes and skills in preventing complications of immobility such as bed
sores, pneumonia, deep vein thrombosis, atelectasis, etc. in order to improve patient’s condition.

Specific Objectives:

1. To gather patient’s information and to know past and present history of the patient
2. To have knowledge about the disease of the patient
3. Review the anatomy and physiology of the organ affected
4. Discuss the pathophysiology of the condition
5. To identify the signs & symptoms of the condition manifested by the patient
6. To provide holistic care appropriate for the patient’s condition
7. To impart health teaching to the patient and family members of how to care for a
patient with fracture

PATIENT’S PROFILE
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 Name: Raiza Marie Tungol Nuque

Address: 44-A-Reyes P-3 Lower Bicutan Taguig City

Age: 4 years old

Sex: Female

Civil Status: Child

Religion: Roman Catholic

Nationality: Filipino

Date and Time of Admission: March 5, 2011 @ 6:00 pm

Room No.: Cubicle 5 @ Children’s Ward

Complaints: Pain at the left thigh with swelling

Impression or Diagnosis: Fracture Close-Comminuted Proximal Middle 3rd

Femur Left

Physician: Dr. Apalisoc

Institution: Philippine Orthopedic Center

HISTORY OF PAST AND PRESENT ILLNESS

A. PAST HISTORY

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 According to the patient’s mother, Raiza had experienced minor illnesses like
common colds, fever and coughs. And whenever she had this signs and symptoms, it was
relieved by OTC drugs that are being bought by her mother. Her mother added that she
never been hospitalized before the accident happened.

B. PRESENT HISTORY

Few hours prior to admission, Raiza’s mother was washing their clothes while she was
playing with her scooter outside their house at 44-A-Reyes P-3 Lower Bicutan, Taguig City
when suddenly a jeepney reached her place and allegedly hit her feet. Raiza sustained multiple
abrasions on her left and right lower extremities and felt pain on her right thigh. So, her mother
immediately brought her to the Philippine Orthopedic Center and was subsequently admitted.

During the admission day, she undergone X-ray, Complete Blood Count, Prothrombin Time
and Physical Assessment. The X-ray reveals the location and severity of the affected bone. On
the other hand, the CBC reveals low hematocrit count- 0.31, increase leukocyte count of 22.20 x
109/L, low Hemoglobin of 98 g/L, and increased Platelet count of 605 x 10^9/L. The
Prothrombin time of the patient is 16.5 seconds which is increased. And lastly, the physical exam
reveals multiple abrasions in both lower extremities and swelling at the right thigh.

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PEARSON ASSESSMENT

March 29, 2011 TUESDAY March 30, 2011 WEDNESDAY April 1, 2011 FRIDAY
7-8 am 9-10 am 7-8 am

- my patient’s name is Raiza Marie
Tungol Nuque, a 4 years old girl who
lives at Lower Bicutan, Taguig City.
- admitted last March 5, 2011 @ 6pm
with chief complaint of pain on her
thigh.
- verbal response: responded well,
answers questions properly, and was
oriented.
- received patient lying on bed,
conscious and coherent
- verbal response: responded well,
answers questions properly and was
oriented.
- no complaints of pain or other
problems noted.
- received patient sitting on wheelchair
with 1 ½ Spica Cast, conscious and
coherent.
- with complaint of itchiness inside the
applied cast.

- motor response: responded well at

upper extremities, right leg is hard to
flex.

- with wound covered with sterile

gauze and cleansed with hydrogen
peroxide on her right leg.

- abrasions found on her feet.

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- psychosocial development:

PRE-SCHOOL (Initiative VS. Guilt)

¶URINE OUTPUT: ¶URINE OUTPUT: ¶URINE OUTPUT:

>Frequency: 1 slightly soaked diaper >Frequency: 1 diaper >Frequency: 0

>Color: yellowish output >Color: yellowish output >Color: --

>Transparency: turbid >Transparency: turbid >Transparency: --

¶BOWEL ELIMINATION: ¶BOWEL ELIMINATION: ¶BOWEL ELIMINATION:

>Frequency: 1 >Frequency: 0 >Frequency: 0

>Consistency: formed >Consistency: -- >Consistency: --

>Color: yellowish-brown output >Color: -- >Color: --

- No perspiration noted during the shift

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ACTIVITIES:
- limited movement due to traction
applied.
- assisted by the mother during
hygiene time and elimination.
- assisted by mother in changing
clothes.
- she don’t want to eat rice.
REST AND SLEEP:
- she slept 10 hours last night.
- comfortable when sleeping.
- with one pillow under the head.
- with 6-8 hours of sleep with waking-
up pattern.
- with frequent nap at day time.
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ACTIVITIES:
- limited movement due to traction
applied.
- assisted by the mother during
hygiene time and elimination.
- assisted by mother in changing
clothes.
- she has good appetite, eats rice.
- talking actively with other patients
and to the student nurse.
- active in drawing and interpreting it
to me.
REST AND SLEEP:
- she slept 11 hours last night.
- comfortable when sleeping.
- with one pillow under the head.
- with 6-8 hours of sleep with waking-
up pattern.
ACTIVITIES:
- limited movement due to cast applied
- assisted by the mother during
hygiene time and elimination, and
wound cleaning.
- assisted by mother in changing
clothes.
- active and jolly.
REST AND SLEEP:
- she slept 7 hours last night.
- uncomfortable due to fibreglass cast
that has applied last night.
- with complaint of itchiness.
- with 6-8 hours of sleep with waking-
up pattern.
- BLOOD TYPE: “O” - BLOOD TYPE: “O” - BLOOD TYPE: “O”

- TEMP: 36° C/Axilla - TEMP: 36.2° C/Axilla - TEMP: 36° C/Axilla

- RR: 30 cpm - RR: 33 cpm - RR: 31 cpm

- HEART RATE: 134 bpm - HEART RATE: 137 bpm - HEART RATE: 132 bpm

- No known allergies to any foods and - No known allergies to any foods and - No known allergies to any foods and
medications. medications. medications.

- no side rails. - no side rails. - no side rails.

-MEDICATIONS: -MEDICATIONS: -MEDICATIONS:

~Multivitamins + Iron Syrup 5ml ~Multivitamins + Iron Syrup 5ml ~Multivitamins + Iron Syrup 5ml
OD OD OD

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- RR:30 (normal range) - RR:33 (normal range) - RR:31 (normal range)

- HR: 134 bpm - HR: 137 bpm - HR: 132 bpm

- Capillary refill- 2 sec. - Capillary refill- 2 sec. - Capillary refill- 2 sec.

- No O2 supplementation - No O2 supplementation - No O2 supplementation

- No nasal discharges. - No nasal discharges. - No nasal discharges.

- No nasal polyps. - No nasal polyps. - No nasal polyps.

- Diet as tolerated - Diet as tolerated - Diet as tolerated

- Doesn’t want rice - no IVF attached - no IVF attached

- no IVF attached - PRESCRIBED: high calorie & high - PRESCRIBED: high calorie & high
calcium calcium
- PRESCRIBED: high calorie & high
calcium and junk foods - PREFFERED: high calorie & fat - PREFFERED: high fat & calorie

- PREFFERED: high fat - RESTRICTED: none - RESTRICTED: none

- RESTRICTED: none

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ACTUAL DIAGNOSTIC EXAMS

HEMATOLOGY

PArAMETERS NORMAL 1ST LAS INDICATION

T
Hemoglobin Mass 127-183g/L 97 129 Before, the hemoglobin is decrease which
may indicate various anemias, pregnancy,
severe or prolonged hemorrhage,
and with excessive fluid intake at present it
is normal already
Hematocrit 0.37-0.54 0.31 0.40 Before it is Decreased, may indicate severe
anemias, anemia, acute massive blood loss,
but now it is in the normal range
Leukocyte Count 4.5-10x10^9/L 25.9 7.20 Before it is increased, may indicate acute
infections,trauma or surgery, leukemia,
malignant disease, necrosis; decreased
with viral infections, bone marrow
suppression, primary bone marrow
disease, but now it is already in the normal
range
Defferential
Count
Segmenters 0.50-0.70 0.45 Normal
Lymphocytes 0.20-0.40 0.40 Normal
Monocytes 0.00-0.07 0.04 Normal
Eosinophils 0.00-0.05 0.11 increased may indicate allergy, parasitic
disease, collagen disease, subacute
infections;

Reticulocytes 0.5-2%
Platelet Count 150-400x10^9/L 629 377 Increased may indicate malignancy,
myeloproliferative disease, rheumatoid
arthritis,
and postoperatively; about 50% of
patients with unexpected increase of platelet
count will be found to have a malignancy, at
present is is noe on its normal range
Coaglation
Studies
Prothrombin Time 11-15secs 16.5 12 Prolonged by deficiency of factors I, II,
V, VII, and X, fat malabsorption,severe
liver disease, coumaDin anticoagulant
therapy. Present cbc shows normal
Prothrombin time
% 70-120
Activity
Active PTT
RH typing

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 CRP
Semi-quantitative <6mg/L
CRP

MCV 82-92fL 86 Normal

MCH 28-32 28 Normal

MCHC 32-38% 32 Normal

Blood type: “o”

IDEAL DIAGNOSTIC PROCEDURES

COMPLETE BLOOD COUNT- Is used as a broad screening test to check for such disorders as
anemia, infection, and many other disease

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Many patients will have baseline CBC tests to help determine their general health status. If they
are healthy or they have cell populations that are within normal limits, then they may not require
another CBC until their health status changes or until their doctor feels taht it is necessary.

PARAMETERS NORMAL

Hemoglobin Mass 127-183g/L

Hematocrit 0.37-0.54

Leukocyte Count 4.5-10x10^9/L

Defferential Count
Segmenters 0.50-0.70
Lymphocytes 0.20-0.40
Monocytes 0.00-0.07
Eosinophils 0.00-0.05
Reticulocytes 0.5-2%
Platelet Count 150-400x10^9/L
Coaglation Studies

Prothrombin Time 11-15secs

% 70-120
Activity
Active PTT
RH typing
CRP
Semi-quantitative CRP <6mg/L

MCV 82-92fL
MCH 28-32

MCHC 32-38%
X-RAY/RADIOGRAPH- is a non-invasive medical test that helps physicians diagnose and treat
medical conditions. Imaging with x-rays involves exposing a part of the body to a small dose of
ionizing radiation to produce pictures of the inside of the body. X-rays are the oldest and most
used frequently used form of medical imaging.

 are important in evaluating patients with musculoskeletal disorders. Bone films determine
bone density, texture, erosion and changes in bone relationships. Multiple x-ray views are
needed for full assessment of the structure being examined. X-ray of the cortex of the

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 bone reveals the presence of any widening, narrowing, and signs of irregularity. Joint x-
rays will reveal the presence of fluid, irregularity, spur formation, narrowing and changes
in the joint structure.

URINALYSIS- is a used as a screening and/or diagnostic tool because it can help detect
substances or cellular material in the urine associated with different metabolic and kidney
disorders. It is ordered widely and routinely to detect any abnormalities that require follow up.
Often, substances such as protein or glucose will begin to appear in the urine before patients are
aware that they may have a problem. It is used to detect urinary tract infections and other
disorders of the urinary tract. In patients with acute or chronic conditions, such as kidney disease,
the urinalysis may be ordered at intervals as a rapid method to help monitor organ function,
status, and response to treatment.

COMPUTED TOMOGRAPHY SCAN AND MAGNETIC RESONANCE IMAGING- it

shows the extent of the fracture damage, how the fragment of the bone is misaligned, shows the
soft tissue around the bone which help to detect injury to nearby tendons and ligaments, shows
evidence of cancer, shows swelling or bruising within the bone, shows occult fractures before
they appear on x-rays.

 CT SCAN- shows in detail a specific plane of involved bone. It can be useful in

orthopedic diagnosis by revealing tumors of the soft tissue or injuries to the ligaments or
tendons. It is helpful in identifying the location and the extent f fractures in areas difficult
to define like the acetabulum. Studies may be performed with or without contrast and last
about an hour.
 MRI- is a non-invasive, special imaging technique that uses magnetic fields, radiowaves,
and computers to demonstrate abnormalities such as tumors, narrowing of tissue
pathways through bone of soft tissue as muscle, tendon, and cartilage. Because an
electromagnetic is used, patient with any metal implants, braces or facemakers are not
allowed for this procedure.

BONE SCANNING- imaging procedure that involves use of radioactive substance called
technetium- 99 labelled pyrophosphate. Occult fractures are detected 3-5 days after the injury. If
pathogenic fracture is suspected bone scan help to check the problems of the bones, ones that
might not be producing symptoms

 Reflex the degree to which the matrix of the bone takes up a bone seeking radioactive
isotope that is injected into the system. The scan is done 4-6 hours after the isotope
injection.

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 Anatomy &
physiology

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 The femur is a long bone whose axis of movement is well outside of its substance for
most of its length. The thigh bone, extending from the hip to the knee of four- and two-legged
vertebrates, including humans. The femur is the largest, longest, and strongest bone of the human
skeleton. Its rounded, smooth head fits into a socket in the pelvis called the acetabulum to form
the hip joint (an example of a ball-and-socket joint). The head of the femur is joined to the bone
shaft by a narrow piece of bone known as the neck of the femur. The neck of the femur is a point
of structural weakness and a common fracture site. The lower end of the femur hinges with the
tibia (shinbone) to form the knee joint.

The femur can be felt through the skin at two sites. At the lower end, the bone is enlarged
to form two lumps called the condyles that distribute the weight-bearing load on the knee joint.
On the outer side of the upper end of the femur is a protuberance called the greater trochanter.
The gluteus and psoas muscles are inserted on the greater and lesser trochanter, respectively.
The lateral and medial epicondyles articulate with the tibia and the trochlear groove
accommodates the patella (kneecap).

Complete – fracture lines involves entire cross-section of the bone, and bone fragments are
usually displaced.

Closed – the fracture does not extend trough the skin.

Comminuted fracture – a fracture in which the bone is broken into more than two pieces. A
crushing force is usually responsible and there is often extensive injury to surrounding soft
tissues.

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PATHOPHYSIOLOGY

Vehicular accident

Patient was hitted by a jeepney

Thigh received direct violent trauma

Middle third bone of the femur breaks across the entire cross section

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 X-RAY

Bone splintered into several fragments

Muscles are destroyed and undergo muscle spasm which pulls the fragments in different
positions

Blood vessels and marrow of the bone are disrupted

Tissues are damaged

Bleeding occurs

Inflammation

Pain, deformity, loss functions, shortening of the leg, crepitus, swelling and discoloration

INTERVENTIONS

Steinman Pin Insertion via General Anaesthesia 90-90° traction

1 ½ HIP SPICA CAST

EXPLANATION

Trauma is the most common cause of fracture. The trauma is caused by vehicular
accidents. The amount and direction of the force will vary from accident to accident resulting
from violent direct trauma are either comminuted or multiple. Muscles are attached to the bones,
once the bones are destroyed, muscles tend to go through spasm which is the reason why the
splintered fragments of the bone moves away or will be scattered, in this case , the middle third
of the femur is damaged, the proximal bone is displaced due to muscle spasm. Blood vessels and
the bone marrows are also destroyed due to trauma occurred, tissue damage causes bleeding.
Aside from bleeding, inflammation occurs. Pain, deformity, loss function, shortening of the leg,
crepitus, swelling and discoloration occurs.

Insertion of Steinman pin is done. Skeletal Traction was also applied to the patient,
specifically 90-90° traction for more than a month and applied a cast, specifically 1 ½ Hip Spica
cast.

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MANAGEMENT
MEDICAL AND SURGICAL MANAGEMENTS

a. MEDICAL MANAGEMENT

1. TRACTION
 is the act of pulling and drawing which is associated with counter traction.
 This is used to keep aligned while the fracture heals. An array of ropes, pulleys, and
weights are used to continuously pull on the limb.
 Skeletal Traction is used using Steinman pin with holder
 90-90° is used, and it is indicated for fracture f the proximal 3rd of the femur
 The patient is under 4lbs traction weight bag
 She is under traction for more than a month.

2. CAST
 Is made by wrapping rolls of plaster or fiberglass strip that harden once wetted. Plaster
often used for the initial cast when a displaced fracture is being treated

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  Fiberglass cast is applied to the patient
 1 ½ hip spica cast was applied to affected area.

3. MEDICATIONS
 CO-AMOXICLAV
 PARACETAMOL 250mg, 5ml q 4 hours for temperature of more than 37.8°C
 ASCORBIC ACID SYRUP 5ml

b. SURGICAL MANAGEMENT

IDEAL

 OPEN REDUCTION INTERNAL FIXATION- the fracture fragments are reduced

through the use of internal fixation devices in the form of metallic pins, wire, screws,
plates, nails or rods, which maybe attach to the sides of bone or inserted through the bony
fragments or directly into the medullary cavity of the bone.

ACTUAL

 STEINMAN PIN INSERTION- Steinman pin is inserted t the left distal third femur by
Dr. Badies under General Anaesthesia. IV sedation by Dr. Yabyabin.

PROMOTIVE AND PREVENTIVE MANAGEMENT

A. PROMOTIVE MANAGEMENT

 Provide a safe and conducive environment for fast recovery which is free from sources of
stress which may cause anxiety and potential pathogens which may cause infection.
 Encourage and assist in passive range of motion exercises to prevent stiffness and
increase the strength of the muscles not only of the affected but of the unaffected limbs as
well.
 Encourage patient to eat protein-rich food to promote wound healing.
 Instruct patient to avoid unnecessary movement of the fractured extremity
 Observe aseptic technique in caring for the wound

B. PREVENTIVE MANAGEMENT

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 Avoid playing alone outside the house and without supervision
 Refrain from overusing the affected lower extremities to prevent another fracture and
further complications
 Encourage intake of high calorie and high calcium diet to help faster recovery
 Observe motor vehicles around the patient’s environment
 Let patient play in a motor vehicle free area to avoid accident
 Exercise the unaffected extremities to sustain strength

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Nursing care plan

CUES DIAGNOSIS ANALYSIS OBJECTIVE INTERVENTION RATIONALE EVALUATION

Subjective: P- Impaired physical Vehicular accident After 4 hours of INDEPENDENT: GOAL MET
mobility related to rendering >Asses degree of >Client may be After 4 hours of
“Nahihirapan na nga pain and discomfort appropriate nursing immobility produced by restricted by self- rendering
siya eh, gusto na and physiologic interventions, the injury/treatment and perception out of appropriate nursing
daw umuwi.” immobility Strong force causes client will improve note client’s perception proportion with interventions, the
As verbalized by the E- Pain and femoral fracture and muscle strength and of immobility. actual physical client demonstrated
patient’s mother. discomfort and muscle spasm do some range of limitations requiring increase muscle
physiologic motions on the interventions to strength as
Objective: immobility extremities to promote progress evidenced by
S- As evidenced By: prevent atrophy. toward wellness. demonstrating some
>Limited ROM Damage bone nerve range of motion
>Decreased muscle >Limited ROM ending >Encourage >Provides exercises on the
strength and control >Decreased muscle participation in opportunity for extremities.
>Unable to walk due strength and control diversional/recreational release of energy,
to traction applied >Unable to walk due activities such as refocuses attention,
>With fair skin to traction applied Impaired Physical drawing, playing toys on enhances client’s
>With Steinmann >With fair skin Mobility bed. Maintain sense of control and
pin inserted at >With Steinmann stimulating aids in reducing
proximal middle 3rd pin inserted at environment; such as social isolation.
of the femur(90-90˚ proximal middle 3rd radio, TV, newspapers,
traction) of the femur(90-90˚ personal
>No signs of traction) possessions/pictures,
swelling at >No signs of clock Calendar visits,
Steinmann pin site swelling at from family/friends.
>Needs assistance in Steinmann pin site
doing ADL’s. >Needs assistance in
doing ADL’s.
>Instruct client in/assist >Increases blood

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 with active/passive flow to muscles and
ROM exercises of bone to improve
affected and unaffected muscle tone and
extremities. maintain joint
mobility, prevent
contractures and
atrophy and calcium
resorption from
disuse.

>Encourage of isometric >Isometrics contract

exercises starting with muscles without
the unaffected limb. bending joints or
moving limbs and
help maintain
muscle strength and
mass.

>Provide footboard,
wrist splints, >Useful in
trochanter/hand rolls as maintaining
appropriate. functional position
of extremities,
hands/feet and
preventing
complications.
>Place in supine
position periodically if >Reduces risk of
possible when traction is flexion contracture
used to stabilized lower of femur.
limb fractures.

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 >Instruct in/encourage
use of trapeze and >Facilitates
“position” for lower movement during
limb fractures. hygiene/ skin care
and linen changes,
reduces discomfort
of remaining flat in
bed. Post position
involves placing the
injured foot flat on
the Bed with the
knee bent while
grasping the trapeze
and lifting the body
off the bed.

>Assist with self care >Improves muscle

activities (e.g., bathing, strength and
brushing.) circulation, enhances
client’s respiratory
function and
prevents
complications such
as respiratory
pneumonia, etc.

>Monitor blood pressure >Postural

with resumption of hypotension is a
activity. Note reports of common problem
dizziness. following prolonged
bed rest and may
require specific

23
 interventions
(gradual elevation to
upright position).
>Reposition periodically
and encourage coughing >Prevents and
or breathing exercises. reduces incidence of
skin and respiratory
complications.

>Auscultate bowel
sounds. Monitor >Bed rest, use of
elimination habits and analgesics and
provide for regular changes in dietary
bowel routine. Place on habits can slow
bedside commode, if peristalsis and
feasible, or use fracture produce
pan. Provide privacy. constipation.
Nursing measures
that facilitate
elimination may
prevent
complications.

>Perform a thorough
assessment of client’s >To help in tissue
condition prior to bowel repair. Constipations
habits. in orthopedic clients
is a major issue and
needs immediate and
ongoing attention.

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 >Keeps the body
>Encourage increased well hydrated,
fluid intake to 2000- decreasing risk of
3000 mL/day. urinary infection,
stone formation and
helps prevent
constipation.

>In the presence of

>Provide diet high in musculoskeletal
proteins, carbohydrates, injuries, early good
vitamins and minerals. feeding is needed as
nutrients required for
healing are rapidly
depleted. This can
have a profound
effect on muscle
mass, tone and
strength. Protein
foods increase
contents in small
bowel, resulting in
gas formation and
constipation.
Therefore,
gastrointestinal
function should be
fully restores before
protein foods and
increased.

>Adding bulk to

25
 >Increase the amount of stool helps prevent
roughage/fiber in the constipation. Gas
diet. Limit gas forming forming foods can
foods. cause abdominal
distention especially
in presence of
decreased intestinal
mobility.

Collaborative:
>Used in creating
>Consult with aggressive
physical/occupational individualized
therapist and/or activity program.
rehabilitation specialist. Client may require
log term assistance
with movement,
strengthening and
weight-bearing
activities as well as
use of adjuncts.

>Clients with
>Refer to fractures especially
dietician/nutrition team when associated
as indicated. with trauma may
have special
nutritional
considerations to
maximize healing of
bones and tissues.

26
 >Important to
>Initiate bowel program promote regular
(stool softeners, enemas, bowel evacuation
laxatives) as indicated. and prevent
constipation.

>Refer to psychiatric >Client may require

clinical nurse more intensive
specialist/therapist as treatment to delay
indicated. with reality of
current condition,
prolonged
immobility, and
perceived loss of
control.

27
Drug study

NAME OF DOSAGE & ACTION INDICATION CONTRAINDICA ADVERSE & NURSING

DRUG FREQUENCY TION SIDE EFFECTS RESPONSIBILIT
IES
1. CEFAZOLIN 250mg IV ANST(-) - bind to bacterial - treatment of skin - hypersensitivity to - CNS: seizures (↑ - Assess patient for
as loading dose cell wall membrane, and skin structure cephalosphorins doses) infection (V/S:
causing cell death. infections (including - serious sensitivity to - GI: appearance of
burn wounds), bone penicillins pseudomembranous wound, urine and
and joint infections. colitis, diarrhea, stool, WBC) at
nausea, vomiting, beginning & during
cramps therapy.
- DERM: rashes, - Before initiating
urticaria therapy, obtain a
- HEMAT: blood history to determine
dyscrasias, hemolytic previous use of and
anemia reactions to
penicillins or
cephalosphorins.
Persons with a
negative history of
penicillin sensitivity
may still have an

28
 allergic response.
2. IBUPROFEN 250mg/ 5ml 5ml - inhibits - mild to moderate - hypersensitivity - CNS: headache, - assess pain (note
BID PRN for pain prostaglandin pain or - active GI bleeding or dizziness, type, location, &
synthesis. dysmenorrhea ulcer disease. drowsiness, psychic intensity) prior to
-decreased pain and - lowering of fever. disturbances and 1-2 hr following
inflammation - EENT: amblyopia, administration.
- reduction of fever. blurred vision, - advise client to take
tinnitus ibuprofen with a full
- CV: arrhythmias, glass of water and to
edema remain in an upright
- GI: GI bleeding, position for 15-30
hepatitis, min after
constipation, administration.
dyspepsia, nausea, -
vomiting, abdominal
discomfort
- GU: cystitis,
hematuria, renal
failure
- DERM: rashes
- HEMAT: blood
dyscarias, prolonged
bleeding time
3. PRACETAMOL 250mg/ 5ml 5ml q - inhibits the - mild pain - previous - GI: hepatic failure, - assess overall
4° for T> 37.8° C synthesis of - fever hypersensitivity hepatotoxicity health status and
prostaglandins that - products containing (overdose) alcohol usage before
may serve as alcohol, aspartame, - GU: renal failure administering
mediators of pain saccharin, sugar, or (high doses/chronic acetaminophen.
and fever, primarily tartrazine should be use) Malnourished
in the CNS avoided in patients - DERM: rash, patients or chronic
- analgesia who have uticaria alcohol abusers are
- antipyresis hypersensitivity or at higher risk of
intolerance to this developing

29
 compounds. hepatotoxicity with
chronic use of usual
doses of this drug.
- FEVER: assess
fever; note presence
of associated signs
(diaphoresis,
tachycardia, etc.)
4. ASCORBIC 5ml syrup OD - For delayed - tartrazine - CNS: drowsiness, - follow 10 rights of
ACID SYRUP hepersensitivity fatigue, headache, drug administration
fracture or wound
insomnia - document any signs
healing - GI: cramps, of over dose such as
diarrhea, hearturn, decrease level of
- treatment &
nausea, vomiting consciousness, etc.
prevention of Vit. C
- GU: kidney stones
deficiency
- DERM: flushing
5. 5ml Syrup & hold - prevents and treat - abdominal - take detailed drug
MULTIVITAMINS ascorbic acid nutritional vitamin
discomfort, epigastric history prior to
+ IRON SYRUP ad mineral
deficiency. Increase distress, GI reactions, initiation of therapy.
body resistance
peptic ulcerations, Observe signs of
against disease.
headache, nausea, allergic response in
vertigo. those with aspirin or
NSAID sensitivity.
Lab test should be
done. Monitor
therapeutic
effectiveness.

30
DISCHARGE PLANNING

 Multivitamins iron syrup

 Calcium 1 tab od x 30 days
 Follow strict medication compliance
 Avoid not following schedules of medication to
prevent drug-resistance
 Follow proper order dose of drugs to achieve drug
reactions
 Avoid OTC drugs that is not prescribed by the
physician
 Passive Rom exercises:
- Simple stretching
- Moving he affected leg
- Circular motion of the affected foot`
- Have rest periods during physical activities
- Do deep breathing exercises
 Strict medication compliance
 Intake of vitamin c and d to strengthen immune system
and in helping bone growth
 Assistance of the family for physical therapy or
activities of the patient
 Continuous passive rom exercises

 Strict medication compliance do physical therapy and

passive rom exercises
 Promote proper wound cleaning
 Promote hand washing to prevent infection
 Promote proper nutrition
 Intake of vitamin c and d to strengthen immune system
and in helping bone growth
 Monitor signs and symptoms of infection
 Monitor complications
 Go for follow-up check up and update health by going
to regular check-up
 Continue medications as prescribed by the doctor

31
  Diet as tolerated
 Increase Calcium and protein intake

 Instruct patient to keep his wound dressing clean and

dry
 Monitor signs and symptoms of infections
 Monitor for complications
 Instruct patient to have passive range of motion
exercise
 Instruct patient to ask assistance when doing such
things
 Instruct patient not to go outside the house when alone
 Instruct patient to avoid areas with lot of motor
vehicles
 Instruct patient to see motor vehicles around her

UPDATES

32
 Three-Quarters of Hip Fracture Patients Are Vitamin D Deficient, Indian Study Reveals
ScienceDaily (Dec. 13, 2010) — New Delhi researchers show that vitamin D levels may be a
useful index for the assessment of hip fracture risk in elderly people.

A study in New Delhi India has revealed high rates of vitamin D deficiency among hip
fracture patients, confirming the conclusions of similar international studies which point to
vitamin D deficiency as a risk factor for hip fracture.
A group of 90 hip fracture patients was compared to a matched control group of similar
age, sex and co-morbidity. Of the patients who had suffered hip fractures, 76.7% were shown to
be vitamin D deficient as measured by serum 25(OH)D levels of less than 20 ng/ml. In addition,
68.9% had elevated PTH levels. In comparison, only 32.3% of the controls had vitamin D
deficiency and 42.2% had elevated PTH levels (secondary hyperparathyroidism).
Vitamin D deficiency has been linked to the pathogenesis of osteoporosis and is
increasingly thought to play a role in muscle strength, certain cancers, multiple sclerosis and
diabetes. Vitamin D levels are very low in the Indian population in all age groups, and could be
explained by skin pigmentation, traditional clothing and the avoidance of sunlight.
The results of the New Delhi study confirm that serum 25 (OH)D levels may be a useful
index for the assessment of risk of hip fracture in elderly people.
The study (OC13) was presented at the IOF Regionals -- 1st Asia-Pacific Regional
Osteoporosis Meeting being held in Singapore from December 10-13, 2010.

Bibliography

 BOOKS
Bare, Brenda I. and Smeltzer, Suzzane C., Textbook of Medical-Surgical Nursing. 10th
Edition Philadelphia: I.B Lippincott Company. 2004.

33
 Nettina, Sandra M., Manual of nursing Practice. 7th Edtion. I.B. Lippincott Company.
2001.

Rozler, Barbara et al. Fundamentals of Nursing. 5th Edition. Newyork: Addison-

Weatleylongman, Incorporated. 1998.

Marleb, Elaine N. Essential of Human Anatomy and Physiology. 7th Edition. Singapore.
Pearson Education South Asia Pte. Ltd. 2004.

Potter, Patricia and Perry, Anne. Fundamentals of Nursing. 6th Edition Baltimore: C.V.
Mosby and Company. 2005.

Doenges, M., Moorhouse, M.F. , Geissler – Murr, A. “ Nurses Pocket Guide”, Diagnosis,
interventions and rationales, 9th Edition (2004).

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

 INTERNET

http://www.scribd.com/doc/19800479/Case-Study-Fracture

http://www.britannica.com/bps/media-view/101308/0/1/0

http://www.pediatric-orthopedics.com/Topics/Bones/Femur/femur.html

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