Nursing Case Study (FRACTURE)

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Nursing Case Study (FRACTURE)

A nursing case study about fracture. It's accurate and can be used as reference to any nursing students out there.

This is a very Helpful topic, which can help you with your school requirements. It Can always be hard searching on the net for the right information.

SO, I am providing you an accurate Case study about fracture.

Fracture

Fracture is a medical condition in which there is a break in the continuity of the bone. A bone fracture can be the result of high force impact or stress, or trivial injury as a result of certain medical conditions that weaken the bones, such as osteoporosis, bone cancer, or osteogenesis imperfecta, where the fracture is then properly termed a pathological fracture.

Closed (simple) fractures are those in which the skin is intact, while open

(compound) fractures involve wounds that communicate with the fracture, or where fracture hematoma is exposed, and may thus expose bone to contamination. Open injuries carry a higher risk of infection.

Comminuted fracture: A fracture in which the bone has broken into a number of pieces.Other considerations in fracture care are displacement (fracture gap) and angulation. If angulation or displacement is large, reduction (manipulation) of the bone may be required and, in adults, frequently requires surgical care. These injuries may take longer to heal than injuries without displacement or angulation.

Although bone tissue itself contains no nociceptors, bone fracture is very painful for several reasons. Breaking in the continuity of the periosteum, with or without similar discontinuity in endosteum, as both contain multiple nociceptors. Edema of nearby soft tissues caused by bleeding of torn periosteal blood vessels evokes pressure pain. Muscle spasms trying to hold bone fragments in place

Orthopedic surgeons treat fractures throughout the skeletal frame, except for the skull (neurosurgeon) and face (ENT, or ear, nose, and throat, surgeon). Extremity fractures are most common, and usually occur in men younger than age 45, and then become more common in women over age 45. The reason for the difference is when women go through menopause, and stop producing estrogen, the rate of bone loss increases. Incidence rate of fractures in the Philippines is 475, 597 over

86,241,697 million estimated population, according to US Census Bureau, International Data Base, 2004.

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Anatomy And Physiology

The Skeletal System serves many important functions; it provides the shape and form for our bodies in addition to supporting, protecting, allowing bodily movement, producing blood for the body, and storing minerals. Its 206 bones form a rigid framework to which the softer tissues and organs of the body are attached. Blood cells are produced by the marrow located in some bones. An average of 2.6 million red blood cells are produced each second by the bone marrow to replace those worn out and destroyed by the liver. Bones serve as a storage area for minerals such as calcium and phosphorus. When an excess is present in the blood, buildup will occur within the bones. When the supply of these minerals within the blood is low, it will be withdrawn from the bones to replenish the supply. The skeletal system is divided into 2. The axial and the appendicular skeleton.

The bones of the body fall into four general categories: long bones, short bones, flat bones, and irregular bones. Long bones are longer than they are wide and work as levers. The bones of the upper and lower extremities (ex. humerus, tibia, femur, ulna, metacarpals, etc.) are of this type. Short bones are short, cube-shaped, and found in the wrists and ankles. Flat bones have broad surfaces for protection of organs and attachment of muscles (ex. ribs, cranial bones, bones of shoulder girdle). Irregular bones are all others that do not fall into the previous categories. They have varied shapes, sizes, and surfaces features and include the bones of the vertebrae and a few in the skull. Bones are composed of tissue that may take one of two forms. Compact, or dense bone, and spongy, or cancellous, bone. Most bones contain both types. Compact bone is dense, hard, and forms the protective exterior portion of all bones. Spongy bone is inside the compact bone and is very porous (full of tiny holes). Spongy bone occurs in most bones.

The bone tissue is composed of several types of bone cells embedded in a web of inorganic salts (mostly calcium and phosphorus) to give the bone strength, and collagenous fibers and ground substance to give the bone flexibility. the femur is the longest and largest bone. The average adult male femur is 48 centimeters (18.9 in) in length and 2.84 cm (1.12in) in diameter at the midshaft, and can support up to 30 times the weight of an adult. It forms part of the hip joint (at theacetabulum) and part of the knee joint, which is located above. There are four eminences, or protuberances, in the human femur: the head, the greater trochanter, the lesser trochanter, and the lower extremity.

They appear at various times from just before birth to about age 14. Initially, they are joined to the main body of the femur with cartilage, which gradually becomes ossified until the protuberances become an integral part of the femur bone, usually in early adulthood. The shaft of femur is cylindrical with a rough line on its posterior surface (linea aspera).The intercondylar fossa is present between the condyles at the distal end of the femur. In addition to the intercondylar eminence on the tibial plateau, there is both an anterior and posterior intercondylar fossa (area), the sites of anterior cruciate and posterior cruciate ligament attachment, respectively.

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Pathophysiology

PLAYING OF SPORT CAUSES STRESS ON THE FEMUR--->TWISTED LEG OF THE PATIENT

(POSSIBLE PHYSICAL CONTACT AND LEANED TO MUCH WEIGHT ON THE TWISTED LEG)

--->FRACTURE

(Fracture Close Middle/ 3rd, Comminuted Left Femur)---> SKELETAL TRACTION (12lbs)

---> (OPEN REDUCTION INTERNAL FIXATION)

Drug study

Name of Drug : GN: CELECOXIB BN: CELEBRIX

Classification and Mechanism of Action: -NSAID'S

(Non-steroidal anti inflammatory drugs)

-Exhbits anti-inflammatory, analgesics, ant antipyretic action due to inhibition of COX-2 Enzyne

Indications and Usage: -Osteoarthritis

Adults: 100 mg P.O. b.i.d -Rheumatoid arthritis

Adults: 100mg to 200 mg b.i.d - Acute pain and Dysmenorrhea Adults: 400 mg P.O

Once daily

Contraindication:

%u2022 Hypersensitivity to drug Side Effects:

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CNS: dizziness, drowsiness, headache, insomnia. Fatigue CV: angina, tachycardia, peripheral edema

EENT: tinnitus, epistaxis, sinuisitis

GI: nausea, vomiting, diarrhea, constipation, abdominal pain dyspepsia, dry mouth Hepatic: Hepatoxicity

Hematologic: ecchymosis, neutropenia Musculoskeletal: back pain, leg cramps Respiratory: upper respiratory tract infection SKIN: rash

Nursing Responsibilities:

-Advise patient to immediately report bloody stools, vomiting of blood. -Instruct patient to take drug with food or milk

-Advise the S.O to accompany the patient in going to the comfort room Name of Drug:

GN: MEFENAMIC ACID BN: DOLFENAL

Classification and Mechanism of ACtion: - NSAID'S

(Non-steroidal anti inflammatory drugs) - Inhibit cyclooxygenase

an enzyme needed for prostaglandin synthesis this inhibition stimulates the anti-inflammatory response and blocks pain impulses

Indication and Usage: - Acute pain

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Contraindication:

%u2022 Hypersensitivity to drug Side Effects:

CNS: dizziness, drowsiness, headache, insomnia. Fatigue CV: angina, tachycardia, peripheral edema

EENT: tinnitus, epistaxis, sinuisitis

GI: nausea, vomiting, diarrhea, constipation, abdominal pain dyspepsia, dry mouth Hepatic: Hepatoxicity

Hematologic: ecchymosis, neutropenia Musculoskeletal: back pain, joint pain Metabolic: dehydration

SKIN: rash, diaphoresis Nursing Responsibilities:

-Assess patient's pain before giving the medication -Instruct patient to take

drug with food or milk

-Advise the S.O to accompany the patient in going to the comfort room -Advise patient to report immediately persistence or failure to relieve pain.

Nursing Care Plan

Scientific Analysis

Fractures occur when bone cannot withstand those outside forces. Fracture, break, or crack all mean the same thing. One term is not better or worse than another. The integrity of the bone has been lost and the bone structure fails. The nerve endings that surround bones contain pain fibers and and these fibers become irritated when the bone is broken or bruised. Broken bones bleed, and the blood and associated swelling (edema) causes pain.

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Referrence:

Penn State Milton S. Hershly Medical Center, (2006). Bone Fracture, retrieved by http://www.hmc.psu.edu/healthinfo/b/bonefracture.htm

Objectives

After an hour of nurse -patient interaction the client will be able to: a.) Verbalize understanding of individual causative/ risk factor(s). b.) Identify interventions to prevent/ reduce risk of infection.

c.) Demonstrate techniques, lifestyle changes to promote safe environment. d.) Achieve timely wound healing; be free of purulent drainage or erythema; be afebrile.

Nursing Interventions:

- Inspect the skin for preexisting irritation or breaks in continuity. - Assess muscle tone, reflexes, and ability to speak.

-Observe wounds for formation of bronze discoloration of skin frothy/fruity smelling drainage.

-Provide sterile pin/wound care according to protocol and exercise meticulous hand washing

- Instruct patient not to touch the insertion sites. -Monitor vital signs.

- Monitor patients visitor's/ caregivers for respiratory illnesses

- Recommend routine or preoperative body showers/ scrubs, when indicated. - Administer medication as indicated:

Tetanus toxoid

- Provide wound/bone irrigation and apply warm soak as indicated. - Maintain adequate hydration.

- Provide information/ involve in appropriate community and national education programs.

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Health Teaching Plan

GOALS/OBJECTIVES

Following a 30 minute nurse-client interation, the patient will be able to: a. Define the causative factors of the current condition of the patient b. Demonstrate proper exercises of the unaffected lower extremity c. Display positive attitude while health teachings are provided CONTENTS

COMMINUTED FRACTURE

-A fracture in which bone is broken, splintered or crushed into a number of pieces. A fracture is considered comminuted when there are atleast 3 bone fragments.

REHABILITATION EXERCISES

-to improve the strength of the leg and gradually increase pain-free range of motion. Exercise will keep your joints from becoming stiffer, and it strengthens the muscles surrounding the joints. Strong muscles provide needed support, making movement easier and reducing pain.

%u2022 Rehabilitation after surgery

Keep in mind that if your femoral fracture requires surgery the soft tissue needs time to heal before exercise can begin.

A physical therapy program usually begins with range-of-motion and resistive

exercises, then incorporates power, aerobic and muscular endurance, flexibility, and coordination drills.

a.) Unloading the knee

Put a light weight (5 to 10 pounds) on your ankle and sit in a position that allows the leg to dangle (on a bench, tall stool, edge of bed). Hold for 5 to 15 minutes, 1 to 3 times a day.

b.) Knee extension

Sit in a chair and rest your foot on another chair across from you so that the knee is slightly raised. Gently push the raised knee toward the floor using only leg muscles. Hold the stretch for 5 to 10 seconds, then rest a minute. Repeat 10 times. Do every day up to 3 times a day.

TEACHING STRATEGIES:

Lecture Method - to verbally transmit information directly to the learner, for the purpose of instruction . Lecture Method provides a background information as basis for presentation on the particular topic.