Fractured Femur-case Pres

21 

Loading.... (view fulltext now)

Loading....

Loading....

Loading....

Loading....

Full text

(1)

UNIVERSAL COLLEGE OF NURSING

8273 Dr. A. Santos Avenue, Parañaque City Telefax 8298615/8204276

Open Type III-S Complete Comminuted Fracture D3-L Femur

A Case Study

Submitted to:

Helen Ferriols. MAN

Clinical Instructor

East Avenue Medical Center

In Partial fulfillment of the Requirements

in the Related Learning Experience

Baquilar, Lorielyn D.

Caloza, Anivill B.

Cantor, Christopher C.

De Vega, Joyce M.

Echevarria, Adora S.

Lovedioro, Vergel C.

Lozada, Rose Ann Shayne F.

Madredeo, Ronalyn B.

Natividad, Brian C.

Pring, Bernardino L.

Salvador, Charles V.

Group C

BSN III

(2)

We choose this case because it requires a broader scope of research which will benefit us

We chose this case to learn orthopedic in advance

To have a study to share to our fellow student

Background Knowledge

A Fracture is a break in the continuity of bone and is defined according to its type and

extent. Fractures occur when the bone is subjected to stress greater than it can absorb. Fractures

are cause by direct blows, crushing forces, sudden twisting motions, extreme muscle

contractions. When the bone is broken, adjacent structures are also affected, resulting in soft

tissue edema, hemorrhage into muscles and joints, joint dislocations, ruptured tendons, severed

nerves, and damaged blood vessels. Body organs maybe injured by the force that cause the

fracture or by fracture fragments.

TYPES OF FRACTURE

Greenstick fracture: an incomplete fracture in which the bone is bent. This type occurs

most often in children.

Transverse

fracture: a fracture at a right

angle to the bone's axis.

Oblique fracture: a fracture in which the break has a curved or sloped pattern.

Comminuted

fracture: a fracture in which

(3)

An impacted fracture is one whose ends are driven into each other. This is commonly

seen in arm fractures in children and is sometimes known as a buckle fracture. Other

types of fracture are pathologic fracture, caused by a disease that weakens the bones, and

stress fracture, a hairline crack

A depressed fracture results from a force that drives a piece of bone down. This

fracture may effect the outer table of the skull, the inner table, or both if the force is

strong and localized. This is a depressed fracture on the left parietal part of a skull.

An avulsion fracture is a bone fracture which occurs when a fragment of bone tears

away from the main mass of bone as a result of physical trauma

An uncomplicated

closed fracture/simple

fracture in

which the fractured ends of

(4)

A spiral fracture (also called a torsion fracture) is a bone fracture in which the bone has

been twisted apart

A compression

fracture occurs when the

normal vertebral body of the spine is squished, or compressed, to a smaller height

Compound

fracture: A fracture in

which the bone is sticking through the skin. Also called an open fracture.

(5)
(6)
(7)

Patients Profile

Name:

MC

Age:

57 years old

Date of Birth:

July 7, 1952

Status:

Widowed

Nationality:

Filipino

Religion:

Roman Catholic

Home Address:

Batasan Hills Quezon City

Date of Admission: December 24, 2009

Time of Admission: 8:15 am

Admitting Diagnosis: Fx Open III-S Complete Comminuted D3-L Femur

Past Medical History

Highblood

Asthma

Breast Mass at Lateral aspect of the left Breast

(8)

Date Performed:

January 18, 2010

Time:

9:00 am

Name:

MC

Age:

57 years old

Primary Language: Tagalog

Height:

5’3’’

Weight:

54 kg

Vital Signs:

BP- 110/80 mmHG

Temp- 36.9 C

PR- 82 BPM

RR- 22

Assessment:

Hair Color

- Black and White

Body Build

- Proportionate

Overall hygiene and grooming

- Clean and neat

Note Body and Breath Odor

- No Body odor; No Breath odor

Signs of distress in posture or facial Expression

- no distress noted

Note obvious signs of Health/ Illness

- Weak and with fractured at left Leg

Client’s Attitude

- Cooperative and able to follow instructions

Client’s affect/mood; appropriateness of the responses

- Appropriate to situation

Quantity of Speech, Quality and Organization

- understable, clear tone; exhibits thought association

Relevance and organization of thoughts

- makes sense; has sense of reality

Physical Assessment

(9)

ASSESSED FINDINGS I. Gross general appearance 1.1 Height 1.2 Weight 1.3 Body Build 1.4 Posture/ Gait 1.5 Skin Color 1.6 Personal Hygiene/ Grooming 1.7 Body Breath Odor 1.8 Nutritional Status 1.9 Age appropriateness 1.10 Sensory status

fair skin color neat and clean

No Body and Breath Odor BMI: 21.1 Her face is Appropriate to her age Well developed 1.6 m 54 kg normal posture fair skin color

no foul smelling odor BMI: 18.5-24.9 Appropriate to Age Well developed Normal Normal Ectomorphic Normal Normal Normal Normal Normal Normal Normal 2. Physiologi cal Cues 2.1 Temperature 2.2 Pulse 2.3 Respiration 2.4 Blood Pressure 36.9 C 82 bpm 22 cpm 110/80 mmHG 36.5-37.5 C 60-100 bpm 16-22 cpm 120/80 mmhg Normal Normal Normal Normal

(10)

3. Behavior 3.1 Verbal (Speech-quality; quantity; coherence; relevance; pattern; organization of thought) -good speech quality -understable, clear tone; exhibits thought association - good speech quality -organized the thought Normal 3.2 Non-verbal Body language Gesture Movement Facial expression Attitude Affect/ mood Appropriateness of response -can response to a body language -can do facial expression -can response to a body language -can do facial expression -Normal HEAD TO TOE PHYSICAL EXAMINATION TECHNIQUE NORMAL / STANDARD ACTUAL FINDINGS ANALYSIS Head

1. Skull Size, shape, Palpation contour, any lumps, deformities -rounded -smooth skull contour -absence of nodules or masses -symmetrical in shape -smooth skull contour -absence of nodules or masses Normal

2. Scalp / hair Inspection Appearance, hair color, distribution,

texture, presence of lice, nits and

dandruff

-hair evenly distributed -hair black in color

-silky hair -no presence of nits

and lice -no presence of tenderness -even distribution of hair -black and white hair color -silky -no presence of nits and lice -not tender Normal 3. Face Inspection

(11)

shape, expression, Appearance and movements slightly asymmetric facial features -symmetric facial movements facial movements

4. Eyes/Vision Eye Structures

a. Eyeball - note Any protrusion b. Lid margins Observe scaling Secretions, position, Symmetry, ability to blink and frequency c. Conjunctiva note color, appearance d. Sclera – note Color, appearance e. Pupils – size, Shape, symmetry, Reaction to light, and accommodation f. Eyebrows/lashes Color, symmetry, quantity of hair, placement g. Eye movement in all directions -no protrusion -lids close symmetrically -no secretion -symmetrical -15-20 blinks/min -transparent; shiny, smooth, and pink or

red -sclera appears

white in color -pupil equally round

reactive to light accommodation

(PERRLA)

-evenly distributed hair

-black and white in color -symmetrically aligned -curled slightly outward -both eyes coordinated (cardinal movement/s) -no protrusion -symmet rical closeness of lids -no secretion -symmetrical -can blinks 16/min -pinkish in color -shiny -white in color -pupil equally round -even distribution of hair -black and white -aligned symmetrical -coordinates by movement Normal Normal Normal Normal Normal Normal Normal

(12)

5. Ears/hearing a. Pinna Inspection Parallelism, size, shape, appearance, placement. Palpation Palpate for firmness of the cartilage and for

tenderness. b. External canal Inspection Check color, appearance, and any discharge. e. Hearing acuity Whisper from clients ear at a distance of 2 feet

away from the clients back

-symmetrical; aligned with outer

canthus of eye, about 10 from

verical -mobile, firm, and

not tender; pinna recoils after it is

folded -grayish tan color

-presence of wet cerumen in various

shades of brown -no discharge

-able to hear ticking in both ears -normal voice tone

(audible) -symmetrical -firm -not tender - grayish an in color -wet cerumen -able to hear on both ears Normal Normal Normal Normal 6. Nose Inspection Placement, discharges and Patency -symmetric and straight -no discharge -air moves freely as

the client breaths through the nares

-midline alignment -no discharge -air moves freely Normal

7. Mouth / lips Inspection Color, shape, moisture and symmetry, appearance Gums Color, appearance Teeth

-uniform pink color -soft, moist, smooth

texture -symmetry of

contour -ability to purse lips

-pink gums -moist, firm texture

to gums -no retraction of gums -smooth, white, -pinkish in color -soft, moist, smooth -ability to purse lips -pinkish in color -firm and moist Normal Normal

(13)

Color, arrangement, general condition,

breath

Tongue

Size, color, shape, symmetry, moisture, movement Palate – Hard / soft Color, texture, shape Soft Palate – (w/ penlight) pink, smooth uvula

in midline

Oropharynx / tonsil

Color, texture, elicit gag reflex

present shinny tooth enamel, -pink color -moves freely -moist; slightly rough -symmetrically aligned -lighter pink hard

palate -light pink,

smooth-soft palate -more irregular texture -symmetrical in shape -pink in color -uvula positioned in midline of soft palate -pink and smooth

posterior wall -gag reflex present

-No more Tooth -pinkish -symmetrical -moist -pinkish in color -smooth -symmetry of the shape -pinkish -uvula present in midline -pinkish -smooth -presence of gag reflex Normal Normal Normal Normal 8. Cheeks Inspection

Color, appearance -pink in color -Fair color Normal

9. Neck (Inspection) Symmetry, position, movement (chin to chest, ear to shoulder) (Palpation)

Palpate for lumps,

-symmetrical (muscles equal in size) -coordinated, smooth movements with no discomfort -complete range of motion

-lymph nodes not palpable

-head centered

Normal

(14)

nodes, tenderness -not palpable 10. Chest Anterior Posterior (Inspection) Note symmetry, color, deformities, breathing pattern (Palpation) Any lumps, masses Inspection Symmetry, retractions, deformities

Palpate for vocal

(tactile) fremitus

Auscultate

Breath sounds

-skin intact -quiet, rhythmic and

effortless respirations

-no masses

-chest wall intact -spinal column is

straight -right and left shoulders and hips

are at the same height -bilateral symmetry of vocal fremitus -vasicular and bronchovesicular breath sounds -rhythmic respirations Normal 11. Heart Inspection Check for lifts, heaves, pulsation Palpation 2nd ICS (right) Aortic valve 2nd ICS (left) pulmonic valve 5th ICS (left sternal

border) tricuspid mid-clavicular – below the nipple)

apical

Auscultation

Check cardiac rate at apical area

Inspect

Jugular Veins for distention

-complete pulsation of the heart, normal

heart sound

-normal heart rate -usually heard at all

sites -no distention -veins not visible

Normal

Normal

Normal 12. Breast Inspection

(15)

Size, Shape, symmetry, color, any dimpling, discharges in the nipples Palpation

Note any mumps, masses, tenderness, (clockwise borders

inward)

-skin uniform in color; skin smooth and intact; no nipple

discharge -no tenderness, masses/nodules -Presence of Breast Mass(7x5 cm) at Lateral Aspect of the Left Breast Normal Abnormal 13. Abdomen Inspection Color, contour, symmetry, skin integrity, scars Auscultate for bowel sounds, vascular sounds, peritoneal friction rub Palpation Palpate 4 quadrants, note areas of tenderness, lumps, masses, distention in circular motion using finger pads.

Percussion

Percuss 4 quadrants from LQD clockwise, note any tympany

or dullness -unblemished skin; uniform in color; symmetric contour -audible bowel sound -absence of arterial bruits -absence of friction rub -no tenderness; relax abdomen with

smooth, consistent tension

-tympany over the stomach and gas

filled bowels, dullness especially

over the liver and spleen, or a full bladder Normal Normal Normal Normal 14. Upper

Extremities Symmetry, size, Inspection length, deformities, skin

-equal in size, both

(16)

lesions, scars, ROM movement Hands Size, number of fingers, color of nail, capillary refill, hygiene movement -range of motion varies -5 fingers in 1 hand -pinkish color, able

to return after the capillary refill -able to return capillary refill within 2-3 seconds -5 fingers in 1 hand Normal 15. Lower

Extremities InspectionSymmetry, size, length, deformities, hair distribution, scars, lesions, movement (flexion, extension, rotation) Feet Inspection Color, symmetry, deformities, number of toes, scars, lesions, hygiene. Movement (flexion, extension, rotation) -no deformities, no skin lesion and

scars

-fair skin color -no scars/lesions -can extend, flex

and rotate -skin intact -presence of Gun shot wound at Left femur -fair skin color -presence of gun shot wound at Left femur -can’t extend and flex Left

Leg

Abnormal

(17)

Course in the ward

Doctor’s Order

Nursing Responsibilities

1) Maintain Tractions

Inspect Integrity of Tractions

Inspect for Infections

Daily wound Dressing

Educate Patient for proper

immobilization

1) Safety

Ensure Client’s Safety

Side rail’s Up for safety

Put Client’s belongings within reach

Educate significant others about safety

precautions

(18)

1) Refer for OR schedule

Assess patient’s financial status

Refer for Social service( PCSO, Phil

Health)

Educate patient regarding operation

Anatomy and Physiology

Skeletal System

The skeleton has six main functions

Support- It provides the framework which supports the body and maintain its shape.

Movement- The bones are the levers that help the body move in different directions and in

different ways.

Protection

The skeleton protects many vital organs

Cranium protects the brain.

Ribs/Sternum protects the lungs, heart and some digestive organs.

Pelvis protects and supports the digestive and reproductive organs.

Spinal column protects the spine.

.

Blood cell production

Inside of the long bones in our bodies, there is a cavity that is filled with a substance called Bone Marrow. In this tissue, new blood cells are produced, and damaged blood cells are repaired. Red bone marrow produces red blood cells, white blood cells and other blood elements.

The skeleton is the site of hematopoiesis, which takes place in red bone marrow. Marrow is

found in the center of long bones.

Storage

Mineral is a substance that the body needs to carry out all of our bodily functions like thinking, breathing and moving around. One of the minerals that the body needs is calcium. Calcium is a major part of bone, and this is where the body stores its calcium.

Endocrine regulation

Bone cells release a hormone called osteocalcin, which contributes to the regulation of blood

sugar (glucose) and fat deposition. Osteocalcin increases both the insulin secretion and

sensitivity, in addition to boosting the number of insulin-producing cells and reducing stores of

fat.

(19)
(20)

Fractured femur with plate and screws

(21)

Hematology

Dec. 24

Jan. 4

Normal

Units

WBC

22.1

15.9

5-10 Adults

9-20 New born

X10

9

/L

Hemoglobin

119

95

140-170 M

120-140 F

gm/L

Hematocrit

0.367

0.28

0.45-0.50 M

0.38-0.48 F

%

Neutrophils

0.86

0.46

0.31-0.76 Adult

0.40-0.50

Newborn

%

Lymphocytes

0.11

0.30

0.24-0.44 Adult

0.31-0.60 New

born

%

Monocytes

0.02

0.02

0.00-0.06 Adult

%

Eosinophils

-

0.20

0.02-0.04

%

Basophils

-

0.02

0.00-0.01

%

Bands

0.01

-

0.02-0.04

%

Platelet

Adequate

182

150-450

X10

9

/L

MCV

90.8

86.2

80-100

Fl

MCH

29.5

29.4

27-31

Pg

MCHC

325

341

320-360

g/L

RDW

13.2

12.8

11.0-14.6

%

Serology

Results

Findings

Units

Glucose

4.8

3.9

mmol/L

N Cholesterol

4.4

0.0-5.2

mmol/L

LDL Cholesterol

3.3

2.6-4.1

mmol/L

Triglycerides

0.94

0.4-1.7

mmol/L

HDL-Cholesterol

0.64

0.91-1.56

mmol/L

Blood Urea Nitrogen

4.9

2.5-6.1

mmol/L

Creatinine

78

53-115

umol/L

Sodium

138

135-148

mmol/L

Figure

Updating...

References

Updating...

Related subjects :