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with an admitting diagnosis of Open Complete Comminuted Fracture at the left tibia, fibula. This presentation also intends to help patient promote health and medical understanding of such condition through the application of the nursing skills. Specific
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To raise the level of awareness of patient on health problems that he may encounter. To facilitate patient in taking necessary actions to solve and prevent the identified problems on his own. To help patient in motivating him to continue the health care provided by the health workers. To render nursing care and information to patient through the application of the nursing skills.
A fracture is any break in the continuity of bone. Fractures are named according to their severity, the shape or position of the fracture line, or even the physician who first described them. It is defined according to type and extent. In some cases, a bone may fracture without visibly breaking. Fractures occur when the bone is subjected to stress greater than it can absorb. It can be caused by a direct blow, crushing force, sudden twisting motion, or even extreme muscle contraction. 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 the fracture fragments. Among the common kinds of fractures are the following:
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Open (compound) fracture: The broken ends of the bone protrude through the skin. Conversely, a closed (simple) fracture does not break the skin. Comminuted fracture: The bone splinters at the site of impact, and smaller bone bone fragments lie between the two main fragments. Greenstick fracture: A partial fracture in which one side of the bone is broken and the other side bends; occurs only in children, whose bones are not yet fully ossified and contain more organic material than inorganic material Impacted fracture: One end of the fractured bone is forcefully driven into the interior of the other. Pott’s fracture: A fracture of the distal end of the lateral leg, with one serious injury of the distal tibial articulation. Colles’ fracture: A fracture of the distal end of the lateral forearm in which the distal fragment is displaced posteriorly.
Fractures may also be described according to anatomic placement of fragments, particularly if they are displaced or nondisplaced. Injuries to the skeletal structure may vary from a simple linear fracture to a severe crushing injury. The type and location of the fracture and the extent of damage to surrounding structures determine the therapeutic management. Maximum functional recovery is the goal of management.
is the larger. Fractures of the tibia and fibula often occur in association with each other. An interosseous bone connects the tibia and fibula.The most common fracture below the knee is one of the tibia and fibula that results from a direct blow. falls with the foot in a flexed position. and considerable edema. The tibia. The distal end has a projection called the lateral malleolus that articulates with the talus bone of the ankle. They are numbered I to V being with the great toe. Its distal end articulates with the tibia and patella. The fibula is parallel and lateral to the tibia. The position of the bone segments is determined by the pull of attached muscles. The first metatarsal is thicker than the others because it bears more weight. pain and impaired sensation and decreased mobility. The femur. the head of the fibula. muscle spasm. the cuboid. The proximal end. the three cuneiform bones called the first. triangular bone located anterior to the knee joint. gravity. and its distal end with the fibula and the talus bone of the ankle. or thigh bone. but it is considerably smaller than the tibia. the 5 metatarsals in the metatarsus. Its proximal end articulates the acetabulum of the hip bone. to maintain position of the tendon when the knee is bent. deformity. these fractures are open and involve severe soft tissue damage because there is little subcutaneous tissue in the area. The patient presents with pain. second. The tibia articulates at its proximal end with the femur and fibula. The metatarsus is the intermediate region of the foot and consists of five metatarsal bones numbered I to V. which is medial.The patella functions to increase the leverage of the tendon of the quadriceps femoris muscle. It is a sesamoid bone that develops in the tendon of the quadriceps femoris muscle. The signs and symptoms of a fracture include unnatural alignment. obvious hematoma. and third cuneiforms. The phalanges comprise the distal component of the foot and resemble those of the hand both in number and arrangement. They include the talus and calcaneus. weight-bearing bone of the leg. articulates with the inferior surface of the lateral condyle of the tibia below the level of the knee joint to form the proximal tibiofibular joint. ANATOMY AND PHYSIOLOGY Lower Limb Each lower limb has 30 bones in four locations: (1) the femur in the thigh. and the direction and magnitude of the force that caused the fracture. swelling. heaviest and strongest bone in the body. medial. and to protect the knee joint. or shin bone. is the longest . Frequently. (3) the tibia and fibula in the leg. is a small. tenderness. or kneecap. from the medial to the lateral position. (4) and the 7 tarsals in the tarsus. (2) the patella. and the 14 phalanges in the foot. or a violent twisting motion. The patella. . The tarsus is the proximal region of the foot and consists of seven tarsal bones.
A large branch of tree hit him at the back and at the same time another struck him at his left leg. and 3 of his friends are having their lunch at a mountain slope in their place. Nutritional/ Metabolic Pattern .L. 2006 he was admitted by Dr. wound cleaning and wound dressing for the injury he obtained from the impact at his left leg. Treatments were done such as Closed Tube Thoracotomy due to the impact of the branch on his posterior chest. Immediately he was brought to a hospital in Cabanatuan. The following day. F. Demographic Data | Physical Assessment and General Appearance | Head to Toe Assessment Gordon’s Functional Health Pattern Health-Perception/ Health Management Pattern The patient is almost generally the same as how every Filipino seeks health assistance. The incident happened in the morning of July 6. so he decided to transfer to another hospital. Although he was not hospitalized prior to his current illness. he would not approach health workers not unless it is lifethreatening. fibula. July 30 at exactly 3:50pm he had undergone an operation conducted by Dr. Without any problem regarding his health. but his father died of asthma. He noticed that the healthcare providers in the said hospital did nothing but to clean his wounds and replace the dressing. is a victim of nature-insinuated accident. Geronilla at the East Avenue Medical Center wherein his admitting diagnosis is Open Complete Comminuted Fracture at the left tibia. Family Health History No hereditary disease can be attributed from his mother side. he had no records or medical history of being admitted with any disease to any other hospital. On July 29.. L. the patient has the proper perception whether he is being treated correctly as with the management done to him at the hospital in Cabanatuan. The operation performed was Debridement Impaction and Application of External Fixator at the left tibia. Other than the latter.NURSING ASSESSMENT Present Health History The patient. 2006 wherein F. Past Health History Prior to his hospitalization at Cabanatuan and Quezon City. Tagaba and was given a spinal anesthesia by Dr. no other hereditary disease from both of his parents are within the patient’s knowledge. Sangcate.
Although he is not fond of eating fish. he is also fond of smoking cigarette. He is not fond of playing physical games. His hearing ability is also in normal condition and so does his sense of sight. Cognitive/ Perceptual Pattern From his point of view. he usually sleeps for 4 hours and takes nap in the afternoon. consuming almost 10 sticks a day. Sleep-rest Pattern The patient sleeps for an average of 8 hours per day before his confinement. The patient did not confirm that he is into an intimate relationship right now. the patient likes to have drink with friends.The patient eats three times a day. Sexuality & Reproductive Pattern Being 5th among children of six wherein 5 of them are female and him. he has a good memory. Self Perception/ Self-Concept Pattern The patient says that he is very much comfortable with his body image prior to his injury. Aside from drinking. During his hospital stay. He says that he can still remember things of great importance especially with regards to his family and loved ones. He usually drinks coffee every morning. he loves to eat vegetables such as okra and is fond of munching fruits like bananas and catmon. same as with his stay in the hospital. Even if his left leg is injured. During his hospital stay. he is instructed with diet as tolerated. . drinking a glass or two of gin or brandy. he managed to have a stable gender identity during his growing years. He urinates more frequently (average of 4 times daily) during his stay at the hospital than the time prior to his admission. Elimination Pattern According to the patient. He says that he eats a balanced diet. He implied that he would rather watch television and court a girl. He had a difficulty of moving around the bed due to the external fixator attached to his leg. He started drinking and smoking almost 5 years ago. Role/ Relationship Pattern He still lives with his mother and performs his obligations as a son. the only male among them. when he is at home or even at work he usually defecates for at least once a day. he still feels optimistic about regaining his old functionality and image. He often does this almost once a week. He prefers to drink water than carbonated beverages. Activity/ Exercise Pattern For his leisure time.
and external fixators. The specific method used on the nature of the fracture in this case is closed reduction. Reduction of a fracture refers to the restoration of the fracture fragments to anatomic alignment and rotation. Pin postions is maintained through attachment to a portable frame. early mobility. Medical & Surgical Management As in the case of the patient in this study. In most cases. Extremely severe fractures may require placement of a natural or artificial bone graft. Devitalized bone fragments are removed. continuous traction. and screws. Methods of external fixation include bandages. or held in correct position and alignment. or a rod may be used to hold the realigned bones in place. plus a splint or cast may also be used to protect the area. splints. and a splint. He makes his decision in accordance to his principles in life and how he perceives it. the patient likes to listen to soothing music to relieve him from anxiety. Intravenous antibiotics are prescribed to prevent or treat infection. dressings. the bone fragments must be immobilized. and regaining of normal function and strength through rehabilitation. the operation performed was Debridement Impaction & Application of External Fixator at the left tibia.Coping/ Stress-tolerance Pattern As part of his stress-tolerance activity. until union occurs. In an open fracture. Debridement and irrigation is used to remove anaerobic organisms. immobilization. aligned and immobilized by a series of pins inserted in the bone. but not really the type of follower who goes to the church every Sunday to hear mass. Fracture treatment involves realigning the bone fragments (reduction) close to their normal or anatomic position and holding the fragments in place (immobilization) so that bone union can occur. Open reduction is a method is used if the bone is fragmented or difficult to reduce. External fixators are used to manage open fractures with soft tissue damage. The objectives of management are to prevent infection of the wound. The bone fragments are moved into their normal position. there is a risk of tetanus. He also smokes for that matter and often he relaxes his body by taking a time off his work and spending time with his friends. They provide stable support for severe comminuted fractures while permitting active treatment of damaged soft tisuues. fracture reduction becomes more difficult as the injury begins healing. The fixator facilitates patient comfort. casts. and may requires screws and a plate to hold the fragments in place. The doctor makes a cut in the skin covering the break to expose the bone fragments. After the fracture has been reduced. The fracture is then carefully reduced and stabilized by external fixator. soft tissue and bone and to promote healing of soft tissue and bone. gas gangrene and osteomyelitis. . The fracture is reduced. Value/ Belief Pattern The patient is a Roman Catholic. a plate with screws. The principles of fracture treatment include reduction. Immobilization is accomplished by external. The doctor closes the incision with stitches.
D – iet . Partial weight bearing is begun when prescribed and is progressed as the fracture heals in 4 to 8 weeks. as in the case of the patient. Gradual resumption of activities is promoted within the therapeutic prescription. was treated with external fixation. Hip. intake of pain relievers as prescribed and dietary supplements as well. This would promote less risk for infection. Isometric and muscle-setting exercises are encouraged to minimize disus atrophy and to promote circulation. and surgeon is advise if signs of neurovascular compromise are identified. cool and pale toes. Reduction and immobilization are maintained as prescribed to promote bone and soft tissue healing. Open complete comminuted fracture of the tibia.and active exercise of adjacent uninvolved joints. Swelling is controlled by elevating the injured extremity and applying ice as prescribed. Reassurance. Complications related to disuse and immobility are minimized. Discharge Plan M – edication Intake of pain relievers in case the site is in pain. anxiety and discomfort. Uncontrolled swelling and pain. T – reatment Management of such condition would include proper therapy and exercises of the extremities. H – ygiene Advise to follow proper body hygiene and to maintain cleanliness on site. E – conomic The use of nonpharmacotherapy such as exercises and elevation of lower extremity to control edema and pain are encouraged to avoid further expenditure on medication. O – ut Patient/ Follow-up In cases wherin pain beyond limits of discomfort can be felt. Participation in activities of daily living is encouraged to promote independent functioning and self-esteem. foot and knee exercises are encouraged within the limits of the immobilizing device. Neurovascular status is monitored. position changes and pain relief strategies controls feeling of restlessness. advise to report to physician or surgeon immediately. loose fixators must be immediately reported to the physician for proper management. signs of infection.
Nursing assistance was also given to help him in his activities of daily living. carbohydrates. Hygiene was also strictly implemented to avoid risk for infection. With proper nutrition and conformity to the medications & therapy. He was transferred from a hospital at Cabanatuan to East Avenue Medical Center to seek for further advise and proper treatment of his case. health teachings and medical check-up is advised. Health teaching is a very important role on the part of the nurses. recovery would be easier and faster. He had a tibial fracture last July 6 due to a blunt injury froma foreign object fall. dietary fiber. due to increased trabsudation of of the fluid from the capillaries Fracture – a break in a bone usually caused by trauma Impaction – a condition in which one fragment of a fractured bone is driven into another and is fixed in that position Open reduction – a reduction performed after making an incision through the soft parts in order to expose the fracture or dislocation . Definition Of Terms Debridement – removal of foreign material and devitalized tissue from a wound Edema – excessive accumulation of fluid in the tissue spaces. Proper nursing care such as pain relief using nonpharmacotherapy and administration of prescribed drugs were done to promote comfort.Instruct to eat foods that are rich in protein. Evaluation Conclusion The patient in this study had undergone debridement impaction and application of external fixator at the lest tibia. Vitamins A & C to promote wound healing. Recommendation Strict compliance to the medical treatment. This is of great significance to the knowledge deficit of patients regarding health and illness.
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