FRACTURE PPT

GROUP 12D

CASE PRESENTATION :BONE FRACTURE

Cruz, Janeleine

Baluarte, Annie Rose

Bagtas, John Mikian

Arago, Ghilah Mae

Alura, Christian Genmar Leader

Trias, Sean Marvim

Shih, Hsin-Yu

Salarda Mica Jaycel

Pino, Rachel

Panao, Paelyn Jozel

Enriquez, Angelica

2 days PTC, patient fell from a 6-foot double-deck bed. He used his left arm to break his fall. There was no head trauma, nor loss of consciousness. He seeks consultation at our institution for further evaluation and color.

case study scenario

Introduction

Fracture is a partial or complete breaking in the bone which can be classified into an open or closed fracture there are also a variety of names that can describe a fracture like greenstick, transverse, spiral, oblique, compression, comminuted, segmental, and avulsion. Most often fractures happen when more force or effort is applied to the bone than the bone can handle, bones are also at their weakest when they are twisted. Bone fractures can be caused by a variety of things such as falls, injury, direct hit to any part of the body, and even over exertion, fractures can also be caused by diseases that weakens the bones some examples of this is osteoporosis and bone cancer. Symptoms may vary from person to person but may include pain, trouble using the injured area, swelling, deformity, warmth, bruising, and redness. Fractures are diagnosed with a dull health history including how the injury occurred along with a physical exam and some tests like x-ray, MRI, and a CT scan. Treatments for a fracture includes splint, cast, medicine, traction, and surgery. Most fractures are caused by injuries or accidents but there are some things we can do to reduce the risk of bone fractures which includes but are not limited to eating a healthy diet with vitamin D and calcium as well as doing weight-bearing exercise to keep the bones strong.

Our case study aims to broaden the knowledge and develop our own critical thinking skills as well as other nursing students that can help us advance ourselves as a whole in providing quality nursing care for clients that suffered and is suffering from Bone Fracture or any other injury.

GENERAL OBJECTIVE

• To define Fracture • To identify and understand Fracture risk factors, signs, and symptoms, treatment, and management. • Learn more about complications that may come with the 2 types of fracture • Know the measures we can take to prevent Fractures • Describing the anatomy and physiology of Fractures • Discuss the pathophysiology of Fractures • Studying the importance of laboratory diagnosis and how to properly look at it • To make proper nursing care plans and gather the drug therapy that is related to client's care for Fracture

SPECIFIC OBJECTIVES

• To formulate a discharge plan that is appropriate with the nursing care plan according to the client's needs.• Discuss the pathophysiology of head injury• Studying the importance of laboratory diagnosis and how to properly look at it • To make proper nursing care plans and gather the drug therapy that is related to client’s care for head injury and the procedure of craniotomy • to formulate a discharge plan that is appropriate with the nursing care plan according to the client’s needs.

SPECIFIC OBJECTIVES

ADDRESS: Valenzuela City

Roman Catholic

BIRTHDATE: May 04, 1986

34 years old

PATIENT'S PROFILE

Single

Filipino

Male

Patient E.F

PATIENT'S PROFILE

TIME OF ADMISSION

DATE OF ADMISSION

ADMITTING DIAGNOSIS

CHIEF COMLAINT

12:15 PM

August 09, 2020.

Fracture, Close completed, Radius

Left forearm pain

(+) Hypertension (father side)

• Single • Occasionally drinker • Smoker (a year ago) • Working as a welder

SOCIAL AND PERSONAL HISTORY

FAMILY HISTORY

PRESENT

• 2 days PTC, patient fell from a 6-foot double deck bed, used left arm to break the fall • There was no head trauma nor loss of consciousness • Sought consultation at our institution for further evaluation and management

NURSING HISTORY

Without skeletal system, how an individual can sit, stand, and walk – no rigid framework to support the soft tissue of the body and no joints which makes the body to move Skeletal system contains bones, joints, cartilages, tendons and ligaments which supports and protects the body’s internal organ. Major muscles are attached to bone and help them move. Blood cells are formed in the center of various bones in the soft tissue called marrow. Skeletal system consist of dynamic, living tissues that are able togrow, detect pain stimuli, adapt stress and undergo repair after injury. Skeleton acts as lever that drives force of movement, medulla that contains red bone marrow or filled with yellow bone marrow with adipose tissue.

ANATOMY AND PHYSIOLOGY

Read more

Bone become displaced in response to both causative forces and spasm in associated muscles.

Fracture occurs in muscle that were attached to bone are disrupted and cause spasm

Crushing movement

PATHOPHYSIOLOGY

PHYSICAL ASSESSMENT

PHYSICAL ASSESSMENT

PHYSICAL ASSESSMENT

LABORATORY RESULTS

FRACTURE LAB RESULTS AND INTERPRETATION

GORDON'S FUNCTIONAL HEALTH PATTERN

GORDON'S FUNCTIONAL HEALTH PATTERN

COURSE IN THE WARD

DOCTOR'S ORDER

 Start PNSS 1L x KVO.  Ordered CBC with PC, Na, K, CL, BT, RH and X-ray of left forearm APL view  Ordered Tramadol 50 mg 1 amp BID PRN for pain  Schedul patient for OR for tomorrow (August 10, 2020)

DATE AND TIME

August 9, 2020 12:15 PM Day of Admission

 Admitted the patient with a chief complaint of left forearm pain.  Patient placed in DAI.  Hooked up PNSS 1L x KVO.  Prepared and explained to the patient the needed tests.  Administered Tramadol 50 mg 1 amp BID PRN for pain.  Maintained patient on splint.  Prepared 1 unit pack of RBC proper type and cross matched for OR use.  V/S were taken: BP 120/80, RR 18, PR 90, Temp 36.8 C

NURSING ACTION

COURSE IN THE WARD

DATE AND TIME

August 9, 2020 12:15 PM Day of Admission

COURSE IN THE WARD

DOCTOR'S ORDER

 Advise the patient for a surgical procedure ORIF plating radius left.  Ordered IVF PNSS 1L x 8 hours with side drip of D5W 500mL + 300 mg of Tramadol to run for 24 hours.  Ordered Cefuroxime 1.5 g TIV q 8 hours ANSTI  Ordered Omeprazole 40mg IV OD  Repeat post-op X-Ray left forearm, elbow, wrist AP lat view  Ordered Ketorolac 30mg TIV  Ordered patient to go home.  Ordered Cefuroxime 500 mg tab 3x a day for 7 days.

DATE AND TIME

August 10, 2020 Post-operative

 Consent was secured with post-op order.  Hooked up IVF PNSS 1L x 8 hours with side drip of D5W 500mL + 300 mg of Tramadol to run for 24 hours.  Administered Cefuroxime 1.5 g TIV q 8 hours ANSTI.  Administered Omeprazole 40mg IV OD.  Prepared the patient for X-ray.  V/S were taken: BP 130/90, RR 25, PR 97, Temp 36.8, patient complained of pain, scale of 7/10 showed facial grimace of disgust and restless.  Assisted the staff nurse in giving Ketorolac 30mg TIV  Encouraged patient to perform deep breathing exercise and relaxation technique (listening to music).  Prepared for discharge planning. Advised the patient regarding the medication.

NURSING ACTION

COURSE IN THE WARD

DATE AND TIME

August 10, 2020 Post-operative

DRUG STUDY

TRAMADOL, CEFUROXIME, OMEPRAZOLE, KETOROLAC.

TRAMADOL

SIDE EFFECTS Common tramadol side effects may include: • constipation, nausea, vomiting, stomach pain; • dizziness, drowsiness, tiredness; • headache; or • Itching.

INDICATIONTramadol is approved for the management of moderate to severe pain in adults.

MECHANISM OF ACTION Tramadol modulates the descending pain pathways within the central nervous system through the binding of parent and M1 metabolite to μ-opioid receptors and the weak inhibition of the reuptake of norepinephrine and serotonin.

GENERIC NAME: Tramadol BRAND NAME: Ultram CLASSIFICATION: Narcotic Analgesics DOSAGE/ROUTE/ FREQUENCY: 50mg 1 amp BID PRN

TRAMADOL

NURSING CONSIDERATIONS • Watch for new seizures or increased seizure activity, especially at the onset of drug treatment. Document the number, duration, and severity of seizures, and report these findings immediately to the physician or nursing staff.• Be alert for excessive sedation or somnolence. Notify physician or nurse immediately if patient is unconscious or extremely difficult to arouse. • Monitor other changes in mood and behavior, including euphoria, confusion, malaise, nervousness, and anxiety. Notify physician if these changes become problematic. • Use appropriate pain scales (visual analogue scales, others) to document whether this drug is successful in helping manage the patient's pain. • Assess any incoordination or increased muscle tone. Report any coordination problems or hypertonia that might impair function or increase the risk of falls. • Assess dizziness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician and nursing staff, and caution the patient and family/caregivers to guard against falls and trauma.

CONTRAINDICATIONS Hypersensitivity to tramadol or opioids. Known or suspected gastrointestinal obstruction, including paralytic ileus.

CEFUROXIME

SIDE EFFECTS Nausea, vomiting, diarrhea, strange taste in the mouth, or stomach pain may occur.

INDICATIONCefuroxime is used to treat a wide variety of bacterial infections. It may also be used to prevent infection from certain surgeries.

MECHANISM OF ACTION Cefuroxime is a bactericidal agent that acts by inhibition of bacterial cell wall synthesis. Cefuroxime has activity in the presence of some beta-lactamases, both penicillinases and cephalosporinases, of Gram-negative and Gram-positive bacteria.

GENERIC NAME: Cefuroxime BRAND NAME: Ceftin CLASSIFICATION: Cephalosporin antibiotics DOSAGE/ROUTE/ FREQUENCY: 1.5 g TIV Q 8 hrs ANSTI

CEFUROXIME

NURSING CONSIDERATIONS Culture infection, and arrange for sensitivity tests before and during therapy if expected response is not seen. Give oral drug with food to decrease GI upset and enhance absorption. Have vitamin K available in case hypoprothrombinemia occurs. Discontinue if hypersensitivity reaction occurs.

CONTRAINDICATIONS Cefuroxime is contraindicated in patients with cephalosporin hypersensitivity or cephamycin hypersensitivity. Cefuroxime should be used cautiously in patients with hypersensitivity to penicillin.

OMEPRAZOLE

NURSING CONSIDERATIONS • Advise patient to avoid alcohol and foods that may cause an increase in GI irritation. • Instruct patient to report bothersome or prolonged side effects, including skin problems (itching, rash) or GI effects (nausea, diarrhea, vomiting, constipation, heartburn, flatulence, abdominal pain).

CONTRAINDICATIONS Omeprazole is contraindicated in patients with a history of hypersensitivity to the drug or any excipients from the dosage form.

TORADOL

SIDE EFFECTS Common side effects may include: nausea, stomach pain, indigestion, diarrhea; dizziness, drowsiness; headache; or. swelling.

INDICATIONndicated for the short-term ( ≤ 5 days) management of moderately severe acute pain that requires analgesia at the opioid level, usually in a postoperative setting.

MECHANISM OF ACTION Toradol (ketorolac tromethamine) is a nonsteroidal anti-inflammatory drug (NSAID) that is used to treat moderately severe pain and inflammation, usually after surgery. Toradol works by blocking the production of prostaglandins, compounds that cause pain, fever, and inflammation.

GENERIC NAME: Ketorolac BRAND NAME: Toradol CLASSIFICATION: NSAIDs DOSAGE/ROUTE/ FREQUENCY: 30mg TIV

TORADOL

NURSING CONSIDERATIONS Don’t forget to assess first the patient before administering this drug: know the history (e.g. allergies, renal impairment, etc.) and physical condition of the patient (reflexes, ophthalmologic and audiometric evaluation, orientation, clotting times, serum electrolytes, etc.) In case of hypersensitivity, be sure that emergency equipment is available. Drug vials should be protected from light. To maintain serum levels and control pain effectively, administer it every six hours. Report any signs of itching, swelling in the ankles, sore throat, easy bruising, etc.

CONTRAINDICATIONS Contraindicated in individuals who have adverse reactions or are allergic to NSAIDs. It is not recommended to be given intraoperatively or preoperatively due to the increased risk for bleeding. In patients with renal disease or renal failure, ketorolac is contraindicated because it may increase fluid retention and worsen renal function. GI-related contraindications for ketorolac include patients with active peptic ulcer disease, recent GI bleed, or GI perforations.

ACUTE PAIN

NCP 1

IMPAIRED PHYSICAL MOBILITY

NCP 2

RISK FOR INFECTION

NCP 3

MEDICATION

DISCHARGE PLAN

Encouraged the patient to finish the meds or she has been prescribed. Emphasize the patient's importance and purpose. To ensure compliance, advise the patient to keep a written timetable or set a reminder on the calendar. The doctor has prescribed the following medication: Cefuroxime 500 mg tab 3x a day for 7 days

EXERCISE

DISCHARGE PLAN

Encourage the patient to do these stretch once or twice a day as tolerated.

• Perform triceps stretch
• Biceps stretch wrist flexors stretch, wrist extensors stretch pronation/supination stretches for the wrist.

TREATMENT

DISCHARGE PLAN

• Encouraged the patient to keep his arm raised to reduce pain and swelling.
• Advised the patient to apply an ice pack over the injured area for 15 to 20 minutes every 3 to 6 hours.
• Rest the arm as much as possible.
• Advised the patient that do not get the splint wet
• Check the skin around your splint each day for any redness or open skin.
• Elevate extremity. The affected extremity is elevated to minimize edema.

HEALTH TEACHING

DISCHARGE PLAN

• Instructed the patient regarding proper methods to control edema and pain.
• Encouraged the patient to engage exercises to maintain the health of the unaffected muscles and to increase the strength of muscles needed for transferring and for using assistive devices.
• Plans are made to help the patients modify the home environment to promote safety.
• Educated the patient about stress management and how to cope up with changes in his routine activity.

OUT-PATIENT

DISCHARGE PLAN

• Follow up with your healthcare provider, or as advised. If a splint was applied.
• Advised the patient If any of the following occur, contact your healthcare professional immediately: swelling of your forearm or fingers

• Increased tightness, looseness, or pain occurs under the splint
• The splint becomes wet or soft
• Discussed to the patient the importance of follow up check-ups.

DIET

DISCHARGE PLAN

• Encouraged to take in and use calcium.
• Meat, fish, milk, cheese, cottage cheese, yogurt, nuts, seeds, beans, soy products, and fortified cereals.
• What to avoid:
• Alcohol, salt, and lots of caffeine.

SPIRITUAL

DISCHARGE PLAN

• Pray for fast healing and recovery.
• Talked to the family to provide emotional support
• Encouraged the patient to communicate of his spiritual feelings.

THANK YOU