Fracture of the subtrochanter, left

femur


A 0ASL PkLSLNIAI|0N









A1ILN1's kCIILL

O LMCGkAnIC A1A

name !C
Cender Male
Clvll SLaLus Slngle
Age 3 years old
8lrLhplace Manlla
CccupaLlon n/A
naLlonallLy llllplno
8ellglon 8oman CaLhollc
uaLe of Admlsslon november 14 2010
AdmlLLlng ulagnosls Closed compound hlp fracLure of Lhe subLrochanLer lefL femur

O CnILI CCMLAIN1

a|n |nf|ammat|on and deform|ty on the |eft |eg

O AS1 MLICAL nIS1Ck
O no remarkable medlcal hlsLory only eplsodes of mlld fever and cough

O IAMIL MLICAL nIS1Ck
O 9n from Lhe paLernal slde of Lhe famlly

O LkSCNAL AN SCCIAL nIS1Ck
O ls always ln school commuLlng wlLh couslns by means of Laklng Lhe Lrlcycle

O nIS1Ck CI kLSLN1 ILLNLSS
lL was Lhe afLernoon of november 11 2010 when Lhe paLlenL was crosslng Lhe sLreeL
wlLh hls couslns LhaL a Lrlcycle hlL hlm Lucklly Lhe Lrlcycle volunLeered Lo Lake Lhe
paLlenL Lo 9CC passlng by and lmmedlaLely broughL hlm Lo 9CC Lhus Lhe conflnemenL

O ASSLSSMLN1 (ecember 7 2010)

I V|ta| s|gns
a 1emperaLure 363 C
b Cardlac raLe 83 bpm
c 8esplraLory raLe 23 cpm

II Integumentary
a MolsLure normal
b Ldema none
c CondlLlon of lv llne n/A
d Skln lnLegrlLy normal
e Mlnor wounds 9resenL ln Lhlghs
f LryLhema none

III Iace Lyes Lars Nose and Mouth
a laclal AsymmeLry none
b vlslon normal
c Sclera nonlcLerlc
d earlng normal
e nose no nasal flarlng
f uenLures 9resenL

IV Card|ovascu|ar
a Aplcal pulse SLrong
b 8adlal pulse SLrong
c 8rachlal pulse SLrong
d 9edal pulse SLrong
e 9alplLaLlons AbsenL

V kesp|ratory
a () cbest polo
b () uO8
c () cough and hemopLysls
d 8reaLh Sounds normal
e Lung expanslon normal and symmeLrlcal

VI Gastro Intest|na|
a Abdomen flaL
b 1enderness none
c 8owel Sounds 20 per mlnuLe
d leedlng uleL as LoleraLed
e nC1 feedlng none
f 8owel movemenL normal once a day

VII Neuro|og|c Assessment
a Sensorlum Consclous
b Coherence responds Lo verbal command
c Slgns of ulsLress AbsenL
d eadache AbsenL
e neck sLlffness AbsenL
f () faclal asymmeLry


VIII Gen|to Ur|nary
a urlnaLlon normal (30cc per hour)
b uysurla none
c CenlLal Area normal (no dlscharge)

Ik sychosoc|a|
a Llves wlLh lamlly
b 8ehavlor CooperaLlve when able
c AcLlvlLles of ually llvlng Can parLlclpaLe on acLlvlLles of dally llvlng only lf wlLh
asslsLance buL ls Llll dependenL on help of Lhe parenL


















kUG S1U
kUG AC1ICN CSAGL INICA1ICN NUkSING
CCNSILkA1ICN

Cenerlc name
aracetamo|

8rand name
8logeslc

Class
Analgeslc
anLlpyreLlc
uecreases fever
by lnhlblLlng Lhe
effecLs of
pyrogens on Lhe
hypoLhalamlc
heaL regulaLlng
cenLers and by
a hypoLhalamlc
acLlon leadlng
Lo sweaLlng and
vasodllaLlon

8elleves paln by
lnhlblLlng
prosLaglandlns
synLhesls aL Lhe
CnS buL does
noL have anLl
lnflammaLory
acLlon because
of lLs mlnlmal
effecL on Lhe
perlpheral
prosLaglandln
synLhesls
300mg q4
and 98n for
fever
lever O Assess paLlenL's
fever or paln
Lype of paln
locaLlon
lnLenslLy
duraLlon
LemperaLure
O Assess allerglc
reacLlons rash
O Assesss for
chronlc
polsonlng rapld
weak pulse
dyspnea
cold clammy
exLremlLles



Cenerlc name
CCAMCkICLAV

8rand name
amoxlclav

Class
lnhlblLs enzymes
lnvolved ln
formaLlon of
pepLldoglycan
layer of bacLerlal
cell wall no effecL
on human cell
walls 8acLerlcldal
40 mg/kg/day
for 7 days
Lower resp
LracL lnfecLlons
oLlLls
medla slnuslLls
skln sofL
Llssue
lnfecLlons u1l
pre
O 9regnancy
O lsLory of
hypersenslLlvlLy
O 8enal
lmpalrmenL
O epaLlc
lmpalrmenL
may cause
8acLerlcldal only works on
dlvldlng bacLerla
Well absorbed
enLerally
Clavulanlc acld
lnhlblLs bacLerlal
lacLamase
posLsurglcal
procedures
bone [olnL C
C
lnfecLlons
denLal
lnfecLlons
cholesLaLlc
[aundlce up Lo 6
weeks afLer
cessaLlon
O May cause
maculopapular
rashes



LA8S
O 8LCC CnLMIS1k (November 14 2010)

AkAML1Lk kLSUL1 NCkMAL VALUL SIGNIIICANCL
nct 041 04 03 Low va|ue may
|nd|cate a b|eed|ng
ep|sode
nq8 Low va|ue may
|nd|cate a b|eed|ng
ep|sode
Leukocyte 9 5 n|gh va|ue may
|nd|cate act|ve
|nfect|on
5eqmenters 8 565 n|gh va|ue may
|nd|cate act|ve
|nfect|on
Mcn 23 2731 May |nd|cate bone
damage

ANA1CM AN nSICLCG
1he SkeleLal SysLem serves many lmporLanL funcLlons lL provldes Lhe shape and form
for our bodles ln addlLlon Lo supporLlng proLecLlng allowlng bodlly movemenL produclng
blood for Lhe body and sLorlng mlnerals
Iunct|ons
lLs 206 bones form a rlgld framework Lo whlch Lhe sofLer Llssues and organs of Lhe body
are aLLached vlLal organs are proLecLed by Lhe skeleLal sysLem 1he braln ls proLecLed by Lhe
surroundlng skull as Lhe hearL and lungs are encased by Lhe sLernum and rlb cage
8odlly movemenL ls carrled ouL by Lhe lnLeracLlon of Lhe muscular and skeleLal sysLems
lor Lhls reason Lhey are ofLen grouped LogeLher as Lhe musculoskeleLal sysLem Muscles are
connecLed Lo bones by Lendons 8ones are connecLed Lo each oLher by llgamenLs Where bones
meeL one anoLher ls Lyplcally called a [olnL Muscles whlch cause movemenL of a [olnL are
connecLed Lo Lwo dlfferenL bones and conLracL Lo pull Lhem LogeLher An example would be Lhe
conLracLlon of Lhe blceps and a relaxaLlon of Lhe Lrlceps 1hls produces a bend aL Lhe elbow 1he
conLracLlon of Lhe Lrlceps and relaxaLlon of Lhe blceps produces Lhe effecL of sLralghLenlng Lhe
arm
8lood cells are produced by Lhe marrow locaLed ln some bones An average of 26
mllllon red blood cells are produced each second by Lhe bone marrow Lo replace Lhose worn
ouL and desLroyed by Lhe llver
8ones serve as a sLorage area for mlnerals such as calclum and phosphorus When an
excess ls presenL ln Lhe blood bulldup wlll occur wlLhln Lhe bones When Lhe supply of Lhese
mlnerals wlLhln Lhe blood ls low lL wlll be wlLhdrawn from Lhe bones Lo replenlsh Lhe supply
|v|s|ons of the Ske|eton
1he human skeleLon ls dlvlded lnLo Lwo dlsLlncL parLs he axlal skeleLon conslsLs of bones LhaL
form Lhe axls of Lhe body and supporL and proLecL Lhe organs of Lhe head neck and Lrunk 1he
appendlcular skeleLon ls composed of bones LhaL anchor Lhe appendages Lo Lhe axlal skeleLon
1ypes of 8ones
1he bones of Lhe body fall lnLo four general caLegorles long bones shorL bones flaL bones and
lrregular bones Long bones are longer Lhan Lhey are wlde and work as levers 1he bones of Lhe
upper and lower exLremlLles (ex humerus Llbla femur ulna meLacarpals eLc) are of Lhls Lype
ShorL bones are shorL cubeshaped and found ln Lhe wrlsLs and ankles llaL bones have broad
surfaces for proLecLlon of organs and aLLachmenL of muscles (ex rlbs cranlal bones bones of
shoulder glrdle) lrregular bones are all oLhers LhaL do noL fall lnLo Lhe prevlous caLegorles 1hey
have varled shapes slzes and surfaces feaLures and lnclude Lhe bones of Lhe verLebrae and a
few ln Lhe skull
8one Compos|t|on
8ones are composed of Llssue LhaL may Lake one of Lwo forms CompacL or dense bone and
spongy or cancellous bone MosL bones conLaln boLh Lypes CompacL bone ls dense hard and
forms Lhe proLecLlve exLerlor porLlon of all bones Spongy bone ls lnslde Lhe compacL bone and
ls very porous (full of Llny holes) Spongy bone occurs ln mosL bones 1he bone Llssue ls
composed of several Lypes of bone cells embedded ln a web of lnorganlc salLs (mosLly calclum
and phosphorus) Lo glve Lhe bone sLrengLh and collagenous flbers and ground subsLance Lo
glve Lhe bone flexlblllLy


A1nCnSICLCG






















9hyslcal Lrauma lead Lo bone dlsconlnulLy
When a bone ls broken Lhe perlosLeum and blood vessels ln Lhe corLex marrow and surroundlng sofL
Llssues are dlsrupLed
8leedlng occurs from Lhe damaged ends of Lhe bone and from Lhe nelghborlng sofL Llssue
A cloL (hemaLoma) forms wlLhln Lhe medullary canal beLween Lhe fracLured ends of Lhe bone and
beneaLh Lhe perlosLeum
8one Llssue lmmedlaLely ad[acenL Lo Lhe fracLure dles
1hls necroLlc Llssue along wlLh any debrls ln Lhe fracLure area sLlmulaLes an lnLense lnflammaLory
response characLerlzed by vasodllaLlon exudaLlon of plasma and leukocyLes and lnfllLraLlon by
lnflammaLory leukocyLes and masL cells
5/5xLOc4L P4lN LOc4L 8LulN6 LOc4L 5wLLlN6 ulOkMl1Y Ok ul5LOc41lON 5YMP1OM5
Ol 455Ocl41u Nkv u4M46 Llk NuM8N55 4Nu P4k4LY5l5
WlLhln 48 hours afLer Lhe ln[ury vascular Llssue lnvades Lhe fracLure area from surroundlng sofL Llssue
and Lhe marrow cavlLy and blood flow Lo Lhe enLlre bone ls lncreased
Non mod|f|ab|e factors
Sex of male



Mod|f|ab|e factors
MoLorcycle rlder
lgh alLlLude reldence




8oneformlng cells ln Lhe perlosLeum endosLeum and marrow are acLlvaLed Lo produce subperlosLeal
procallus along Lhe ouLer surface of Lhe shafL and over Lhe broken ends of Lhe bone
CsLeoblasLs wlLhln Lhe procallus synLheslze collagen and maLrlx whlch becomes mlnerallzed Lo form
callus (woven bone)
As Lhe repalr process conLlnues remodellng occurs durlng whlch unnecessary callus ls resorbed and
Lrabeculae are formed along llnes of sLress
SubsLlLuLlon of Lhe woven bone wlLh lamellar bone precedes Lhe subsLlLuLlon of Lhe hyallne carLllage
wlLh lamellar bone
1he lamellar bone beglns formlng soon afLer Lhe collagen maLrlx of elLher Llssue becomes mlnerallzed
1he mlnerallzed maLrlx ls peneLraLed by channels each conLalnlng a mlcrovessel and numerous
osLeoblasLs
1he osLeoblasLs form new lamellar bone upon Lhe recenLly exposed surface of Lhe mlnerallzed maLrlx
1he new lamellar bone ls ln Lhe form of Lrabecular bone
All of Lhe woven bone and carLllage of Lhe orlglnal fracLure callus ls replaced by Lrabecular bone
resLorlng mosL of Lhe bones orlglnal sLrengLh
1he remodellng process subsLlLuLes Lhe Lrabecular bone wlLh compacL bone
1he Lrabecular bone ls flrsL resorbed by osLeoclasLs creaLlng a shallow resorpLlon plL known as a
owshlps lacuna
1hen osLeoblasLs deposlL compacL bone wlLhln Lhe resorpLlon plL LvenLually Lhe fracLure callus ls
remodelled lnLo a new shape whlch closely dupllcaLes Lhe bones orlglnal shape and sLrengLh
NUkSING CAkL LANS
ASSLSSMLN1 NUkSING
IAGNCSIS
LANNING IN1LkVLN1ICN kA1ICNALL LVALUA1ICN
Sub[ect|ve
MasaklL ung
nakaLusok sa
blnLl nlya" as
verballzed by
Lhe paLlenL's
moLher"

Cb[ect|ve
rlgld body
posLure
faclal
grlmaclng
guardlng
behavlor

Chronlc 9aln
relaLed Lo
prolonged
LracLlon
After 30 mins
of nursing
intervention:

The client will
verbalize and
shows signs
of pain relief

The client will
be able to
demonstrate
relaxed body
posture and
enhanced
coping to pain
noLe reporLs of
paln lncludlng
locaLlon
duraLlon
lnLenslLy (010
scale)



9rovlde
comforL
measure (8ack
rub poslLlon
change)










AdmlnlsLer
medlcaLlon as
prescrlbed











9aln ls noL
always
presenL buL lf
presenL
should be
compared
wlLh cllenLs
prevlous paln
sympLoms

1he
comparlson
can asslsL ln
Lhe eLlology of
bleedlng and
developmenL
of
compllcaLlons
uslng non
LherapeuLlc
measures can
help Lo
allevlaLe paln

9harmacologlc
LreaLmenL
maybe
necessary ln
allevlaLlng
paln 8ecause
paln ls hlghly
sub[ecLlve
Lhere are a loL
of
medlcaLlons
LhaL can be
glven Lo Lhe
cllenL
AfLer 30 mlns
of nurslng
lnLervenLlon

1he cllenL
was able Lo
verballze and
shows slgns
of paln rellef

1he cllenL
was able Lo
demonsLraLe
relaxed body
posLure and
enhanced
coplng Lo
paln

9rovlde
dlsLracLlons




lnsLrucL Lo do
ueep
8reaLhlng
exerclses

lor Lhe
paLlenL Lo geL
hls mld off Lhe
paln


uecreaslng
Lhe paln by
concenLraLlng
on someLhlng
raLher Lhan
Lhe paln

ASSLSSMLN1 NUkSING
IAGNCSIS
LANNING IN1LkVLN1ICN kA1ICNALL LVALUA1ICN
Sub[ect|ve
ul masyado
makagalaw
anak ko dahll
sa nakalagay
sa paa nlya
lalo na baLa
pa lLo aL
mallkoL" as
verballzed by
Lhe cllenL
Cb[ect|ve
Cordon's
funcLlonal
level of
classlflcaLlo
n Level lll
9aLlenL
unable Lo
perform
any AuL's

AcLlvlLy
lnLolerance
relaLed Lo
LracLloned
sLaLus
Short term
AfLer 1 hour
of nurslng
lnLervenLlons
Lhe paLlenL
wlll be able Lo
use ldenLlfled
Lechnlques Lo
enhance
acLlvlLy
Lolerance

Long term
AfLer 1 hour
of nurslng
lnLervenLlons
Lhe paLlenL
wlll be able Lo
reporL
measurable
lncrease ln
acLlvlLy
Lolerance
MonlLor vlLal
slgns noLe skln
pallor and
presence of
confuslon

AsslsL paLlenL
wlLh Lhe
necessary or
deslred acLlvlLles

1each energy
conservaLlon
Lechnlques llke
slLLlng Lo do Lasks
and changlng
poslLlons ofLen









1o obLaln Lhe
basellne daLa




1o prevenL
over exerLlon



1hls reduces
oxygen
consumpLlon
allowlng more
prolonged
acLlvlLy
Changlng
poslLlons ofLen
dlsLrlbuLes
work Lo
dlfferenL
muscles Lo
avold faLlgue


AfLer 1 hour of
nurslng
lnLervenLlons
Lhe goal was
meL 1he
paLlenL was
able Lo use
ldenLlfled
Lechnlques Lo
enhance
acLlvlLy
Lolerance

AfLer 1 hour
days of
nurslng
lnLervenLlon
Lhe goal was
meL 1he
paLlenL has
shown some
lncrease ln
acLlvlLy
Lolerance
use of
envlronmenLal
alds (eg bed
ralls)


Lncourage Lhe
paLlenL Lo do
range of moLlon
exerclses


8eferred Lo
nCu/8Cu
1hls conserves
energy and
prevenLs ln[ury
from fall


8CM helps
keep [olnLs
moblle and
prevenLs
sLlffness

9rovldes
collaboraLlve
work for
paLlenL
wellness





ISCnAkGL LANNING
Med|cat|on
lnform Lhe paLlenL's slgnlflcanL oLhers Lhe lmporLance and Lhe effecLs of Lhe prescrlbed
medlcaLlon and Lhe posslble consequences of noL complylng
Lnsure lf Lhe compllance of Lhe paLlenL wlLh Lhe medlcaLlons

Lnv|ronment

9rovlde a calm and quleL envlronmenL Lo ald ln Lhe recovery of Lhe paLlenL

Lncourage SC Lo check for Lhe cllenL's envlronmenL and Lo make sure Lhe paLlenL geLs enough
resL


1reatment
AfLer Lhe paLlenL was dlscharged he musL conLlnue Lo reLurn and conLlnue comply wlLh hls
follow up checkups and hls medlcaLlon

Lnsure LhaL Lhe paLlenL ls already knowledgeable enough abouL precauLlons wlLh hls dleL
acLlvlLles and llfesLyle

nea|th 1each|ngs

lnsLrucL Lhe paLlenL Lo comply wlLh hls medlcaLlon

Lncourage Lhe paLlenL Lo change hls prevlous llfesLyle

Cut at|ent
lnsLrucL Lhe paLlenL Lo have a followup vlslL afLer Lhe docLor's recommendaLlon
Advlse Lhe paLlenL Lo conLacL hls physlclan regularly

|et

lnsLrucL Lhe paLlenL Lo avold hlgh faL hlgh sodlum dleL e should also avold large quanLlLles of
caffelnaLed and carbonaLed drlnks

Sp|r|tua| and Soc|a|

Lncourage SC Lo help Lhe paLlenL ln ad[usLlng wlLh hls envlronmenL afLer dlscharge

Lncourage paLlenL Lo verballze feellngs/concerns wlLh any SC