INTRODUCTION

Around 1.35 million people die due to road traffic accidents yearly. In the Philippines,
there is an increasing trend of mortality and morbidity caused by road crashes. Transport and
Vehicular Crash cases, risk factors such as drug use, alcohol use, mobile phone use, seatbelt, and
helmet use are included. There are also data on vehicle type, place of crash, and activity.
Descriptive and inferential statistics were computed to explore and analyze the ONEISS dataset,
particularly the epidemiology of transport and vehicular crashes (TVC)
The most common types of injuries for the TVC victims were abrasions, contusions,
burns, and concussions while the vehicle most involved in TVC was the motorcycle. Motorcycle
use was found to be associated with worse emergency room (ER) outcomes and the highest
injury types such as multiple injuries, abrasion, avulsion and burn. Alcohol use was also
significantly associated with multiple injuries, abrasion, avulsion, burn, open fracture, open
wound, and amputation
The trend of road traffic vehicular crashes affecting mainly the younger population has
economic repercussions. Motorcycles are also most involved in crashes, hence, the need for
motorcycle safety laws in the country. There is also a need to strengthen current laws and
legislation governing road safety and to focus on structuring a systematic post-crash response for
both the local government and hospitals throughout the Philippines.

PATIENT’S DEMOGRAPHIC DATA

Name of patient: Patient LS
Age: 22 years old Sex: Male
Address: Carangag San Andres, Catanduanes
Occupation: Student
Marital Status: Single
Religion: Roman Catholic
Nationality: Filipino
Date of Admission: September 29, 2022; 12:30am
Date of Discharge: October 8, 2022; 11:45am
Surgery (if any): Intermandibular Maxillary Fixation
 UPON ADMISSION DATA
Chief Complaint:
NOI: Vehicular accident
TOI: 9:45pm
DOI: 9/28/22
POI: Datag
Vital signs:
BP: 91/62mmHg Temperature: 37.6oC
PR: 78 beats per minute O2Sat: 94%
Weight: 60kg Height: 152.4cm
Attending Physician: Dr. Adelwisso Jesus V. Badong, MD

CASE SUMMARY
A 22 year old man was admitted in Eastern Bicol Medical Center. Prior to admission, according
to his sister, the patient was driving under the influence of alcohol intoxication that led to
multiple physical injury secondary to vehicular accident. The date of incident was September 28,
2022, time of incident was 9:45 in the evening, and place of incident was in Datag San Andres,
Catanduanes. He was then rushed to EBMC hospital and could not recall how he got admitted to
surgical ward.

IMPRESSION/DIAGNOSIS
Admission Diagnosis: Multiple physical injury secondary to vehicular accident; alcohol
intoxication
Final Diagnosis: Cerebral concussion secondary to vehicular accident; parafacial fracture
 PHYSICAL EXAMINATION
Assessment (September 30, 2022):
Patient was received lying in bed, asleep, and looks are appropriate to age. With ongoing
IVF of PNSS 1L at right arm. Multiple abrasions on the face, swollen face and eyes noted.
Patient appears to be uncomfortable and looks weak. Vital signs were taken:
BP: 130/90mmHg Temperature: 36.6oC
PR: 80 bpm O2Sat: 98%
RR: 21 breaths per minute

Patient History
I. Chief Complaint
Patient was brought to the emergency room via ambulance due to vehicular accident.
II. Family History
There were no reports of history of Cancer, Tuberculosis, Heart related diseases,
Diabetes, and kidney related diseases. But according to his sister they have history of
Hypertension on both sides of their parents.
III. Birth History
The patient was delivered via normal spontaneous vaginal delivery at full term, no pre-
natal and post-natal complications were noted.
IV. Medical History
Patient has completed all immunization shots (BCG, Measles, Hepatitis, OPV, DPT,
MMR). He has not experienced illness such as mumps, measles, rubella, varicella and typhoid
fever.
V. Developmental Milestones
Patient LS has no noted developmental delays, Developmental milestones are on par with
age.
VI. Nutrition and Metabolic Pattern
During pre-hospitalization patient SL`s regular diet is a common Filipino meal. Stated
that he consumes variety of foods which is high in fats but made sure that vegetables are
included in meals for at least three times a week.
VII. Elimination Pattern
Patient reported that SL has no constipation and regularly defecated. His stool was
described as semi-formed, brown in color and no particular different odor. The patient does not
experience excessive perspiration or body odor.
VIII. Sleep and Rest Pattern
He stated that he sleeps about 7-8 hours a day with no sleep disturbances and no
irregularities in sleep pattern.
IX. Activities of Daily Living:
CRITERIA PRIOR TO AFTER INTERPRETENTION
HOSPITALIZATION HOSPITALIZATION / ANALYSIS
Nutrition Usually consumed rice Loss of appetite; Abnormal
and meat, sometimes sutured upper lip
vegetables
Elimination Defecates 3x per week IRREGULAR Abnormal
PATTERN
Exercise Walking, playing Appears weak Abnormal
basketball
Rest and sleep Sleep 8 hours He sleeps 5 hours Abnormal
Hygiene Takes a bath every day Unkempt hygiene Abnormal
Substance use Drinks alcoholic N/A
beverages with friend
at least 3 times a week;
Use of e-cigarette

X. Vital Signs:
Blood Pressure
10/04/2022 12PM 140/90mmHg
4PM & 8PM 130/80mmHg
10/05/2022 4PM 130/80mmHg
10/06/2022 8AM 100/60mmHg
10/07/2022 8PM 130/100mmHg
Even if there is still blood loss, the body's physiological reaction to trauma is the
production of endogenous catecholamines, which raises the heart rate and systemic vascular
resistance. Initial blood pressure rises as a result of the cumulative effects. When in a stressful
scenario, the body creates a surge of hormones. These hormones cause the heart to beat more
quickly and the blood vessels to constrict, which momentarily raises the blood pressure. There is
no evidence that stress alone causes persistently high blood pressure. However, responding to
stress in an unhealthy manner can raise the risk of hypertension, heart attacks, and strokes.
 LABORATORY AND DIAGNOSTIC TEST
1. Complete Blood Count
Hematology is the study of blood and blood disorders. Hematologists and
hematopathologists are highly trained healthcare providers who specialize in diseases of the
blood and blood components. These include blood and bone marrow cells. One of the most
common hematology tests is the complete blood count, or CBC. This test is often conducted
during a routine exam and can detect anemia, clotting problems, blood cancers, immune system
disorders and infections.
Hematology is the specialty responsible for the diagnosis and management of a wide
range of benign and malignant disorders of the red and white blood cells, platelets and the
coagulation system in adults and children.
Date of report: 9/29/22
HEMATOLOGY
SI Result SI Value SI Result SI Value
Hematocrit 0.48 M – 0.40-0.54 Eosinophils 0.02-0.04
F – 0.37-0.47 Basophils 0.00-0.01
Hemoglobin 146 M – 140-160g/L ESR M – 0-10mm/hr
F – 120-140g/L F – 0-20mm/hr
RBC Count 4.0-4.2x1012/L Platelet 150-350x109/L
Count
WBC Count 25.53 5-10x109/L Bleeding 2-2.30 minutes
Time
Clotting 2-4 minutes
Time
Differential CRT 15-45 minutes
Count
Neutrophils MCV 77.5-85.5
Segmenters 0.86 0.58-0.66 MCH 26.5-31.3
Stabs 0.03-0.05 MCHC 32.4-35.4
Juveniles 0.00-0.02 Blood Type “O+”
Myclocytes 0.00-0.01 Others:
Lymphocytes 0.09 0.21-0.3
Monocytes 0.05 0.04-0.06
A high white blood cell count typically means that more white blood cells are being
produced to fight an infection. In the case of the patient, he has multiple skin abrasions that
bacterial infection starts to break into the skin.
 Neutrophils and lymphocytes are types of white blood cells that play a critical role in
protecting the body from infections, among other roles. White blood cells are a key component
of the body’s response to stress and coordinate the process known as inflammation.

RADIOLOGIC REPORT
Examination: MANDIBULAR APO, TOWNE’S VIEW
Date of report: October 4, 2022
FINDINGS:
There is note of a complete, transversely oriented, displaced fracture in the ramus of the right
hemimandible.
The joint spaces are maintained.
The soft tissues are unremarkable with intact fascial planes.

CT SCAN RESULT
PLAIN CRANIAL CT SCAN
Date of report: October 1, 2022
Clinical Data: Multiple physical injuries secondary to vehicular accident
Comparison: None
Technique: Plain multiaxial tomographic sections of the head were obtained.
FINDINGS:
No evidence of intracranial hemorrhage.
There is normal gray-white matter demarcation.
The midline structures are undisplaced.
The sulci, Sylvian fissures, and cerebral folia are intact.
The ventricles are normal in size.
No extra-axial fluid collection or hematoma is noted.
The calvarium is unremarkable.
Soft tissue swelling with hyperdense component are seen in the right parietal and fronto-
temporal scalp as well as in the bilateral periorbital and right malar regions.
The included facial bones show fractures, as follows:
- Right orbital floor
- Right zygomatic bone and arch
- Greater wing on the right sphenoid bone
- Anterior and posterolateral walls of the right maxillary sinus
- Neck of the right mandibular condylar process
Hyperdensities are seen in the visualized paranasal sinus.
Minimal opacities are seen in the left middle ear and mastoid air cells.
IMPRESSION:
1. No evident trauma-related intracranial hemorrhage or extra-axial hematoma
2. No evident calvarial fracture
3. Soft tissue swelling with hematoma in the right parietal and fronto-temporal scalp and in the
bilateral periorbital and right malar regions
4. Facial bone fractures, as described
5. Polyhemoantra
6. Otomastoiditis, left

Examination: SKULL APL

Date of report: 9/29/22
RADIOLOGI FINDINGS:
The visualized bones are intact.
There is no evidence of fracture seen in the views obtained.
IMPRESSION:
Negative for fracture.
 TREATMENT CARRIED OUT FOR THE PATIENT
A. Medical
Pharmacological
9/29/22
1:00pm - Mefenamic Acid 500mg 1tab was given orally PRN for pain
9am, 1pm, 5pm, 9pm – Mannitol 150cc TIV bolus then q4
12:15am – TT 0.5ml IV STAT
12:30am – Paracetamol 300mg IV STAT then q4, PRN for fever >38.5oC
2:30am, 10am, 6pm – Cefazolin 1gm q8 (-) ANST

9/30/22 – 10/03/22
1am, 5am, 9am, 1pm, 5pm, 9pm – Mannitol 150cc TIV bolus then q4
2am, 10am, 6pm – Cefazolin 1gm q8 (-) ANST

10/03/22
Mannitol 150cc TIV bolus then q4 was discontinued

10/04/22 – 10/07/22
2am, 6pm – Cefazolin 1gm q8 (-) ANST
12pm, 6pm – Mupirocin ointment apply BID for 1 week

10/05/22 – 10/07/22
12pm, 6pm – Mefenamic Acid 500mg cap PRN for pain

10/06/22
Odorless mouthwash gargle TID was prescribed
Cefuroxime 500mg/tab TID for 5 days was prescribed
10/07/22
12pm, 6pm – Cefuroxime 500mg/tab TID for 5 days
6am, 12pm, 6pm – Odorless mouthwash gargle TID
B. Surgery (if any)
Procedure done: Intermandibular Maxiallry Fixation

MEDICAL TREATMENT
Name of Drug: Cefazolin
Drug Classification: First-generation cephalosporin; antibiotic
Dose: 1gm
Route: IV
Frequency: q8
Action: Inhibits cell-wall synthesis, promoting osmotic instability; usually bactericidal. Hinders
or kills susceptible bacteria.
Possible Side effects: Dizziness, headache, malaise, paresthesia, abdominal cramps, anal
pruritus, anorexia, diarrhea, dyspepsia, glossitis, nausea, oral candidiasis, vomiting anemia,
dyspnea, injection site infections
Nurse’s Responsibilities:
- Assess the patient’s infection before therapy and regularly thereafter.
- Before giving the first dose, ask the patient about previous reactions to cephalosporin or
penicillin.
- If adverse GI reactions occur, monitor patient’s hydration.
- Tell patient to report adverse reactions.

Name of Drug: Mannitol

Drug Classification: Osmotic diuretic
Dose: 150cc
Route: IV
Frequency: q4
Action: Increases osmotic pressure of glomerular filtrate, inhibiting tubular reabsorption of
water and electrolytes. This elevates blood osmolality, enhancing water and sodium flow into
extracellular fluid. It increases water excretion, decreases intracranial or intraocular pressure,
prevents or treats kidney dysfunction, and promotes excretion of drug over dosage.
Possible Side effects: Headache, confusion, seizures, circulatory overload, heart failure,
tachycardia, chest pain, blurred vision, rhinitis, thirst, nausea, vomiting, diarrhea, urine retention,
water intoxication, cellular dehydration, electrolyte imbalances.
Nurse’s Responsibilities:
- Assess patient’s condition before therapy and thereafter to monitor the drug’s
effectiveness.
- Monitor vital signs, central venous pressure, and fluid intake and output hourly.
- Monitor weight and kidney function, as well as serum and urine sodium and potassium
levels.
- Be alert for adverse reactions and drug interactions.
- Tell patient he may feel thirsty or have a dry mouth, and emphasize importance of
drinking only the amount of fluid provided.
- Instruct patient to immediately report pain in chest, back, or legs, or shortness of breath.

Name of Drug: Tramadol

Drug Classification: Opioid agonist; analgesic
Dose: 50mg
Route: IV
Frequency: q8; PRN for severe pain
Action: Unknown; centrally acting synthetic analgesic compound not chemically related to
opioids that is thought to bind to opioid receptors and inhibit reuptake or norepinephrine and
serotonin. Relieves pain.
Possible Side effects: Anxiety, dizziness, CNS stimulation, confusion, headache, malaise,
nervousness, seizures, sleep disorder, somnolence, vertigo, vasodilation, visual disturbances,
abdominal pain, anorexia, constipation, diarrhea, dry mouth, dyspepsia, flatulence, nausea,
vomiting, urinary frequency/retention, hypertonia, respiratory depression, pruritus, rash,
sweating.
Nurse’s Responsibilities:
- Monitor CV and respiratory status.
- Be alert for adverse reactions and drug interactions.
- Assess family’s and patient’s knowledge of drug therapy.
- For better analgesic effect, give drug before onset of intense pain.
Name of Drug: Paracetamol
Drug Classification: Para-aminophenol derivative; non-opioid analgesic, antipyretic
Dose: 300mg
Route: IV
Frequency: q4 for fever > 38.5oC
Action: Blocks pain impulses, probably by inhibiting prostaglandin or pain receptor sensitizers.
May relieve fever by acting hypothalamic heat-regulating center.
Possible Side effects: Hemolytic anemia, leukopenia, neutropenia, liver damage, jaundice, rash,
urticarial.
Nurse’s Responsibilities:
- Assess patient’s temperature or pain before and during therapy.
- Assess patient’s drug history, and calculate total daily dosage accordingly. Many OTC
products and combination prescription pain products contain acetaminophen.
- Warn patient that high doses or unsupervised long-term use can cause liver damage.
Excessive alcohol intake use may increase risk of hepatotoxicity.

Name of Drug: Mefenamic Acid

Drug Classification: Non-steroidal Anti-Inflammatory Drug (NSAID)
Dose: 500mg
Route: Oral
Frequency: PRN for pain
Action: Used to relieve mild to moderate pain, including menstrual pain (pain that happens
before or during a menstrual period). Mefenamic acid is in a class of medications called
NSAIDs. It works by stopping the body's production of a substance that causes pain, fever, and
inflammation.
Possible Side effects: Ulcer, bleeding, holes in stomach or intestine, indigestion, headache,
drowsiness, dizziness, allergic reaction, heart failure, heart attack, stroke, diarrhea, vomiting,
dehydration, electrolyte imbalances.
Nurse’s Responsibilities:
- Assess patients who develop severe diarrhea and vomiting for dehydration and electrolye
imbalance.
 - Discontinue drug promptly if diarrhea, dark stool, hematemesis, ecchymosis, epistaxis, or
rash occur and do not use again.
- Notify physician if persistent GI discomfort, sore throat, fever, or malaise occur.
Name of Drug: Paracetamol
Drug Classification: Para-aminophenol derivative; non-opioid analgesic, antipyretic
Dose: 500mg
Route: Oral
Frequency: q6 for fever >37.5oC
Action: Blocks pain impulses, probably by inhibiting prostaglandin or pain receptor sensitizers.
May relieve fever by acting hypothalamic heat-regulating center.
Possible Side effects: Hemolytic anemia, leukopenia, neutropenia, liver damage, jaundice, rash,
urticarial.
Nurse’s Responsibilities:
- Assess patient’s temperature or pain before and during therapy.
- Assess patient’s drug history, and calculate total daily dosage accordingly. Many OTC
products and combination prescription pain products contain acetaminophen.
- Warn patient that high doses or unsupervised long-term use can cause liver damage.
Excessive alcohol intake use may increase risk of hepatotoxicity.

Name of Drug: Cefuroxime

Drug Classification: Second-generation cephalosporin
Dose: 500mg
Route: Oral
Frequency: BID
Action: Inhibits cell-wall synthesis, promoting osmotic instability; usually bactericidal. Hinders
of kills susceptible bacteria, including many gram-positive organisms and enteric gram-negative
bacilli.
Possible Side effects: Dizziness, headache, malaise, paresthesia, abdominal cramps, anorexia,
diarrhea, dyspepsia, nausea, vomiting, hemolytic anemia, dyspnea.
Nurse’s Responsibilities:
- Assess patient’s infection before therapy and regularly thereafter.
- Before giving first dose, ask patient about previous reactions to cephalosporin and
penicillin.
 - Be alert for adverse reactions and drug interactions.
- If adverse GI reactions occur, monitor patient’s hydration.
- Tablets may be dissolved in small amounts of apple, orange, or grape juice or chocolate
milk. However, drug has bitter taste that’s difficult to mask, even with food.
- Instruct patient to take drug exactly as prescribed, even after he feels better.
- Advise patient to take oral suspension with food to enhance absorption.
- Tell patient to report adverse reactions.

Name of Drug: Mupirocin ointment

Drug Classification: Anti-bacterial; topical
Dose:
Route: Topical
Frequency: BID
Action: Inhibits bacterial protein synthesis by binding to bacterial isoleucyl transfer RNA
synthetase. It is mainly efficacious against Gram-positive aerobes such as staphylococci.
Possible Side effects: Blistering, crusting, irritation, reddening of the skin, canker sores, cracked
and dry skin, pain, swelling, tenderness, sores, ulcers, white spots on the lips or tongue or inside
of the mouth.
Nurse’s Responsibilities:
- Monitor any new or increased skin reactions including localized pain, burning, itching, or
stinging.
- Discontinue ointment and contact physician if a sensitivity reaction or chemical irritation
occurs.

Name of Drug: Odorless Mouthwash Gargle

Drug Classification: Anti-septic
Dose:
Route: Oral
Frequency: TID
Action: Bacterial cell wall destruction, bacterial enzymatic inhibition, and extraction of bacterial
lipopolysaccharides.
Possible Side effects: Persistent or inflamed canker sores, bleeding gums, symptoms of dry
mouth, pain or sensitivity when brushing teeth after using mouthwash, teeth staining.
 Nurse’s Responsibilities:
- Report if mouth is dry or chapped lips, sores, redness, bleeding, odors, or white patches
on the tongue or inside the mouth.

NURSING CARE PLAN

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION EVALUAITON
Subjective Data: Risk for After 8 hours of -Monitor vital signs. Note presence After 8 hours of
infection related nursing of chills, fever, malaise, changes in nursing
to post- intervention the mentation. intervention the
operative patient will achieve RATIONALE: Hypotension, patient was able
incision timely wound confusion may be seen with gas to remain free
Objective Data: secondary to healing, be free of gangrene; tachycardia, chills, fever from any
BP: 110/90 repair of purulent drainage reflect developing sepsis. infection and
TEMP: 37.1 mandibular or erythema, and maintain normal
PR: 88bpm fracture be afebrile -Observe wounds for bullae body temperature.
RR: 19 formation, crepitation, and bronze Goal was met
O2Sat: 98% discoloration of the skin, frothy or
fruity-smelling drainage.
RATIONALE: Signs suggestive of
gas gangrene infection.

Inspect the skin for preexisting

irritation or breaks in continuity.
RATIONALE: Pins or wires should
not be inserted through skin
infections, rashes, or abrasions
(which may lead to bone infection).

-Investigate abrupt onset of pain

and limitation of movement with
localized edema and erythema in
the injured extremity.
RATIONALE: May indicate the
development of osteomyelitis.

-Instruct the patient not to touch

the insertion sites.
RATIONALE: Minimizes
opportunity for contamination.

-Provide sterile pin or wound care

according to protocol and exercise
meticulous handwashing.
RATIONALE: May prevent cross-
contamination and the possibility of
 infection.

Administer medications, as
indicated:

- IV and topical antibiotics

Wide-spectrum antibiotics may be
used prophylactically or may be
geared toward a specific
microorganism.
- Tetanus toxoid
Given prophylactically because the
possibility of tetanus exists with any
open wound. Note: Risk increases
when injury or wound(s) occur in
“field conditions” (outdoor, rural
areas, work environment).

-Provide wound or bone irrigations

and apply warm or moist soaks as
indicated.
RATIONALE: Local debridement
and cleansing of wounds reduce
microorganisms and the incidence of
systemic infection. Continuous
antimicrobial drip into bone may be
necessary to treat osteomyelitis,
especially if the blood supply to the
bone is compromised.

-Assist with procedures (incision

and drainage, placement of drains,
hyperbaric oxygen therapy).
RATIONALE: Numerous procedures
may be carried out in the treatment of
local infections, osteomyelitis, gas
gangrene
Subjective Data: Acute Pain After 8 hours of Assess and record the patient’s After hours of
“Gakulog ang related to nursing level of pain. nursing
sainyang kimot Movement of intervention the Utilize pain intensity rating scale intervention the
kapag ya try niyang bone fragments, patient will able to including Wong-Baker FACES pain patient was able
magtalam” as edema, and verbalize relief of rating scale, visual analog scale, and
to verbalized
verbalized by the injury to the soft pain and will FLACC (face, legs, activity, crying,
guardian tissue around display relaxed consolability) scale. Take note of the
relief of pain
maxillary and manner. relieving and aggravating factors and and maintain
Objective Data: mandibular area nonverbal pain cues such as changes relaxed manner.
- Edema in vital signs, emotions, and The goal was
- Tenderness behavior. Pain assessment determines met
- Abnormal the effectiveness of interventions.
movement Many factors, including the level of
 and crepitus anxiety, may affect the perception of
pain.

VS Encourage the patient to discuss

BP: 110/90 problems related to the injury.
TEMP: 37.1 Helps alleviate anxiety. The patient
PR: 88bpm may feel the need to relive the
RR:19 accident experience.
O2Sat: 98%
Maintain immobilization of
affected part using bed rest, cast,
splint, traction.
Immobilization relieves pain and
prevents bone displacement and
extension of tissue injury.

Elevate and support injured

extremity.
Promotes venous return, decreases
edema and may reduce pain.

Elevate bed covers; keep linens off

toes.
Maintains body warmth without
discomfort due to the pressure of
bedclothes on affected parts.

Medicate before care activities. Let

the patient know it is important to
request medication before the pain
becomes severe.
Promotes muscle relaxation and
enhances participation.

Perform and supervise active and

passive ROM exercises.
Maintains strength and mobility of
unaffected muscles and facilitates
resolution of inflammation in injured
tissues.

Provide alternative comfort

measures (massage, backrub,
position changes).
Improves general circulation; reduces
areas of local pressure and muscle
fatigue.

Provide emotional support and

encourage stress management
techniques (progressive relaxation,
deep-breathing exercises,
visualization, or guided imagery).
Refocuses attention, promotes a
sense of control, and may enhance
coping abilities in managing the
stress of traumatic injury and pain,
which is likely to persist for an
extended period.

Identify diversional activities

appropriate for patient age,
physical abilities, and personal
preferences.
It prevents boredom, reduces muscle
tension, and can increase muscle
strength; it may enhance coping
abilities.

Investigate any reports of unusual

or sudden pain or deep,
progressive, and poorly localized
pain unrelieved by analgesics.
May signal developing complications
(infection, tissue ischemia,
compartmental syndrome).

Apply cold or ice pack first 24–72

hr and as necessary.
Reduces edema and hematoma
formation decreases pain sensation.
The duration of application depends
on the degree of patient comfort and
as long as the skin is carefully
protected.

Administer medications, as
indicated:
Given to reduce pain or muscle
spasms. Administer analgesics
around the clock for 3–5 days.
Studies of ketorolac (Toradol) have
proven effective in alleviating bone
pain, with longer action and fewer
side effects than narcotics agents.
Commonly used medications for pain
include:
Maintain and monitor IV patient-
controlled analgesia (PCA) using
peripheral, epidural, or intrathecal
routes of administration. Maintain
 safe and effective infusions and
equipment.
Routinely administered or PCA
maintains an adequate blood level of
analgesia, preventing fluctuations in
pain relief with associated muscle
tension and spasms.

Subjective Data: Impaired After 4 hours of The patient may be restricted by self-After hours of
“Dai siya masyado physical nursing view or self-perception out of nursing
nakahiwas ta dahil mobility related intervention the proportion with actual physical intervention the
dyan sa sainyang to patient will able to: limitations, requiring information or patient was able
mga lugad. Pati pag musculoskeletal interventions to promote progress to maintain
ihi nasakitan siya” Regain/maintain toward wellness. mobility at
as verbalized by the mobility at the highest possible
guardian. highest possible Auscultate bowel sounds. Monitor level and
level. elimination habits and provide for maintain position
a regular bowel routine. Place on of functions. The
Maintain position bedside commode, if feasible, or goal was met.
Objective Data: of function. use fracture pan. Provide privacy.
Bed rest, use of analgesics, and
- Slowed Increase changes in dietary habits can slow
movement strength/function peristalsis and produce constipation.
of both of affected and Nursing measures that facilitate
upper and compensatory elimination may prevent or limit
lower body parts. complications.
extremities
- Limited Monitor blood pressure (BP) with
range of the resumption of activity. Note
motion reports of dizziness.
Postural hypotension is a common
VS problem following prolonged bed rest
BP: 110/90 and may require specific
TEMP: 37.1 interventions (tilt table with gradual
PR: 88bpm elevation to the upright position).
RR: 19
O2Sat: 98% Encourage participation in
diversional or recreational
activities. Maintain a stimulating
environment (radio, TV,
newspapers, personal possessions,
pictures, clock, calendar, visits
from family and friends).
Provides an opportunity to release
energy, refocuses attention, enhances
patient’s sense of self-control and
self-worth, and aids in reducing
social isolation.

Teach patient or assist with active

and passive ROM exercises of
affected and unaffected
extremities.
Increases blood flow to muscles and
bone to improve muscle tone,
preserve joint mobility, prevent
contractures or atrophy, and calcium
reabsorption from disuse

Assist with self-care activities

(bathing, shaving).
Improves muscle strength and
circulation, enhances patient control
in the situation and promotes self-
directe

Reposition periodically and

encourage coughing and deep-
breathing exercises.
Prevents or reduces the incidence of
skin and respiratory complications
(decubitus, atelectasis, pneumonia).d
wellness.

Encourage increased fluid intake to

2000–3000 mL per day (within
cardiac tolerance), including acid
or ash juices.
Keeps the body well hydrated,
decreasing the risk of urinary
infection, stone formation, and
constipation

Provide a diet high in proteins,

carbohydrates, vitamins, and
minerals, limiting protein content
until the first bowel movement.
In the presence of musculoskeletal
injuries, nutrients required for
healing are rapidly depleted, often
resulting in a weight loss of as much
as 20 to 30 lb (9kg to 13 kg) during
skeletal traction. This can have a
profound effect on muscle mass,
tone, and strength. Protein foods
increase contents in the small bowel,
resulting in gas formation and
constipation. Therefore, the
gastrointestinal (GI) function should
be fully restored before protein foods
are increased.
 HEALTH EDUCATION
The doctor prescribed the following medications:
 Cefuroxime 500mg tab 3x/day for 1 week
 Mefenamic Acid 500mg tab every 6 hours for pain
 Mupirocin Ointment twice a day for 1 week
Nurse on duty advised patient to maintain his dental elastic and was advised to soft diet for one
week. Patient was advised to do a follow-up check-up on October 13, 2022, Thursday at OPD at
8:00am.

PATIENT PROGRESS
Day 1: Patient was admitted per stretcher via ambulance from JMA Hospital accordingly by
relative with chief complaints verbalized by relative as vehicular accident, alcohol intoxication.
With ongoing IVF of PNSS 1L with sutured wound on left upper lip. Patient was then transferred
to surgical ward via stretcher.
Day 2: Patient was received with ongoing IVF, with multiple abrasions noted, GCS of 15 but
preferred to rest most of the time, with order for cranial CT scan.
Day 3: For cranial CT scan at 10am in IHMH via ambulance.
Day 4: With multiple abrasions noted, still with IVF, afebrile, awaiting official cranial CT scan
result, with IFC
Day 5: Still with IVF, to follow cranial CT scan result, GCS of 15, afebrile. With orders for
referral to Dr. Reyes for evaluation of facial fractures, still awaiting for official cranial CT scan
result. Cranial CT scan result attached to chart and relayed to Dr. Badong with orders made and
carried out.
Day 6: Still with IVF, multiple abrasions still noticeable, for referral to Dr. Reyes seen and
examined by him with orders made and carried out. X-ray of mandible APO and Modified
Townes view result followed-up, awaiting for official reading of x-ray. With barton’s bandage,
to follow-up official result of Mandible APO and Townes view x-ray.
Day 7: To secure CD of CT scan for evaluation and pre-op planning as ordered, reminded
watcher to follow-up CD of CT scan, CD not released as technician is on leave per watcher’s
information.
Day 8: Swollen face noted, with multiple abrasions, still with IVF, afebrile. Still for IMMF (on-
call) once materials are available. Patent IVF to consume, IV meds to shift to oral medications,
for IMMF tomorrow (on-call).
Day 9: In to OR per wheelchair, with ongoing IVF, IMMF done by Dr. Reyes under local
anesthesia, back to ward per wheelchair with same IVF, on liquid diet, dental elastic maintained,
monitored for untoward signs and symptoms. With arch bar, afebrile, liquid diet emphasized.
DISCHARGE SUMMARY/DESPOSITION
The patient was discharged from October 8, 2022 at 11:45am. The doctor prescribed
cefuroxime 500mg tab three times a day for one week, mefenamic acid 500mg tab every six
hours for pain, and mupirocin ointment twice a day for one week. Advised to maintain dental
elastic and soft diet for one week. Patient was advised to do a follow-up check-up at OPD on
October 13, 2022.

References:
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 Kassavin, D. S., Kuo, Y.-H., & Ahmed, N. (2011, January). Initial systolic blood
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stress-and-high-blood-pressure/art-20044190
 Catanduanes State University
College of Health Science
Summer Affiliation 2022-2023

A Case Study on Transport and Vehicular Crashes

Presented to the College of Health Sciences

In Partial Fulfilment of NCM 116

Related Learning Experiences

Submitted by:
Don Maico Arcilla
Joshua Benavidez
Abby Kate Austero
BSN IV A