De La Salle Health Sciences Institute College of Nursing and School of Midwifery Dasmariñas, Cavite

NURSING CASE STUDY
Fracture, Closed, Complete, Displaced M-D₃ Femur, R Fracture, Closed, Complete, Undisplaced Medial Malleolus, R

Submitted by: Pascua, Sarah Ariana A. BSN31

Submitted to: Ms. Melanie Nolasco, RN, MAN

April 4, 2011

R Fracture. then suddenly another baby bus hit their vehicle from behind. was standing inside a baby bus near the doorsteps after collecting transportation fees (J. but due to lack of medical equipment. Closed. pt. landed on the pavement initially hitting his right lower side.L was a conductor). Nursing History Five hours PTA.Patient: J. pt. J. Displaced M-D₃ Femur. Pt. was brought to a nearby hospital were first aid was given. The impact caused J. Complete. Closed. Peimon Badiee I. was transferred to Philippine Orthopedic Center. R Attending Physician: Dr.L. Age: 52 years old Sex: Male Civil Status: Married Medical Diagnosis: Fracture. . Complete. hence admission. Chief Complaint • Pain on right thigh II. Undisplaced Medial Malleolus.L.L to be thrown from the bus.

III. Pathophysiology Modifiable Risk Factors: Mechanical overload Stress and fatigue Biologic conditions Protein malnutrition High risk recreation Domestic violence Extreme force/Trauma Medications (steroids) Non-modifiable Risk Factors: Age (elderly and school age) Estrogen loss Metabolic bone disorders Impact/Insult to the bone Bon e Xray Bones break Deformit y Crepitus Immobilit y Soft muscles surrounding the bone disrupt Swelling Tendern ess Spasm Pain Spasm on muscles Misalignment on the bone and bone muscles Bleeding to the bone Formation of hematoma in the medullary canal Bone tissue dies Intense inflammatory response causing WBCs to infiltrate .

Continuous bone disintegrity Nursing Management: Promote Bed Rest ROM exercises Wound Care Assistance in Mobility and ADLs Medical Management: NSAIDs Antibiotics Muscle Relaxants Surgery Basic Skeletal Traction FRACTURE LEGEND: Precipitating Factors Sequence of Events Diagnostics Clinical Manifestations Management .

estrogen loss. extreme force. like of what the patient experienced the bone becomes broken. metabolic bone disorder. biologic condition. The medical management for fracture is the use of NSAIDs for the pain of the patient. and surrounding soft tissues be disrupted. Muscle relaxants for the spasms. marrow. and beneath the periosteum. As the bones break. The bone tissue dies. stress and fatigue. tenderness on affected site and pain. When the bone is exposed to one or more risk factor. spasms on the surrounding muscles of the bone are experienced causing swelling. Bleeding occurs from the damaged ends of the bone and from the neighboring soft tissue. Surgery and traction for realignment of the bones. between the fractured ends of the bone. . Antibiotics for the open wounds. A clot (hematoma) forms within the medullary canal.Synthesis: Fracture may be brought about by different reasons and there are risks that may predispose a patient such as mechanical overload. and age (elderly and school age). domestic violence. medications such as steroids. high risk recreation. Disalignment of the bone and bone muscles are experienced causing the periosteum and blood vessels in the cortex. protein malnutrition. As there is continuous disintergrity fracture is seen.

Procedure/ Date Hematology (03. leukemia. .05 Monocytes 0.50-0. state of hydration and dehydration.40g/L 16.20-0. reaction to inflammation and infections. Normal Values/Findings Hemoglobin 127-183g/L Hematocrit 0.5-10x10^9/L Differential Count Segmenters 0. transport.37-0. distribute antibodies to build the body’s immune system.70 Actual Findings Nursing Responsibilities PRE > Explain procedure the > Explain purpose of the procedure and what the patient should expect during the procedure POST > Assess puncture site >Note for any abnormal bleeding > Tell the client that the results will take some time to be released.70 Lymphocytes 0.04 240 Impression: WBC count is high as they help fight infection and helps produce.IV.05 0. May indicate bacterial infection.16. polycythemia.54g/L WBC 4. >Follow up for the results 132g/L 0.07 Platelet 150-400 0.40 Eosinophils 0.9x10^9/L (above normal) 0.00-0.11) Laboratory and Diagnostics Indication This test is used to evaluate anemia. peripheral blood cellular characters.20 0.00-0.

5-5. >Follow up for the results.16.11) Potassium Chloride Normal Actual Values/Findings Findings 135-148 mEq/L 135.69 mEq/L 97. Serology (03.90 mEq/L 3.16.11) C-Reactive Protein (C-RP) < 6mg/L 96 mg/L (Highly above normal: Indicative of an ongoing inflammatory process inside the body) 52 (Highly above normal: Indicative of increased globulins that may be due to severe infection and is also a sign of inflammation) Erythrocyte Sedimentation Rate (ESR) <15 .60 mEq/L Nursing Responsibilities PRE > Explain procedure the > Explain purpose of the procedure and what the patient should expect during the procedure POST > Assess puncture site >Note for any abnormal bleeding > Tell the client that the results will take some time to be released.30 mEq/L 98-100 mEq/L 3.Procedure / Indication Date Blood Sodium Chemistry (03.

BID PRN if (+) pain • Acute pain • Treatment for Osteoarthritis and Rheumatoid Arthritis *Contraindicated to patients with celecoxib.Assess pain of the client .V. peripheral edema . flushing. ophthalmic effect. vomiting. vomiting. nausea.O. headache AR: dizziness.O.Explain the indication of the drug to the patient INTRA 625mg/tab P. take medications properly POST Document procedure • Monitor for side effects and adverse reactions PRE . light-headedness.Check for Doctor’s order . rash. BN/GN Co-amoxiclav (Bioclavid) • Antibiotic • Penicillin • BetaLactamase inhibitor Medications Dosage/ Frequency/ Route Indication • Osteomye litis • Post-op infections *Contraindicated to patients with penicillin allergy S/E and AR S/E: nausea. peripheral edema. pruritus. GI pain. S/E: dizziness or drowsiness AR: insomnia. asthenia. dyspepsia. GI bleeding. abdominal discomfort Nursing Responsibilities PRE •Check the doctor’s order •Determine client’s sensitivity to drug •10Rs •Explain the purpose for medication INTRA •Administer with meals to reduce GI upset •Watch pt.Apply 10 rights of drug administration . dry mucous membrane. lethargy. TID Celecoxib (Pharex Celecoxib) • NSAID • COX2 Inhibitor 200mg/cap P.

ACTUAL or Active B. 2011 Pt. . JL was able to do active ROM exercises on his unaffected areas A. 1 2 Nursing Priorities Problem Intermittent pain 4/10 Immobility Date Identified March 30. 2011 Pt.sulfonamides. heart failure .Encourage the patient to verbalize any changes in feelings . 1 Problem Sepsis Date Identified March 31. JL’s pain reduced from 4/10 to 2/10 March 31.Administer the drug with food or after meals if GI upset occurs.Document the procedure done VI. severe hepatic problem. take medications properly POST . 2011 . HIGH RISK or Potential Problem No. With asthma. aspirin and other NSAID allergy. Problem No. 2011 March 30.Watch pt. pts. 2011 Date Resolved/Remarks March 30.

umpong ang and reflex the patient will sakit dito sa spasms be able to hita ko. > Performed and supervised active and passive ROM exercises. Patient was able to verbalize a feeling of pain alleviation and the pain decreased to 2/10. RATIONALE > Gives patient assurance that her feelings especially of pain are being recognized > Promotes venous return and reduces pain EVALUATION Goal was met. >(+) right thigh pain > (+) facial grimace >BST on Right thigh and leg INTERVENTION Independent > Encouraged verbalization of pain and other feelings. > Kept affected extremities elevated and supported. 1 (March 30.” secondary to promote and > Pain of 4/10 fracture maintain good physical O: comfort. > Identified diversional activities appropriate for age like reading books and/or magazines. 2011) CUES NURSING LONG TERM DIAGNOSIS GOAL S: Acute Pain After the range > related to of “Pasumpongs tissue trauma hospitalization.VII. and talking with relatives and other patients. > Prevents boredom and can increase muscle strength. Nursing Care Plan SHORT TERM GOAL Patient will be able to verbalize a decrease of pain from 4/10 to 1-0/10 within the shift Actual Problem No. > Maintains strength and facilitates resolution of inflammation in injured tissues .

>Relief of pain. splint. > Maintained immobilization of affected extremities by means of bedrest. >For fast healing and assisted improved comfort. and skeletal traction. maintenance of position of cast. .Collaborative >Administered analgesics as indicated.

pain and increases likelihood of client involvement and progressive activities. >Assisted slowly >Decreases in desired position discomfort.Actual Problem No. injury. May enhance willingness to participate. >Assisted and instructed to perform passive ROM at least four times a day. patient will maintain good body mechanics and prevent deformities. enhances circulation and prevents skin breakdown . muscle strength and joint mobility. >Reduces risk of muscle strain. >Promotes independence and self esteem. >Encourage to participate in all activities as individually able. >Maintains. joint flexibility prevents contractures and aids in reducing muscle tension. 2 (March 31. INTERVENTION RATIONALE EVALUATION Goal was partially met the patient was able participate in active ROM exercises on the unaffected areas > decrease muscle strength on affected areas: Impaired physical mobility r/t decreased strength and endurance secondary to fracture (external devices. pain. muscle weakness) Within the hospitalization . 2011) CUES NURSING LONG TERM DIAGNOSIS GOAL S >”Hindi ako makagalaw at makapwesto ng ayos gawa nitong bale ko” O > (+) BST on left leg SHORT TERM GOAL Within the shift. maintains as indicated. the patient will be able to participate in activities to increase strength and endurance such as performing passive ROM of the affected limb and active ROM on the unaffected areas. >Maintained proper body alignment.

.> Provided a quiet > Reduces stress and environment and excess stimulation. encouraged promoting rest indulgence to diversional activities as appropriate such conversing with immediate family members and thinking of happy thoughts and memories. > Assisted in selfcare activities. > Minimizes exhaustion and helps balance oxygen and demand.

and increased body temperature >Encourage to perform good hand washing technique >Provide health teaching about: 1. patient will demonstrate no signs and symptoms of infection such as being febrile. swelling. 2011) CUES NURSING DIAGNOSIS LONG TERM GOAL Within the range of hospitalization.9x10^9/L related to a site >non-ambulatory for organism >inability to turn invasion from side to side >(+) BST on left leg >dry and intact wound dressing on the insertion site of the Steinmann pin >Open holes (previous place of the Steinmann pin) on the distal 3rd of thigh . Patient remained afebrile and wound dressings are dry and still intact. signs and symptoms of infection and when to report to the health care provider RATIONALE >Represents a break in the first line of defense >To know if there is the presence of possible infection. patient will be able to promote safety through prevention of accidents and prevention of the spread of infection SHORT TERM GOAL Within the shift.Potential Problem No. >Decrease the risk of spreading microorganism s >To impart knowledge and provide long term intervention that may be applied in the future EVALUATION Goal was met. proper hand washing technique and its importance 2. increased pain. O: Risk for >WBC= infection 16. INTERVENTIONS >Assess for presence of open wounds and abrasion >Monitor for signs of infection: redness. 1 (March 31. wounds secreting discharges and foul smell.

Collaborative >Monitor white blood cell count >Increase in WBC may present presence of severe infection .

(include not only pt.’s family was oriented to the pt. >Advised to monitor and assess for infection by noting the signs and symptoms of it (febrile. but also a close relative) Follow up Q& A . Eat vegetables because of its benefits to the pt and to help improve wound healing >Advised pt. >Pt. and pt’s family was oriented to the medication. and pt.’s relative was advised to encourage pt. swelling) >Advised to seek physical therapy consult >Advise to monitor her I&O and let the physician see it. (include not only pt. Discharge Plan Content Strategy Lecture with interaction every visit to patient. but also a close relative) Follow up Q& A Lecture with interaction every visit to patient. to address to the physician his needs and the changes he had encountered for a week. was also advised to avoid fatty and salty foods and educated the relatives to never let pt. Follow up/Check up Lecture with Interaction every visit to patient. but also a close relative) Follow up Q& A 1. side effects and when to take it. >Pt.VIII. Compliance • Medication >Pt. • Diet 2. (include not only pt. purulent discharge.’s diet which is Diet As Tolerated >Pt. not eat on time. its use.

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