Group Case Cacal Orif

University of Perpetual Help System Laguna-Isabela Campus
Minante 1, Cauayan City, Isabela
College of Nursing
FRACTURE CLOSED COMPLETE COMMINUTED

CLAVICLE RIGHT
A Case Study
Presented To
The Faculty of the College of Nursing
University of Perpetual Help System Isabela Campus
Minante Uno, Cauayan City, Isabela
In Partial Fulfilment
Of the Requirements for the Subject
NCM109 Care of Mother and Child (Acute and Chronic)
NCM118 RLE
By:
ACORDA, GLADY’S
AGUSTIN, JEZIRA
ANTONIO, JAMAICA
CABACUNGAN, FLORENCE
DOMINGO, MELISSA
JACINTO, RICA MAE
PABUALAN, PRINCESS
PENAFLOR, RICKY
ROXAS, MHAYLA
SOBERANO, VALIERY
November 14-18, 2022

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CASE OVERVIEW
Clavicle Fracture (Broken Collarbone)
A clavicle fracture is a break in the collarbone, one of the main bones in the shoulder.
This type of fracture is fairly common, accounting for about 5% of all adult fractures.
Most clavicle fractures occur when a fall onto the shoulder or an outstretched arm puts
enough pressure on the bone that it snaps or breaks. A broken collarbone can be very painful and
can make it hard to move your arm.
Many clavicle fractures can be treated by wearing a sling to keep the arm and shoulder
from moving while the bone heals. With some clavicle fractures, however, the pieces of bone
move far out of place when the injury occurs. For these more complicated fractures, surgery may
be needed to realign the collarbone.
Types of Fracture
There are many fractures, but the main categories are complete, incomplete, open, closed, and
pathological. Five major types are as follows:
1. Incomplete: Fracture involves only a portion of the cross-section of the bone. One side
breaks; the other usually just bends (greenstick).
2. Complete: Fracture line involves entire cross-section of the bone, and bone fragments
are usually displaced.
3. Closed: The fracture does not extend through the skin.
4. Open: Bone fragments extend through the muscle and skin, which is potentially infected.
5. Pathological: Fracture occurs in diseased bone (such as cancer, osteoporosis), with no or
only minimal trauma.
Cause
Clavicle fractures are most often caused by a direct blow to the shoulder. This can happen
during a fall onto the shoulder or an accident, like a car collision. A fall onto an outstretched arm
can also cause a clavicle fracture. In a baby, a clavicle fracture can occur during the passage
through the birth canal.
Symptoms
A clavicle fracture can be very painful and may make it hard to move your arm. Other
signs and symptoms of a fracture may include:
 Sagging of the shoulder downward and forward
 Inability to lift the arm because of pain
 A grinding sensation when you try to raise the arm
 A deformity or bump over the break
 Bruising, swelling, and/or tenderness over the collarbone
Physical Examination
In a clavicle fracture, there is usually an obvious deformity, or bump, at the fracture site.
Gentle pressure over the break will bring about pain. Although it is rare for a bone fragment to
break through the skin, it may push the skin into a tent formation.
Diagnostic Test
X-rays. X-rays provide images of dense structures, such as bone. Your doctor will order an X-
ray:
 To help pinpoint the location of the fracture
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 To learn more about the severity of the break

 If other bones are broken, your doctor may order a computerized tomography (CT) scan
to see the fractures in better detail.
Medical Management:
Nonsurgical Treatment
If the broken ends of the bones have not significantly shifted out of place, you may not
need surgery. Many broken collarbones can heal without surgery.
Nonsurgical treatment may include:
 Arm support. A simple arm sling is usually used for comfort immediately after the break
and to keep your arm and shoulder in position while the injury heals.
 Medication. Pain medication, including acetaminophen, can help relieve pain as the
fracture heals.
 Physical therapy. Although there will be some pain, it is important to maintain arm
motion to prevent shoulder and elbow stiffness. Often, patients will begin doing
exercises for elbow motion immediately after the injury.
 After a clavicle fracture, it is common to lose some shoulder and arm strength. Once the
bone begins to heal, your pain will decrease and your doctor may start gentle shoulder
exercises. These exercises will help prevent stiffness and weakness. You will start more
strenuous exercises gradually once the fracture is completely healed.
Follow-up care
You will need to see your doctor regularly until your fracture heals. During these visits,
the doctor will take X-rays to make sure the bone is healing in a good position. After the bone
has healed, you will be able to gradually return to your normal activities.
Complications
In some cases, a clavicle fracture can move out of place before it heals. It is important to
follow up with your doctor as scheduled to make sure the bone stays in position.
If the fracture does not heal, it is called a nonunion.

 In some cases of nonunion, the patient has very little pain and good motion, so no
further treatment is required.
 In other cases, nonunion can result in significant pain and may require an operation for
repair.
If the fracture fragments do move out of place and the bones heal in that position, it is
called a malunion. Surgical treatment for this is very rare, determined by how far out of place
the bones are and how much this affects your arm movement.
A large bump over the fracture site may develop as the fracture heals. This usually gets
smaller over time, but a small bump often remains permanently.
Surgical Treatment
If the broken ends of the bones have significantly shifted out of place, your doctor may
recommend surgery.
Surgery typically involves putting the broken pieces of bone back into position and
preventing them from moving out of place until they are healed. This can improve shoulder
strength when you have recovered.
Open reduction and internal fixation

This is the procedure most often used to treat clavicle fractures. During the procedure, the
bone fragments are first repositioned (reduced) into their normal alignment. The pieces of bone
are then held in place with special metal hardware.
Common methods of internal fixation include:
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 Plates and screws. After being repositioned into their normal alignment, the bone
fragments are held in place with special screws and metal plates attached to the outer
surface of the bone.
 After surgery, you may notice a small patch of numb skin below the incision. This
numbness will become less noticeable with time. Because the clavicle lies directly under
the skin, you may be able to feel the plate through your skin.
 Plates and screws are not routinely removed after the bone has healed, unless they are
causing discomfort. Problems with the hardware are not common, but some patients find
that seatbelts and backpacks can irritate the collarbone area. If this happens, the
hardware can be removed after the fracture has healed.
 Pins or screws. Pins or screws can also be used to hold the fracture in good position
after the bone ends have been put back in place. The incisions for pin or screw
placement are usually smaller than those used for plates.
 Pins or screws often irritate the skin where they have been inserted and are usually
removed once the fracture has healed.
Pain management
 After surgery, you will feel some pain. This is a natural part of the healing process.
Many patients find that using ice and non-prescription pain medications are sufficient to
relieve pain.
 If your pain is severe, your doctor may suggest a prescription-strength medication, such
as an opioid, for a few days.
 Be aware that although opioids help relieve pain after surgery, they are a narcotic and
can be addictive. Opioid dependency and overdose have become critical public health
issues. For this reason, opioids are typically prescribed for a short period of time. It is
important to use opioids only as directed by your doctor and to stop taking them as soon
as your pain begins to improve.
Rehabilitation
 Specific exercises will help restore movement and strengthen your shoulder. Your
doctor may provide you with a home therapy plan or suggest that you work with a
physical therapist.
 Therapy programs typically start with gentle motion exercises. Your doctor will
gradually add strengthening exercises to your program as your fracture heals.
Complications
There are risks associated with any type of surgery. These include:
 Infection
 Bleeding
 Problems with wound healing
 Pain
 Blood clots
 Damage to blood vessels or nerves
 Reaction to anesthesia
Risks that are specific to surgery for clavicle fractures include:

 Difficulty with bone healing
 Lung injury
 Numbness below the clavicle
 Hardware irritation
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DEMOGRAPHIC DATA
NAME: Patient B
AGE: 35 years old
ADDRESS: Rizal, Alicia, Isabela
BIRTHDATE: May 19,1978
SEX: Male
CIVIL STATUS: Married
RELIGION: Born Again
WEIGHT: 68kg
DATE AND TIME OF ADMISSION: November 12, 2022 (7:30 PM)
ADMITTING DIAGNOSIS: Fracture Closed Complete Clavicle Right S/P
ORIF: plating
FINAL DIAGNOSIS: Healed Fracture Clavicle Right S/P ORIF
Plating Clavicle Right
CHIEF COMPLAINT: Swelling Right shoulder
NURSING HISTORY
Present Medical History:

He was driving home when he suddenly had an accident, but the patient said it was a
good thing he had the brakes on, so the patient was out of balance and fell down and the first
thing that hit the pavement was his shoulder which caused fractured at the right shoulder.
He was immediately rushed to the hospital because his shoulder was swollen and he couldn't
move it and he also had a scratch and he was admitted on November 12, 2022 for treatment and
management. They discovered on his chest x-ray that he has a clavicular fracture that will require
surgery to fix. The procedure went well, and Patient B is presently under monitoring
Past Medical History:
No current past medical history
Family History:
- The familial diseases is mentioned by the patient which is asthma
GENOGRAM
(Mrs. B)
Mr. B ASTHMA
Daughter
LEGENDS:
MALE
FEMALE
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GORDON’S HEALTH ASSESSMENT
Assessing the Functional Health Patterns of a Client using an Eclectic Model of Health
HEALTH
NARRATIVE NORMS AND STANDARDS REMARKS
PATTERN
Risk for infection related
Health The client was asked Health is often a subjective state, to fractured clavicle as
Perception – “How is she today”, a person maybe medically evidence by swelling in
Health The client verbalized: diagnosed with an illness but operative site
Management “masakit lang po yung still consider himself of herself
Pattern balikat ko ma’am, at healthy. Risk for injury related to
nahihirapan lang -Fundamentals of Nursing (The fracture of clavicle
akong igalaw”. Art and Science of Nursing
Care) 5th Edition
The client was asked Carol, Lillis & LeMone (2005)
“What is health for
you?” The client
answered: “malusog at Health is a state of complete
masigla nuon po physical, mental and social well-
ma’am ngayun po being and not merely the
medyo hindi po absence of disease or infirmity.
ma’am" -World Health Organization
(WHO)
www.who.int/about
The client was asked
“What diseases did he
experienced for the By following your doctor's
past year? The client instructions and reporting back
verbalized:“yung during follow ups, you can
kadalasan ay lagnat, provide your doctor with insight
minsan ubo, sipon into what is and is not working.
pero hindi naman Based on your feedback, doctors
matagal” can tailor your treatment plans,
adjust medications, or explore
other options and treatment
The client was asked: alternatives.
“What should you do https://www.perecman.com/
to continue having a blog/2020/april/why-its-
healthy body?” The important-to-follow-your-
client answered: doctors-instruc/
“kumakain ng gulay
po, and syempre
vitamins"
Taking medication without the

expertise to understand why
The client was asked: specific medications are chosen
“Do you follow the or not is really dangerous and
advice of doctors on can cause other medical
you or nurses?” The problems.
client answered : “oo,
tsaka minsan lang ako https://www.healthline.com/
mag pacheck-up" health-news/why-taking-an-
antibiotic-without-a-
prescription-is-so-dangerous#A-
local-problem
The client was asked:
“What do you do
when you are sick?”
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The client verbalized :

“uminom ng gamot o
kaya yung mga
dahoon dangla at
oregano "
Nutritional – The client was asked: Eat regular meals and 2-3 snacks Imbalanced nutrition: less
Metabolic “How often do you eat each day to keep calories in than body requirements
Pattern a day?” The client check and cravings at bay. Eat related to insufficient
answered: “tatlong plenty of vegetables, fruits, intake of food
beses po ma’am” whole grains, beans, nuts, seeds,
low fat dairy, low mercury fish
He added: “minsan and lean meats.
nakakalimutang - americanpregnancy.com
kumain dahil lasing na
akong umuuwi.”.
It recommends a daily intake of
between 1.5 and two liters of
water (eight 250 ml or 8fl oz.).
The client was asked: When you are pregnant this
“How many glasses of should increase by another two
water do you drink?” to four glasses (up to three liters)
The client verbalized: a day if the weather is warm or
“asa 8 po na baso, you are exercising.
pero minsa may alak - (WHO)
ako naiinom at kape”
BMI:
The client was asked: Underweight <18.5
“Did you lose or Normal 18.5 to 24.9
gained body weight?” Overweight 25-29.9
The client answered: Obese ≥30
“walang nagbago, yun -(WHO)
parin ang timbang ko
hanggang ngayon”
Height:5’8 inches
Weight: 68 kilograms
Your BMI is 22.8,
indicating your weight
is in the Normal
category.
“How is your
appetite?” The client
answered: “maayos
naman po ma’am”
Readiness for enhance

Elimination The client was asked : A person with healthy digestion urinary elimination
Pattern “How often do you will poop anywhere
defecate?” The client between every other day to three
answered: “dalawa sa times a day. Any less could
isang araw, " suggest possible constipation.
This means you need some more
The client was asked : water to move the boat.
“What is the color, https://www.healthline.com/
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odor and character of health/digestive-health/types-of-

your stool?” The client poop#What-does-a-persons-
answered: “brown at poop-color-mean?
hindi naman matubig o
matigas yung normal Color: Light and dark brown,
lang" green
Odor: Malodorous; may be
The client was asked : affected by certain foods
“How often do you Frequency: twice daily to 3
pee?” What is the times a week.
color, clarity and Consistency: Soft, formed
consistency of your https://www.mayoclinic.org/
urine? The client
answered: “6 sa isang Frequent urination is going more
araw po ma’am, light than you usually do in a day, so
yellow po ihi ko" it's different for everyone. A
regular urination pattern can be
The client was asked: anywhere from four to ten times
“Do you have a a day, with an average of about
problem with the smell six.
of your body?” The https://
client answered: “wala www.verywellfamily.com/
naman normal parin" frequent-urination-in-pregnancy-
4177475
Urine looks paler during

pregnancy because there's a 50
percent increase in blood
volume, so the urine tends to be
clearer and more diluted during
pregnancy,” Dr. Kaaki says.
https://www.unitypoint.org/
livewell/article.aspx?
id=9a3a49d9-bffd-4c0b-a3a6-
9e8b724ac9c0
Activity – Rest
Pattern The client was asked: People who exercise regularly Impaired physical
What is your daily have a lower risk of developing mobility related to skeletal
pattern of activity? many long-term (chronic) impairment as evidence
The client answered: conditions, such as heart disease, by fractured clavicle
Leisure: nanunuod type 2 diabetes, stroke, and some
lang sa phone o sa tv cancers.
minsan nakikipag https://www.nhs.uk/live-well/
kwentuhan sa mga exercise/exercise-health-
kumpare ko” benefits/
Exercise: wala,
ma’am sa trabaho ko
po ma’am exercise na
po para saakin yun,
minsan rin po nag
bubuhat ako ng
mabibigat. Ngayon po
eh malabo na dahil sa
balikat ko ”
Do you follow your
regular exercise plan?
The client answered:
“hindi po ma’am lakad
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lakad nalang po
minsan”
Cognitive – The client was asked: “To know” or “to recognize” or Readiness for enhanced
Perceptual “Do you have a “to conceptualize” Its refer to the knowledge
Pattern problem in hearing?” mental process of an organism
The client verbalized: learns, remembers, think about a
“maayos naman po body of information.
ma’am "
In other words, thoughts always
come before any feeling and
The client was asked : before any action. By changing
“Do you used our thoughts, we can change our
eyeglasses and mood, decrease our anxiety, or
sunglasses?” The improve our relationships.
client answered:
“hindi po ma’am, https://www.slideshare.net/
maayos pa naman po mobile/quratualin/cognitvie-
paningin ko" theory-of-personality
For a person with normal

The client was asked : hearing, when it comes to pitch
“When was your last the human hearing range starts
check up on your low at about 20 Hz. That’s about
eyes?” The client the same as the lowest pedal on a
answered: “hindi pa po pipe organ. On the other side of
ako nag papacheck-up the human hearing range, the
ng mata" highest possible frequency heard
without discomfort is 20,000Hz.
The client was asked : While 20 to 20,000Hz forms the
“Any change in your absolute borders of the human
memory? hearing range, our hearing is
Concentration?”The most sensitive in the 2000 - 5000
client verbalized: Hz frequency range.
“minsan
makakalimutten lang https://www.widex.com.au/
po ma’am”
The client was asked :

“Are you in trouble in
making decisions?”
“wala naman po
ma’am”
Sleep – Rest The client was asked : The exact time depends on when Disturbed sleep pattern
Pattern “Tell me about your you tend to wake up in the related to lifestyle
sleeping patterns?” morning. Another consideration disruptions as evidence by
“Do you have trouble is the amount of sleep you need fractured clavicle
falling asleep?” The per night.
client verbalized: Circadian rhythm also dictates
“maaga akong your natural bedtime and
nagigising para morning wakeup schedules.
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maghanap buhay, Once you get used to going to

minsan late rin ako bed and waking up at the same
matulog pero maaga time each day, your brain adapts
parin ako nagigising to this schedule.
pero ngayun kailangan Most experts recommend that
ko mag pagaling adults get at least 7 hours of
muna” sleep per night. / average of 7 to
9 hours.
The client was asked : https://www.healthline.com/
“How much sleep do
you get each night?”
“minsan 5 hours
minsan nasa 6 hours”

“Do you nap during
the day?” The client
verbalized: “minsan
po ma’am”

“What do you do to
help you fall asleep?”
The client verbalized:
“kavideocall ko asawa
ko kaya natutulungan
niya ako kahit nasa
malayo siya "
“Events or situations may Readiness for enhanced

Self-perception – The client was asked : change the level of the self- self-concept related to
Self-concept “How do you describe concept over time. Illness and maintaining personal
Pattern yourself?” The client trauma can also affect the self- relationships
answered: “mabait, concept.”
minsan masungit lalo (Fundamentals of Nursing 7th
nap ag kailangan mag Ed by Barbara Kozier p. 959 &
disiplina sa anak ko” 962)
Self-concept tends to be more

The client was asked: malleable when we're younger
“Most of the time, feel and still going through the
good (or not so good) process of self-discovery and
about self?” The client identity formation. As we age
answered: “noon and learn who we are and what's
minsan maayos, important to us, these self-
ngayun po hindi " perceptions become much more
detailed and organized. Self-
concept develops, in part,
The client was asked: through our interaction with
“Changes in body or others. In addition to family
things you can’t do?” members and close friends, other
The client answered:” people in our lives can also
“wala yun padin contribute to our self-identity.
hanggang ngayon
sakto lang yung taba https://
ko at bigat ko" www.verywellmind.com/what-
is-self-concept-2795865
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“Things frequently
make you angry?” The
client answered: “pag
makulit anak ko, or
mga pamangkin ko”

“Ever feel you lose
hope?” The client
answered: “hindi
ma’am dahil may mga
pamilya akong lagging
nag papasaya saakin
kaya hindi ako
nawawalan nag
pagasa”
Role – The client was asked: Readiness for enhanced

Relationship “Who is the most Role-Relationship Pattern. It’s family process
Pattern important person(s) in focused on the person’s roles in
your life?” The client the world and relationships with
answered: “pamilya ko others. Evaluated Satisfaction
po ma’am" with roles, role strain, or
dysfunctional relationships.
https://irmanweb.wordpress.com
The client was asked: /
“Describe your
relationship with that
person?” The client Filipinos are known for having
answered: “kahit strong and close family ties.
malayo siya saamin eh They place high regard and put
hindi parin nawawala importance on their family
yung time niya para before anything else. They work
saamin para makasam all day and do all they can to
at makausap siya feed and provide for their family.
Filipinos always find a way to

smile and be happy. Whatever
the problem is, we are always
reminded that our family’s
always there to love and support
us no matter what.
https://medium.com/
@janeellapangoyala/traditional-
filipino-family-values-that-make-
us-distinct-among-others-
7a439fdfd28a
The average female will have
Sexuality – The client was asked: their first period between ages
Reproductive Relationship status? 11 and 14. Periods will continue
Pattern “married ma’am” regularly (usually monthly) until
menopause, or about age 51.
https://www.healthline.com/
health/facts-statistics-
menstruation#Periods-around-
the-world
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The average menstrual cycle

is 24 to 38 days. The typical
period lasts four to eight days.
https://www.healthline.com/
health/facts-statistics-
menstruation#Periods-around-
the-world
Readiness for enhanced

Coping – Stress The client was asked: According to Folkman and coping related to enhance
Tolerance “Tense or relaxed Lazaruz, coping is “the cognitive knowledge of stress
most of the time?” and behavioral effort to manage management
When tense, what specific external and/or internal
helps? The client demands that are appraised as
verbalized: “minsan taxing or exceeding the
relaxed minsan tense, resources of the person”
pero na rerelax ako (Fundamentals of Nursing by
pag nakikita ko anak Kozier P. 1020)
ko at asawa ko na
masaya” Coping may be described as
dealing with problems and
situations, or contending with
The client was asked: them successfully. Coping
“Use any medicines, strategies varies among
drugs, alcohol and individual’s perception of
cigarettes?” The client stressful events. A person’s
answered: “oo coping strategies often change
umiinom pag kasama with reapraisal of a situation.
mga kumpare, pero (Fundamentals of Nursing by B.
sigarilyo hindi, ngayon Kozier, 7th edition, p.1020)
po ma’am may mga
gamot na po akong
iniinom dahil sa
operasyon ko”

“What sustains you
and keeps you on
going?” The client
answered: “dasal
palagi ma’am"

“What do you hold
onto during difficult
times?” The client
answered: “dasal
minsan sinasabi ko
kay nanay pag di kaya
minsan”
Value – Belief The client was asked: Researchers at the Mayo Clinic Readiness for enhanced
Pattern “Generally get things concluded, “Most studies have spiritual well-being
you want from life? shown that religious related to Expresses desire
Important plans for the involvement and spirituality are to enhance prayerfulness.
future?” The client associated with better health
verbalized: “mag outcomes, including greater
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dasal lagi para sa longevity, coping skills, and

pamilya na manatiling health-related quality of life
buo” (even during terminal illness)
and less anxiety, depression, and
The client was asked: suicide.
“Religion important in
life? When https://www.forbes.com/sites/
appropriate: Does this nicolefisher/2019/03/29/science-
help when difficulties says-religion-is-good-for-your-
arise?” The client health/?sh=2098d30b3a12
verbalized: “oo
naman” The family is the central and
important social institution for
health development in which
The client was asked : individuals are born and receive
“Do you believe in resources for their growth and
God?” The client development. It has the primary
answered: “opo influence on the health and
ma’am” development of children.
apps.who.int
“What gives your life
meaning?” The client
answered: “pamilya ko
ma’am”
PHYSICAL ASSESSMENT
Body Parts Methods Findings Interpretation
Head Inspection - Head is symmetrically NORMAL
rounded with no lesions.
Palpation - No presence of pain,
tenderness and swelling NORMAL
Scalp and Hair Inspection - Hair color is black NORMAL

Palpation - Scalp is clean, free from
masses, lumps and
dandruff.
Face Inspection - Appears pale and distress Because of pain
due to surgery and
fractured clavicle
Palpation - No presence of tenderness
or masses.
Eyes Inspection - No presence of redness and
swelling NORMAL
- Conjunctiva is pinkish in
color
- Eyeballs are symmetrically
aligned
Palpation - No masses or bulging NORMAL
Ears Inspection - Ears are equal in size NORMAL
Palpation - No masses NORMAL
Nose Inspection - Can breathe normally in
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both nostrils.
Palpation - Frontal and maxillary NORMAL
sinuses are non-tender to
palpate
Percussion - Sinuses are non-tender to

percuss.
Mouth Inspection - Slightly dry ,

Palpation - No masses on tongue and NORMAL
gums
Neck Inspection - Neck is symmetric NORMAL
- Normal neck movement
- Prominent neck vessels
Palpation - No masses or lumps NORMAL
Breast and Axillary Inspection - Bilateral breast are NORMAL

symmetrical, non-tender.
Palpation - No masses upon palpation. Due to fractured

- Presence of pain clavicle
Thorax (Anterior Inspection - Symmetrical respiratory

and Posterior) effort without uses of NORMAL
accessory muscle.
- Respiratory rate:17 Due to fractured
Palpation - Tenderness and pain clavicle and his
Percussion - Normal resonance over surgery
lung tissue.
Auscultation - Upon auscultation, there’s
no adventitious sounds.
Lungs Percussion - Presence of wheezing ABNORMAL
(Anterior/Posterior) Auscultation sounds
Heart Inspection - The apical pulse is visible NORMAL

(Precordium), Palpation - Upon palpation there is no
Anterior Chest vibrations
Auscultation - No extra heart sounds and
murmurs heard.
- Heart Rate:
Abdomen Inspection - Smooth skin without NORMAL
lesions
Auscultation - Normal gurgle sound
Percussion - Tympanic sounds NORMAL
Palpation - No tenderness and pain

Extremities Inspection - Ssymmetric in length. NORMAL
(Upper) Palpation - No lesions and masses
- PR: 107
- Capillary refill: Below 2
seconds
(Lower) Inspection - Symmetric in length.
- No Presence of redness NORMAL
- No edema
Palpation - No lesions and masses
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Skin Inspection - No redness ad lesions NORMAL

- Temperature: 36.8
Palpation - Absence of lesions and

masses on the surface of
the skin
- Warm to touch.
NEUROLOGICAL ASSESSMENT
NAME CLASSIFICATION MAJOR FINDINGS
FUNCTIONS
I. Olfactory Sensory - Smell - can identify
and smell scent
while eyes are
closed
II. Optic Sensory - Vision (acuity - no signs of
and field of visual
vision); pupil impairment
reactively to - can read and
light and can match
accommodation colors
(efferent
impulse)
III. Oculomotor Motor - Eyelid - both pupils
elevation; most constrict
EOMs; pupil - symmetric eye
size and movement
reactivity - Normal eye
(efferent color
impulse)
IV. Trochlear Motor - EOM (turns - equal pupil size
eyes downward - normal
and laterally) movement of
the upper
eyelids
V. Trigeminal Both - Chewing, facial - eyes naturally
and mouth blink when
sensation, cotton wisp
corneal reflex lightly touched
(sensory) the cornea
VI. Abducens Motor - EOM (turns - turns eyes
eyes laterally) laterally
- no presence of
strabismus
VII. Facial Both - Facial - facial grimace
expression;
taste, corneal
reflex (motor),
eyelid and lip
closure
VIII. Sensory - Hearing; - whispered
Acoustic/Vestibular equilibrium word heard
cochlear clearly
(whispered
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voice test)
- tone heard
clearly (weber
test)
IX. Both - Gagging and - swallowing
Glossopharyngeal swallowing intact
(sensory); taste
X. Vagus Both - Gagging and - gag reflex
swallowing intact
(motor)
XI. Spinal Motor - Shoulder - shoulder
Accessory movement; shrugging
head rotation weakness
XII. Hypoglossal Motor - Tongue - normal tongue
movement; movement
speech
(articulation)
ANATOMY AND PHYSIOLOGY
The clavicle is the bone that connects the breastplate (sternum) to the shoulder. It is a very
solid bone that has a slight S-shape and can be easily seen in many people.
Clavicle is divided into:

 Medial two thirds - Medial two thirds of the clavicle is convex forward
 Lateral one third - Lateral one third is concave forward.
Inferior surface
 Conoid tubercle - Near the acromial end of the clavicle, give attachment to the Conoid
ligament.
 Trapezoid line - Near the acromial end of the clavicle, give attachment to the Trapezoid
ligament.
 Subclavian groove - In the medial third of the shaft of the clavicle, give attachment to
the subclavius muscle.
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 Impression costoclavicular ligament - Rough depressed oval area at sternal end that
give attachment to the costoclavicular ligament.
Superior Surface:
 Attachment for sternocleidomastoid muscle at medial two third of the clavicle
 Attachment for trapezius muscle at lateral one third of clavicle
Anaterior Surface:
 Attachment for Pectoralis major muscle at media two third of the clavicle
 Attachment of deltoid muscle at lateral one third of the clavicle
Functions
 The clavicle holds the arm away from the trunk.
 It also transmits forces from the upper limb to the axial skeleton It provides attachment
for muscles It provides attachment for ligaments that bind it to the first rib at its sternal
end and suspend the scapula from its acromial end.
Fractures of the Clavicle
 It is the most commonly fractured hone in

the body.
 The fracture usually occurs as a result of a
full on the shoulder or outstretched hand.
The force is transmitted along the clavicle,
which breaks at its weakest point, the
junction of the middle and outer third
 After the fracture, the lateral fragment is
depressed by the weight of the arm, and it is
pulled medially and forward by the strong
adductor muscles of the shoulder joint,
especially the pectoralis major.
The medial end is tilted upward by the
sternocleidomastoid muscle.
PATHOPHYSIOLOGY
FRACTURE CLOSED COMPLETE COMMINUTED CLAVICLE RIGHT
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History & Examination

Complication
 Motor vehicle accident
 Fracture dislocation of right
Examination clavicle
 Floating shoulder
 Chest X-ray
Fall Direct blow on shoulder
Force will be transmitted to the bone

(clavicle) from the fore arm/upper
limb
Fracture closed complete comminuted displayed

clavicle right
Medial Lateral third

Middle third
fracture 5% 15%
fracture 80%
Prominent and Medial fragment bone elevated via

palpable fragment sternocleidomastoid
Trapezius muscle cannot hold lateral

fragment due to upper limb weight
Shoulder drop Pain Uneven

Shoulder
If treated If not treated

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Surgical Options Symptomatic malunion

 Open reduction and internal or non-union
fixation using plate and
screws
 With x-ray imaging Prognosis:
Improve with arm sling support
LABORATORY DIAGNOSIS
ROENTGENOGRPHIC REPORT
Name: PATIENT B AGE: 35 XRAY NUMBER:22-
1588
EXAMINATION: DATE: NOVEMBER
12, 2022
EXAMINATION: CHEST PA
Radiological Findings:
 There is a comminuted overriding fracture in the mid-shaft of the right clavicle with
inferior displacement of the distal fractured segment. Overlying soft tissue swelling is
likewise seen.
 There are no parenchymal infiltrates in both lung fields.
 The heart is not enlarged.
 Aorta is unremarkable.
 Chest wall, hemidiaphragms, costophrenic sulci and the rest of the visualized bones
are intact.
IMPRESSION:
Fracture, right clavicle, as described.
ROENTGENOGRPHIC REPORT
Name: PATIENT B AGE: 35 XRAY NUMBER:22-
1588
EXAMINATION: DATE: NOVEMBER
12, 2022
EXAMINATION: RIGHT SHOULDE AP

Radiological Findings:
 There is a comminuted overriding fracture in the mid-shaft of the right clavicle with
inferior displacement of the distal fractured segment. Overlying soft tissue swelling is
likewise seen.
 The rest the visualized osseous structures are intact.
 No lytic or sclerotic lesions noted.
 Include joint spaces are intact.
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NAME: PATIENT B AGE:35/M DATE: 11/12/2022

ADDRESS: RIZAL, ALICIA, ISABELA PHYSICIAN: DR. C
CLINICAL CHEMISTRY
TEST RESULT NORMAL TEST RESULT NORMAL

VALUES VALUES
70.000-150.000 LDL 0.000-
Glucose mg/dl 3.14mmol/L
Fasting 3.9-6.1mmol/L SGOT(AST) 8-38u/L
Cholesterol 0.00-5.20 SGPT(ALT) 4-44u/L
mmol/L
Triglycerides 0.000-1.68 Glycosylated 4.0-6.0%
mmol/l HGB(HbA1c)
BUN 3.0-9.2 mmol/l Sodium 146.5 135.000-145.000
mmol/L
Uric acid 238-416 Potassium 4.04 3.600-5.500
(BUA) mmol/L(male) mmol/L
178-327
mmol/L
(female)
Creatinine 62-124 umol/L Chloride 106.2 98.000-107.000
(male) mmol/L
53-106umol/L
(female)
HbA1-Chole 0.91-2.06 iCalcium 1.05-1.30 mmol/L
mmol/L (male)
LDH 225-450u/L
1.09-2.29 VLDL
mmol/L(female)
NAME: PATIENT B AGE:35/M DATE: 11/13/2022

ADDRESS: RIZAL, ALICIA, ISABELA PHYSICIAN: DR. C
CLINICAL CHEMISTRY
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TEST RESULT NORMAL TEST RESULT NORMAL

VALUES VALUES
70.000-150.000 LDL 2.49 0.000-
Glucose mg/dl 3.14mmol/L
Fasting 5.95 3.9-6.1mmol/L SGOT(AST) 27.92 8-38u/L
Cholesterol 5.61 0.00-5.20 SGPT(ALT) 61.08 4-44u/L
mmol/L
Triglycerides 2.46 0.000-1.68 Glycosylated 4.0-6.0%
mmol/l HGB(HbA1c)
BUN 9.90 3.0-9.2 mmol/l Sodium 135.000-145.000
mmol/L
Uric acid 223.7 238-416 Potassium 3.600-5.500
(BUA) mmol/L(male) mmol/L
178-327
mmol/L
(female)
Creatinine 113.2 62-124 umol/L Chloride 98.000-107.000
(male) mmol/L
53-106umol/L
(female)
HbA1-Chole 2.0 0.91-2.06 iCalcium 1.05-1.30 mmol/L
mmol/L (male)
LDH 225-450u/L
1.12
1.09-2.29 VLDL
mmol/L(female)
COURSE IN THE WARD

PROGRES
DATE/ TIME DOCTORS ORDER RATIONALE
NOTES
11/12/22 o Pls. admit to Pain on right o To elicit comfort
room of choice shoulder o To inform the
BP: 130/80 o Secure consent client to know
PR: 85 o NPO post- the procedure
RR: 22 midnight and to protect
TEMP: 36.5 o TPR Q shift and the client’s
record rights.
o CBC, RBS,
Chest X ray, o To set a baseline
EKG, of vital sign
Electrolyte,
Urinalysis, CBC. o To help the
o D5NSS 1L as immune system
KVO to fight
Meds: infection. Skin
o Cefuroxime test is necessary
750Mg IV q8hrs. to know if the
ANST patient has
o Celecoxib allergy on a
certain
200mg 1 cap. 2x
drug/medication.
a day
o Ketorolac 30mg
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IV q8 ANST o Cefuroxime is
o For CP- works by
clearance stopping the
o Refer growth of
accordingly bacteria.
o Celecoxib is an
anti-
inflammatory
drug that is used
to treat mild to
moderate pain.
o Ketorolac is
used for short-
term treatment
for moderate to
severe pain.
11/13/22 o Schedule patient o To inform the

for ORIF plating client to know
on Tuesday 4PM the procedure
o Secure consent and to protect
o Please inform the client’s
OR/ Dr. C for rights.
anesthesiologist
o NPO post
breakfast on o To inform the
Tuesday 8am physician for the
o D5LRS 1L x procedure to be
8hrs. once on done.
NPO
o Ceftriaxone 1g o NPO can
IV to be given prevent nausea
30 minutes prior and vomiting.
to cutting.
o Ceftriaxone used
to treat bacterial
infection.
11/13/2022 o Thank you Dr. o Combivent to

M for the treat a moderate
referral to severe
o Please see pre op asthma.
form for your
referral o Hydrocortisone
o No absolute is used in
contraindication calming down
to contemplated your body's
procedure immune
o May go ahead response to
with plan reduce pain,
surgery itching and
o Combivent neb 1 swelling
(inflammation).
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hour prior to
surgery them o To set a baseline
immediately post of vital sign
op then Q4 x 3
doses o To inform the
o Hydrocortisone physician for the
100mg IV 1hr. procedure to be
prior to surgery done.
o V/S at q1 hour
post op, refer if
BP is <90/60 or
BP >150/90
o I and O q shift
o Inform Dr.
Malana
o Inform me of
schedule of OR
once procedure
is done.
o Refer
accordingly
11/15/22 o Start o Omeprazole

Omeprazole improves the
POST – OP 40mg IV prior to gastric
OR environment at
o Metoclopramide the induction of
1amp prior to anesthesia.
OR
o Refer o Metoclopramide
used to help stop
you feeling or
being sick (nausea
or vomiting)
11/15/22 o Anesthesia Post- o To set a baseline

6:00pm op orders of vital sign.
o To ward
o Maintain VS o Cefuroxime is
q15mins. until works by
stable then stopping the
q4hrs. thereafter growth of
o DAT with SAP bacteria.
once fully awake
o IVF, PLRS 1L x o Celecoxib is an
80cc per hr. anti-
Medication: inflammatory
o Cefuroxime 750 drug that is used
mg IV q8 to treat mild to
o Paracetamol moderate pain.
900mg IV q8 X
o Ketorolac is
24hrs.
o Ketorolac 30mg used for short-
term treatment
IV q8 x 24hrs
for moderate to
ANST
severe pain.
o Nalbuphine
1amp IV q6 x
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24hrs,
o Celocoxib
200mg PO BID
x5 days after IV
pair medication
o Continue other
medication
o Keep patient
comfortable and
thermoregulated
o Encourage deep
breathing
exercise
o Refer
accordingly
7:00 pm o Give cefuroxime o Cefuroxime is

750mg x 2 more works by
doses then stopping the
discontinue growth of
o Continue pain bacteria.
meds.
o Maintain arm
sling
11/16/22 o MGH o Cefuroxime is
Home Medication: works by
o Cefuroxime stopping the
500mg BID for 7 growth of
days bacteria.
o Paracetamol +
tramadol 1 tab o Paracetamol +
2x a day for pain Tramadol used
o Follow up ester to symptomatic
Garcia on Friday treatment of
November 18, moderate to
2022, 3PM severe pain.
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NURSING CARE PLAN (1)

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
Subjective: Acute pain related to After 8 hours of nursing  Vital signs were  Alterations from After 8 hours of nursing
Open Reduction intervention, the patient monitored every normal may be signs intervention, the patient
“masakit ang kanan kong Internal Fixation will: 4hrs until stable and of infection. has:
braso” as verbalize by the (ORIF) on right dressing was Moistened dressings
patient shoulder  Verbalizes checked are favorable site for  Verbalizes
minimized or microorganism to minimized or
Objective: controlled feeling of  Adjusted culture controlled feeling
pain constricting bandage of pain
 C (Character) Pain and advised to  This is to prevent
in the Right  Verbalizes methods elevate left shoulder diminished  Verbalizes
shoulder. that provide relief circulatory and nerve methods that
 O (Onset) 4-17-22  Instructed to do function and control provide relief
 L (Location) Right  Demonstrate use of activities such as swelling of the site
shoulder relaxation skills and deep breathing  Demonstrate use
 D (Duration) – diversional activities exercise.  To reduce swelling of relaxation skills
“hindi nawawala and prevent stiffness and diversional
yung sakit”  Noted to avoid the stated activities activities
 S (Severity) 10/10 weight bearing until must be done.
 P (Pattern) – allowed Decreased lung
“Kapag ginagalaw capacity.
ko masakit”  Encourage to void
 A(Associated freely  To prevent from
factors) Pain and complications on the
discomfort, facial  Enough rest and incision site, activities
grimace sleep also advised that may extend the
cut must be avoided
 Intake of pain
reliever and  This is advised in
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antibacterial order to prevent

constipation and fecal
impaction
 This promotes healing

by reducing basal
metabolic rate and
allowing oxygen and
nutrients to be utilized
for tissue growth,
healing and
regeneration
 NSAID is an example
to relieve severe to
moderate pain.

Subjective: Impaired physical After 1-2 days of nursing  Established Rapport  To provide optimal care and trust Goal Partially Met
“Hindi ako mobility related intervention the patient  Determine diagnosis that to the patient
masyado nakaka to skeletal will be able to: contributes to immobility  To identify contributing factors After 1-2 days of nursing
galaw dahil dito sa impairment as  Client will maintain  Note situations such as  Cause it may restrict movement intervention the patient
bali ko sa buto” as evidence by position of function fractures  To assess functional mobility was able to:
verbalize by the fractured clavicle  To assess presence of  Maintain position of
patient.  Client will  Determine of immobility in complications function
demonstrate relation to suggested scale  To promote optimum level of  Client will
techniques that  Determine presence of function and prevent complications demonstrate
Objective:
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 Slowed enables resumption complications related to  The patient may be restricted by techniques that
movement of activities immobility (decubitus) self-view or self-perception out of enables resumption
 Decreased  Assess the degree of proportion with actual physical of activities
muscle strength immobility produced by limitations, requiring information  Improve Range of
 Limited range  Improve Range of injury or treatment and note or interventions to promote motion
of motion motion the patient's perception of progress toward wellness.  Inability to move the
 Inability to immobility.  It helps ensure the chosen and affected part as
move  Ability to move the presented materials are culturally evidence by using
purposefully affected part  Assess the health literacy and and educationally appropriate. sling
within physical cultural practices of the  Increased blood flow to muscle and  Maintain/regain
environment patient. bone to improve muscle tone mobility at possible
 Maintain/regain  Teach patient or assist with level
mobility at possible active and passive ROM
level exercises of affected and
unaffected part.

Subjective: Risk for infection Short term Goal:  Inspect the skin for  Pins or wires should Goal Met
“Sabi ng doctor na related to fractured After 8 hours of nursing preexisting irritation or not be inserted
medjo nag karoon ng clavicle as evidence by intervention the patient breaks in continuity. through skin Short term Goal:
pamamaga sa bandang swelling in operative will be able to:  Assess pin sites and skin infections, rashes, or After 8 hours of nursing
naoperahan” as site areas, noting reports of abrasions (which may intervention the patient was
verbalize by the patient  Identify intervention increased pain, burning lead to bone able to:
to prevent/reduce risk sensation, presence of infection).
of infection edema, erythema, foul  May indicate the  Identify intervention to
Objective:  Achieve timely wound odor, or drainage. onset of local prevent/reduce risk of
 Swelling on the healing  Observe wounds for infection or tissue infection
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operative site  Be afebrile as bullae formation, necrosis,  Achieve timely wound

 ORIF at right evidence by the crepitation, and bronze  Signs suggestive of healing
shoulder normal vital signs discoloration of the skin, gas gangrene  Be afebrile as evidence by
within the normal frothy or fruity-smelling infection. the normal vital signs
limit drainage.  Minimizes within the normal limit
 Clean wound  Instruct the patient not to opportunity for  Clean wound
touch the insertion sites. contamination.
Long term Goal:  Monitor vital signs. Note  Hypotension, Long term Goal:
After 2-3 days of nursing presence of chills, fever, confusion may be After 2-3 days of nursing
intervention the patient malaise, changes in seen with gas intervention the patient was
will be able to: mentation. gangrene; able to:
 Provide sterile pin or tachycardia, chills,
 (-) swelling on the wound care according to fever reflect  Report (-) swelling on the
operative site protocol and exercise developing sepsis. operative site
 Free from infection meticulous  May prevent cross-  Free from infection
handwashing. contamination and the
possibility of
DEPENDENT: infection.
 Administer medications,  IV and topical
as indicated antibiotics Wide-
spectrum antibiotics
may be used
prophylactically or
may be geared toward
a specific
microorganism.
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ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATON
Subjective: Risk for injury Short term Goal:  Assess general status of the  To determine client Goal Met
“Konting related to fracture After 8 hours of nursing client condition that may
pagkakamali ko lang of clavicle intervention the patient will:  Assessed environmental cause injury Short term Goal:
baka lalong lumala  Free from any signs of factors that may lead to injury After 8 hours of nursing
tong kalagayan ko” injury  Promoting client safety by:  To determine that intervention the patient
as verbalize by the - Monitor vital signs cause of injury was able to:
patient. Long term Goal - Providing material for  Free from any signs of
After 2-3 days of nursing injury prevention  To lessen the risk of injury
intervention the patient will be - Side rails will be injury, safe
able to: monitored environment and Long term Goal
Objective:  Affected area will remain promote client safety After 2-3 days of nursing
 Need assistance from any signs of injury  Maintain correct body and comfort intervention the patient
in ambulation  Increased range of motion alignment mostly in shoulder was able to:
 Limited motion  Report correct body after position changes  Facilitate comfort and  Report Affected area
 Use of sling alignment  Assess client muscle strength, avoids deformity will remain from any
gross and fine motor signs of injury
coordination  To identify risk for  Increased range of
 Note socioeconomic falls motion
status/availability and use of  Report correct body
resources alignment
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Subjective: Anxiety related to the After 30 mins. of nursing  Monitoring of vital  To identify the After 30 mins. of nursing
broken bones and need intervention, the client will signs and level of baseline information intervention, the client was
“natatakot kasi hindi kona for surgical intervention be able to: anxiety and pan intervention able to:
magagawa yung mga dapat
kong gawin, at limited na  Relieve fear and  Provide  To motivate the  Relieve fear and
yung actions ko” as anxiety by promoting reinforcement client and relieve anxiety by
verbalize by the patient a sense of wellbeing regarding the need of pain promoting a sense
surgical intervention of wellbeing by
Objective: and its prognosis  To aid early recovery client’s
and alleviate fear verbalization of
 Fear concerning  Teach the client to positive feeling.
the broken bone do and practice
and surgical ROM, active and  To provide comfort
management passive exercise and alleviate fear
 Facial grimace
shows worries  Reassurance and
psychological
support
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DRUG STUDY (1)

DRUG MECHANIS DOSAGE INDICATION CONTRAINDICATION ADVERSE EFFECT NURSING RESPONSIBILITIES
NAME M OF S S
ACTION
Generic Second Dose: Pharyngitis, - Contraindicated in Body as a Whole:  Check the patient name
Name: generation  500mg tonsillitis patient’s hypersensitivity Thrombophlebitis (IV site);  Check the doctors order
Cefuroxime cephalosporin infections of to drugs pain, burning  Culture infection, and arrange for
that inhibits the urinary and GI: Diarrhea, nausea, antibiotic sensitivity test before and during therapy if
Brand Name: Route: - Use cautiously in associated colitis
cell wall  oral
lower expected response is not seen
Zoltax synthesis , respiratory patients hypersensitive to Skin: Rash, Pruritus, Uticaria  Monitor patient carefully. Some patients,
promoting tract and skin penicillin because of Urogenital: Increased serum especially those with severe obstructive
osmotic Frequency and skin possibility of cross cretonne and BUN, decreased CAD, have developed increased frequency,
instability : structure sensitivity with other beta creatinine clearance duration or severity of angina or acute MI
usually BID for 7 infection lactam antibiotics after initiation of calcium channel blocker
bactericidal days therapy or at time of dosage increased.
 Monitor BP frequently during initiation of
therapy. Because drug-induced vasodilator
has in gradual onset, acute hypotension is
rare.
 Notify prescriber if signs of HF occur, such
as swelling of hands and feet or shortness
of breath.
 Abrupt withdrawal of drug may in increase
frequency and duration of chest pain. Taper
dose gradually under medal supervision.
 Report onset of loose stools
 Absorption of cefuroxime is enhanced by

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food
 Notify prescriber about rashes or super
infection
DRUG STUDY (2)

DRUG NAME MECHANISM OF DOSAGE INDICATIONS CONTRAINDICATIONS ADVERSE EFFECT NURSING RESPONSIBILITIES
ACTION
Generic Tramadol is a Dose: Mild to moderate Acute intoxication w/ CNS:  Verify patient name
Name: centrally acting opioid  1 tab pain and fever Alcohol, hypnotics, Nausea, drowsiness,  Administer the rights drugs with
Tramadol + analgesic which binds centrally-acting analgesics, stimulation right dose and right time
Paracetamol to mu-opioid receptors Reduce fever in opioids, or psychotropic GI:  State to the parent the importance
Route: viral and drugs;
and weakly inhibits uncontrolled Vomiting, abdominal pain and purpose of drugs to the patient
oral
the reuptake of

bacterial epilepsy. Severe hepatic Hepatic:
Classification: norepinephrine and infections impairment. Concurrent Hepatotoxicity, hepatic
Antipyretic, Serotonin. Frequency use or w/in 2 wk of seizure  If hypersensitivity reaction occurs
non-narcotic : discontinuation from Renal: stop the administration
analgesic Paracetamol, a para BID MAOIS. Renal Failure immediately
aminophenol
derivative, has Caution:  Assess patient fever or pain: type
analgesic, antipyretic Patient w/ epilepsy of pain, location, intensity,
and weak anti- controlled by treatment, duration and temperature
inflammatory activity. risk of seizure, cranial  Assess allergic reaction: rash,
trauma, biliary tract urticaria: if these occurs drug may
Together, tramadol and disorder, altered state of have to be discontinued
paracetamol has faster consciousness for
onset of action  Teach patient to recognize signs of
compared to tramadol chronic overdose: fever, malaise,
alone and longer sore throat, bleeding and bruising
duration of action  Increased fluid intake as indicated
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compared to
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DISCHARGE PLAN
MEDICATION  Instruct the patient and SO to continue his medication as ordered by
the physician.
 Explain the importance of compliance to prescribed medication.
 Cefuroxime 500mg BID for 7 days
 Paracetamol + tramadol 1 tab 2x a day for pain
EXERCISE  Instruct patient and SO to avoid extraneous activity. Excessive
activities that may result to stress. Just advised to perform range of
motions and repetitive body movements for promotion of optimum.
 Encourage patient to rest and do deep breathing exercise.
TREATMENT  Increased oral fluid intake.
 Admission to an intensive care unit intravenous fluids and
electrolytes.
 Bed rest Out-Patient Follow-Up Care.
 Encourage the patient to seek nearest hospital as soon as possible if
symptoms are observed and can't be relieved by the medications.
 Advise the patient to comply prescribed medications if symptoms
persist consult your doctor.
 Encourage and advise family members that massage or applying
back-rub is very relaxing and can reduce pain sensation.
HEALTH  Discuss the possible source of infection of the disease.

EDUCATION  Encourage to take well balance diet and avoid fatty foods, spicy food,
caffeine, and heavy meals.
 Encourage the patient for healthy lifestyle.
 Educate the patient about pain management.
 Educate the patient not to take non prescribe medication or over the
counter drugs for his condition.
 Encourage the patient to seek nearest hospital as soon as possible if
symptoms are observed and can't be relieved by the medications.
 Advise the patient to comply prescribed medications.
 Explore the patient drinking pattern.
OUT-PATIENT  Instruct the patient to have follow-up check up to monitor his
condition.
 Follow up ester Garcia on Friday November 18, 2022, 3PM
DIET  Encourage nutritious foods like vegetables, meat and fruits.
 Instruct the family members to give the patient protein rich foods
such as meat, fish, eggs and nuts, vitamin K rich foods such as green
leafy vegetables.
 Include vitamin C in diet for benefits of immunity boosts and
antiviral and antibacterial properties and helps promote absorption of
iron. Vitamins C rich foods (guava and tomatoes and other citrus
fruits), carbohydrates rich food (breads and rice)
SPIRITUAL  Always pray accordance with their beliefs and asked GOD for
recovery and good health.
PROGNOSIS
Patient is using sling for support and still on medication and on monitoring.

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University of Perpetual Help System Laguna-Isabela Campus

Minante 1, Cauayan City, Isabela

FRACTURE CLOSED COMPLETE COMMINUTED

November 14-18, 2022

 To learn more about the severity of the break

If the fracture does not heal, it is called a nonunion.

Open reduction and internal fixation

Risks that are specific to surgery for clavicle fractures include:

Present Medical History:

GORDON’S HEALTH ASSESSMENT

Taking medication without the

The client verbalized :

Readiness for enhance

odor and character of health/digestive-health/types-of-

Urine looks paler during

For a person with normal

The client was asked :

maghanap buhay, Once you get used to going to

The client was asked :

The client was asked :

“Events or situations may Readiness for enhanced

Self-concept tends to be more

The client was asked:

The client was asked:

Role – The client was asked: Readiness for enhanced

Filipinos always find a way to

The average menstrual cycle

Readiness for enhanced

The client was asked:

The client was asked:

dasal lagi para sa longevity, coping skills, and

Scalp and Hair Inspection - Hair color is black NORMAL

Percussion - Sinuses are non-tender to

Mouth Inspection - Slightly dry ,

Breast and Axillary Inspection - Bilateral breast are NORMAL

Palpation - No masses upon palpation. Due to fractured

Thorax (Anterior Inspection - Symmetrical respiratory

Heart Inspection - The apical pulse is visible NORMAL

Palpation - No tenderness and pain

Skin Inspection - No redness ad lesions NORMAL

Palpation - Absence of lesions and

ANATOMY AND PHYSIOLOGY

Clavicle is divided into:

Fractures of the Clavicle

 It is the most commonly fractured hone in

History & Examination

Fall Direct blow on shoulder

Force will be transmitted to the bone

Fracture closed complete comminuted displayed

Medial Lateral third

Prominent and Medial fragment bone elevated via

Trapezius muscle cannot hold lateral

Shoulder drop Pain Uneven

If treated If not treated

Surgical Options Symptomatic malunion

EXAMINATION: RIGHT SHOULDE AP

NAME: PATIENT B AGE:35/M DATE: 11/12/2022

TEST RESULT NORMAL TEST RESULT NORMAL

NAME: PATIENT B AGE:35/M DATE: 11/13/2022

TEST RESULT NORMAL TEST RESULT NORMAL

COURSE IN THE WARD

11/13/22 o Schedule patient o To inform the

11/13/2022 o Thank you Dr. o Combivent to