Application of Orem Self-care theory on patient with right leg tibular fracture

Base line data

Name- Mr .X
Age- 30 years old
Sex- Male
Occupation- Farmer
Marital status- married
Religion- orthodox Christian
Dx. – Tibular Fracture
Theory applied- Orem’s theory

Mr .X came to Debre-tabor general hospital with complaints of pain, loss of

function ,deformity of extremity, oedema on right lower leg after sustaining

crashing force accident . He was apparently healthy before this injury.He was

unable to do ADL by him-self after injury .

Assessment using Orem's theory

1) Heath care status the patient

• Health status –acutely ill due to fracture
• Socio-cultural orientation- no formal education
• Health care system- institutional health care
• Family system- married, farmer and lead the home
• Patterns of living- at home with partner
• Environment- rural area, items for activity of daily living not easy
 • Perception of his health status – Severely ill

2) Universal self-care requisites

• Air- breath without difficulty

• Water- fluid intake sufficient
• Food- loss appetite , non-nutritious food intake
• Elimination- Can void, but assisted
• Activity/rest- Impaired activity, rest is required due to pain, deformity over
there
• Social interaction- communicates well, good
• Prevention of hazards- needs counsel on bed rest, on diet, on
immobilization

3) Developmental self-care requisites

 Maintenance of developmental environment

 sociable, able to communicate
 Impaired performance of daily activity
 Disturbed self-image
 Free of any risk personal behaviors.

4) Health deviation self-care requisites'

• Adherence to medical regimen- he needs continuity of care and cooperates

with the medicines
• Not much aware about the treatment options for his problem
• Not aware about the side effect of the management
• Needs counseling about body self-image modification until healing
5) Medical problem and plan

• medical diagnosis- right leg tibular fracture

• medical Treatment- immobilization using cast application, anti-
pain( Tramadol 50 mg Iv TD)
 • Supportive therapy- Physiotherapy and Nutritional
6. Areas of inadequacy ( self care demand and agency

• Food Intake –Imbalanced

• Elimination- assisted elimination
• Activity- frequent rest is required, activity level has come down , pain is not
completely removed
• Activity of daily living- impaired
• stress and coping- He feels stressed.
• Self care agency/ ability - inadequate

Nursing diagnosis
• Altered self care activity related to injury of the arm and leg
• Acute pain related to fracture
• Disturbed body self image related to injury .
• Lack of knowledge about disease condition re/to patient verbalization

Outcome and plan

The patient needs whole compensatory care such as

 Relieve pain,
 Improve dieting
 Improved nutrition
 Improve self-image
• Method of helping
 Teaching , counseling
 Treating
 Immobilizing him for short period of time .
 Implementation

• Teaching
• Treating pain
• Assisting in dress, bath, toileting,
• Immobilizing the patient with cast…

Evaluation

• The pt. understood importance the best treatment options

• The patients self-image improves
• The patients self-care activities improved.
• He verbalized that “I will take proteinous diet”
• He stated that relative pain free period