I.

INTRODUCTION

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 that it can absorb. Fractures are caused by direct blows, crushing forces, sudden twisting motions, and even extreme muscle contractions. When the bone is broken, adjacent structures are also affected, resulting in soft tissue edema, hemorrhage into the muscles and joints, joint dislocation, ruptured tendons, severed nerves, and damaged blood vessels. Body organs maybe injured by the force that cause the fracture or by the fracture fragments. There are different types of fractures and these include, complete fracture, incomplete fracture, closed fracture, open fracture and there are also types of fractures that may also be described according to the anatomic placement of fragments, particularly if they are displaced or nondisplaced. Such as greenstick fracture, depressed fracture, oblique fracture, avulsion, spinal fracture, impacted fracture, transverse fracture and compression fracture. A comminuted fracture is one that produces several bone fragments and a closed fracture or simple fracture is one that not cause a break in the skin. Comminuted fracture at the Right Femoral Neck is a fracture in which bones of the Right Femoral Neck has splintered to several fragments. By choosing this condition as a case study, the student nurse expects to broaden her knowledge understanding and management of fracture, not just for the fulfillment of the course requirements in medical-surgical nursing. It is very important for the nurses now a day to be adequately informed regarding the knowledge and skill in managing these conditions since hip fracture has a high incidence among elderly people, who have brittle bones from osteoporosis (particularly women) and who tend to fall frequently. Often, a fractured hip is a catastrophic event that will have a negative impact on the patients life style and quality of life. There are two major types of hip fracture. Intracapsular fractures are fractures of the neck of the femur, Extracapsular fracture are fractures of the trochanteric region and of the subtrocanteric region. Fractures of the neck of the femur may damage the vascular system that supplies blood to the head and the neck of the femur, and the bone may die. Many older adults experience hip fracture that student nurse need to insure recovery and to attend their special need efficiently and effectively. True the knowledge of this condition, a high quality of care will be provided to those people suffering from it.

II.

OBJECTIVES

General Objectives: After three day of student nurse-patient interaction, the patient and the significant others will be able to acquire knowledge, attitudes and skills in preventing complications of immobility.

Specific Objectives: A. STUDENT-NURSE CENTERED After 8 hours of student nurse-patient interaction, the student nurse will be able to: 1. state the history of the patient. 2. identify potential problems of patient 3. review the anatomy and physiology of the organ affective 4. discuss the pathophysiology of the condition. 5. identify the clinical and classical signs and symptoms of the condition. 6. implement holistic nursing care in the care of patient utilizing the nursing process. 7. impart health teachings to patient and family members to care of patient with fracture.

III.

PATIENTS PROFILE

Name: Romualdo Garcia Age: 36 years old Sex:male Civil Status: Single Religion: Roman Catholic Room: Male Orthopedic Ward Impression or Diagnosis: Fracture Open Type 1 Complete Displaced Segmental Femur Left POST OP (OREF) Application of Interfragmentory Screw Femur Left Physician: Dr. Azurin

IV.

HEALTH HISTORY

( NO DATA ACQUIRED)

V.

ANATOMY AND PHYSIOLOGY

The word skeleton comes from the Greek word meaning dried- up body, our internal framework is so beautifully designed and engineered and it puts any modern skyscraper to shame. Strong, yet light, it is perfectly adapted for its functions of body protection and motion. Shaped by an event that happened more than one million years ago when a being first stood erect on hind legs our skeleton is a tower of bones arranged so that we can stand upright and balance ourselves. The skeleton is subdivided into three divisions: the axial skeleton, the boned that form the longitudinal axis of the body, and the appendicular skeleton, the bones of the limbs and girdles. In addition to bones, the skeletal system includes joints, cartilages, and ligaments (fibrous cords that bind the bones together at joints). The joints give the body flexibility and allow movement to occur. Besides contributing to body shape and form, or bones perform several important body functions such as support, protection, movement, storage and blood cell formation.

Classification of Bones

The diaphysis, or shaft, makes up most of the bones length and is composed of compact bone. The diaphysis is covered and protected by a fibrous connective tissue membrane, the periosteum. Hundreds of connective tissue fibers, called Sharpeys fibers, secure the periosteum to the underlying

bone. The epiphyses are the ends of the long bone. Each epiphyses consist of a thin layer of compact bone enclosing the area filled with spongy bone. Articular cartilage, instead of periosteum, covers its external surface. Because the articular cartilage is glassy hyaline cartilage, it provides a smooth, slippery surface that decreases friction at joint surfaces. In adult bones, there is a thin line of bony tissue spanning the epiphyses that looks a bit different from the rest of the bone in that area. This is the epiphyseal line. The epiphyseal line is a remnant of the epiphyseal plate (a flat plate of hyaline cartilage) seen in young, growing bone. Epiphyseal plates cause the lengthwise growth of the long bone. By the end of puberty, when hormones stop long bone growth, epiphyseal plates have been completely replaced by bone, leaving the epiphyseal lines to mark their previous location. In adults, the cavity of the shaft is primarily a storage area for adipose (fat) tissue. It is called the yellow marrow, or medullary, in infants this areas forms blood cells, and red marrow is found these. In adult bones, red marrow is confined to the cavities of spongy bone of flat bones and the epiphyses some long bones. Bone is one of the hardest materials in the body, and although relatively light in weight, it has a remarkable ability to resist tension and other forces acting on it. Nature has given us an extremely strong and exceptionally simple (almost crude) supporting system without up mobility. The calcium salts deposited in the matrix bone its hardness, whereas the organic parts (especially the collagen fibers) provide for bones flexibility and great tensile strength. The femur, or thigh bone, is the only bone in the thigh. It is the heaviest, strongest bone in the body. Its proximal end has a ball-like head, a neck, and greater and lesser trochanters (separrsted anteriorly by the intertrochanteric line and posteriorly by the intertrochanteric crest). The trochanters, intertrochanteric crest and the gluteal tuberosity, located on the shaft, all serve us sites for muscle attachment. The head of the femur articulates with acetabulum of the hip bone in a deep, secure socket. However, the neck of the femur is a common fracture site, especially in old age. The femur slants medially as it runs downward to joint with the leg bones; this brings the knees in line which the bodys center of gravity. The medial course of the femur is more no ticeable in females because of the wider female pelvis. Distally on the femur are the lateral and medial condytes, which articulates the tibia below. Posteriorly, these condytes are separated by the deep intercondylar notch. Anteriorly on the distal femur is the smooth patellar surface, which forms a joint with the patella, or kneecap.

VI.

PATHOPHYSIOLOGY

Stress placed on a bone, exceeds the bone ability to absorb it

Injury in the bone

Disruption in the continuity of bone

Disruption of muscle and blood vessels attached to the ends of the bone

Soft tissue damage

Bleeding

Hematoma forms in medullary canal

Bone tissue surround the fractured site dies

Inflammatory response

VII.

LABORATORY EXAMS

Diagnostic test

Normal values

Patients Result

Significance

April 10, 2008 Complete Blood Count

Hemoglobin

14.0-17.5 g/dL

9.1

- Decreased-various anemias, with excessive fluid intake. -Decreased-severe anemias

Hematocrit

41.5-50.4%

28.8

WBC

4.4-11.0x10^ g/uL

5.32

-Normal

RBC

4.5-5.9x10^ g/uL

2.8

-Decreased- all anemias and leukemia, when blood volume has been restored.

Mean Corpuseular Hemoglobin

-Normal 27.5-33.2 pg 32.7

Mean Cell Volume (MCA) 80-96 fL 103.6

-Increased-macrocytic anemia

Mean Corpuseular Hemoglobin

-Decrease-severe hypochronic anemia 33.4-35.5 % 32

Platelet 150,000-450,000 387

-Normal

Differential Count 40-70 % Neutropihl 67

-Normal

-Normal

0-1 % Basophil 0-5 % Eosinophil 0-8% Monocyte 20-40% Lympocyte

0 -Normal 4 -Increase-viral infection, collagen and hemolytic disorders -Normal 20 Source: Brunner and Suddarths. Textbook of Medical-Surgical Nursing.10th Edition Volume 2. page 2214-2215

09

-Normal Serum 3.6-5 Potassium 6.7-1.5 Creatinine 8.4-10.2 Calcium 1.2-2.2 Protein 3.3-5.5 Albumen 2 Globulin 6.8 Total Protein 65-110 GCT(50gms) 8-35 u/mL 20 145 5.8 -Normal Source: Brunner and Suddarths. Textbook of Medical-Surgical Nursing.10th Edition Volume 2.page 2217,2219,2221,2224,2229,2230,2232 2.9 -Increased-diabetes mellitus 2.9 1.0 -Increased-chronic infection, multiple myeloma -Decreased-malnutrition 8.2 -Decreased-no clinical significance 6.6 -Decreased-anemia, malnutrition 4.7 -Decreased-Muscular atrophy, anemia, leukemia -Decreased-vitamin D. deficiency

-Increased-diabetes mellitus Source: Brunner and Suddarths. Textbook of Medical-Surgical Nursing.10th Edition Volume 2.page 2230,2233, 65-110 118

PBS

-Normal Source: Brunner and Suddarths. Textbook of Medical-Surgical Nursing.10th Edition Volume 2.page 2225, Uric acid 2.5-7.5 4.4mg/dL -Normal

-Normal

Bleeding time-sim 2.3-9.5 6.31 min.-sec. Clotting time 5-15 10.41 min.-sec. Prothombin time 10-13 13.8 sec. -Normal Source: Brunner and Suddarths. Textbook of Medical-Surgical Nursing.10th Edition Volume 2.page 2214 -Normal -Increased-deficiency of factors I, II, V, VII, and X, fat malabsorption

% activity 70-120 INR <1.2 1.03 96.2 %

-Normal

Urinalysis Macroscopic Examination

-Normal

-Normal

Color Yellow Appearance Clear Plt 4.5-7.8 Specific gravity 1.003-1.029 Protein Negative Glucose Negative Ketones Negative Blood Negative Leukocytes Negative Negative Negative Negative Trace Trace 1.010 6.0 Clear Yellow

-Normal

-Glomerular disease, nephritic syndrome -Diabetes mellitus

-Normal

-Normal

-Normal

-Normal

-Normal

-Normal

Nitrite Negative Bilirubin Negative Urohilinogen Normal 0.2 eu/dL Negative -Normal Negative

-Normal Microscopic Examination

-Normal

RBC/hpf 0-5 WBC/hpf 0-5 Bacteria Present Mucus threads Present Amorphous Urates Present Blood cell Negative Few Few Few Few 0-2/hpf 0-2/hpf

-Normal

-Normal

Indicates renal or urinary tract disease Source: Brunner and Suddarths. Textbook of Medical-Surgical Nursing.10th Edition Volume 2.page 2224,2225

IX.

DISCHARGE PLANNING

M- Mefenamic Acid Cefazolin Tramadol Ferrous Sulfate

E- Average Class

T- Physical Therapy/ Mobility Exercise

H-Have a healthy, quiet and stress free environment Always have an adequate rest Instruct patient to do some exercise that he can tolerate Comply on physicians order/teachings

O-The patient is advised to have a follow up check-up a week after he was discharged.

D-Diet as Tolerated