Introduction

We the group 2 was assigned in Surgery ward within 7-3 and 3-11 shift
and was tasked to prepare a case study to one of our patients. One of them
caught my attention and interest due to his incomparable condition among the
patients in the said ward. found his case challenging that made me decide to
choose him as the sub!ect of my case study.
"atient #$ 2% years old from &rgy. San sidro$ &obon 'orthisn Samar was
admitted with a chief complaint of (ehicular )ccident$ multiple abrasion$ stab
wound multiple contusion.
) fracture is a break in the continuity of bone and is defined according to
its type and e*tent. +ractures occur when the bone is sub!ected to stress greater
that it can absorb. +ractures are caused by direct blows$ crushing forces$ sudden
twisting motions$ and e,en e*treme muscle contractions. When the bone is
broken$ ad!acent structures are also affected$ resulting in soft tissue edema$
hemorrhage into the muscles and !oints$ !oint dislocation$ ruptured tendons$
se,ered ner,es$ and damaged blood ,essels. &ody organs may be in!ured by the
force that cause the fracture or by the fracture fragments.
-his are different types of fractures and these include$ complete fracture$
incomplete fracture$ closed fracture$ open fracture and thise 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$ obli.ue fracture$ a,ulsion$ spinal fracture$ impacted
fracture$ trans,erse fracture and compression fracture.
) comminuted fracture is one that produces se,eral bone fragments and a
closed fracture or simple fracture is one that not cause a break in the skin.
/omminuted fracture at the 0ip fracture is a fracture in which bones of the 0ip
fracture has splintered to se,eral fragments.
&y choosing this condition as a case study$ will inhance my knowledge$ skills
and attitude understanding and nursing management of patients with fracture.
Often$ a fractured hip is a catastrophic e,ent that will ha,e a negati,e
impact on the patient1s life style and .uality of life. -hise are two ma!or types of
hip fracture. ntracapsular fractures are fractures of the neck of the femur$
2*tracapsular fracture are fractures of the trochanteric region and of the
subtrocanteric region. +ractures of the neck of the femur may damage the
,ascular system that supplies blood to the head and the neck of the femur$ and
the bone may die. )s a student from 32" college of nursing we must ha,e focus
on caring for patient with fracture.
1
Learning Objectives
4eneral Ob!ecti,es5
)fter 6 days of student nurse-patient interaction$ will be able to enhance
my knowledge$ skills and attitude in caring for patient with fracture$ and will be
able to enhance the knowledge of the patient and significant othiss in pre,enting
de,eloping of complication from fracture.

Specific ob!ecti,es5
Attitude
1. -o obser,e cleanliness in health care area
2. &e able to gain confidence in gi,ing appropriate nursing care to a patient
with hip fracture
3. -o establish a mutual goal with the patient and build trust on it.
%. -o be open minded when interacting with in pain patients.
7. -o be able to e*tract appropriate history related to fracture problems.
Knowledge
1. -o be able to gi,e ideas for the nursing inter,ention that will be performed
2. -o be able to apply the important concept$ theory and principles in caring
for patient with hip fracture
3. -o be able to use 4ordon1s following health pattern in comprehensi,ely
assessing the patient
%. -o be able to use different theory and de,elopmental task and compare it
to the actual patient.
7. -o be able to interpret the client1s response to the specific nursing
inter,ention
Skills
1. -o gi,e appropriate nursing care to the patient with hip fracture
2. -o be comprehensi,e and thoughtful in e*amining the patient1s current
condition
3. -o be competent enough in caring for an bed ridden patient due to
hipfracture
%. -o be able to perform appropriate head to toe assessment
7. -o be able to perform test that will measure the functional pattern of a patient
with hip fracture
2
COMPREHESI!E HEAL"H HIS"OR#
PRIMAR# I$ORMA"IO%
PA"IE" PRO$ILE
a&e% Surio$ #oger
Age% 2% years old
'ender% 8ale
(irt) *ate% October 2%$ 1966
(irt) Place% &obon$ 'orthisn Samar
Status% Single
Occu+ation% :aborer;/onstruction worker;+armer
Religion% #oman /atholic
ationalit,% +ilipino
Ho&e Address% &rgy. San sidron$ &obon$ '. Samar
*ate o- Ad&ission% 'o,ember 11$ 2<12
"i&e o- Ad&ission% 1577 )8
Ad&itting P),sician% =r. (er
Ad&itting *iagnosis% (ehicular )ccident$ multiple abrasion$ stab
wound multiple contusion.
Source o- In-or&ation% "atient and mother
*ate o- Interview% 'o,ember 22$ 2<12
CHIE$ COMPLAI"%
-he patient was brought to the hospital due to (ehicular )ccident$ multiple
abrasion$ stab wound multiple contusion.
Histor, o- Present Illness
=uring the afternoon of 'o,ember 1<$ 2<12$ #oger and his friends ha,e
some drinking sessions they drunk >tuba? according to the patient they consumed
about 1 gallon of -uba$ after they drink tuba they want to drink more to ha,e
more fun$ so they went to fish,ille which is located near their place. n fish,ille
they drink for about @ bottles of colt %7 an alcoholic be,erages which makes they
totally drunk. &ecause #oger wants to go home$ he asked his cousin to dri,e him
home using his bicycle. &ut after that he cannot recall any thing happen and
wokeup in the surgery department.
Activit, +atern Prior to Ad&ission
-he patient can do his )=: and work home$ according to the patient he usually
stays home to help his mothis in doing house chores$ and if e,er the company
contacted him he went to do company to do his construction !ob.
*iagnostic "est
3
=iagnostic test 'ormal ,alues "atient1s
#esult
Significance
Co&+lete (lood
Count
0emoglobin
0ematocrit
W&/
#&/
*i--erential
Count
'eutropihl
&asophil
2osinophil
8onocyte
:ympocyte
Seru&
"otassium
/reatinine
/alcium
"rotein
)lbumen
4lobulin
1%.<-17.7 g;d:
%1.7-7<.%A
%.%-11.<*1<B g;u:
%.7-7.9*1<B g;u:
%<-7< A
<-1 A
<-7 A
<-6A
2<-%<A
3.@-7
@.7-1.7
6.%-1<.2
1.2-2.2
3.3-7.7
2
9.1
26.6
7.32
2.6
@7
<
%
<9
2<
%.7
@.@
6.2
1.<
2.9
2.9
- =ecreased-,arious anemias$
with e*cessi,e fluid intake.
-=ecreased-se,ere anemias
-'ormal
-=ecreased- all anemias and
leukemia$ when blood ,olume
has been restored.
-'ormal
-'ormal
-'ormal
-ncrease-,iral infection$ collagen
and hemolytic disorders
-'ormal
Source5
&runner and Suddarth1s.
-e*tbook of 8edical-Surgical
'ursing.1<
th
2dition (olume 2.
page 221%-2217
-'ormal
-=ecreased-8uscular atrophy$
anemia$ leukemia
-=ecreased-,itamin =. deficiency
-=ecreased-anemia$ malnutrition
-=ecreased-no clinical
significance
-ncreased-chronic infection$
multiple myeloma

Present Pro-ile o- $unctional Healt) Patterns

4
Healt) Perce+tion . Healt) Manage&ent Pattern
-he patient described his usual health before to be fair and body is strong
but now he considered it to be poor and weak. -his is because of the limited
mo,ements he felt$ the inability to walk or stand and difficulty in mo,ing the
e*tremities due to the fracture of his hip. &efore the admission$ the patient eats
more foods rich in fats$ sugar or glucose and cholesterol in their meals and he
drinks plenty of water e,eryday. =uring the patient1s hospitaliCation$ -he patient1s
attending physician encourages his to take more of calcium and (itamin = in
order for his bones to become stronger. -he patient is smoker and alcoholic
drinker and he has no known allergies.
utritional . Metabolic Pattern
-he patient1s usual food intake before the hospitaliCation includes fish$
meat$ ,egetables$ fruits$ chicken and especially foods rich in fats$ sugar;glucose
and cholesterol. 0e consumes more than 6 glasses of water a day. -he patient
was also encourage to take more of /alcium and (itamin = in order for his bones
to become stronger. -he patient smoke and drink alcoholic be,erages$ has no
known allergies. -his is a change in his appetite nowD he often eats a little only
each meal.
Eli&ination Pattern
&efore$ the patient can freely go to the /.#. to ,oid or defecate but now
that he1s hospitaliCed he was ad,ised to wear diaper for his to ha,e difficulty in
standing and walking. -his is no burning sensation during ur%ination and his stool
is brownish formed stool.
Activit,/E0ercise Pattern
-he patient before hospitaliCed wakes up early in the morning for his to
ha,e fine walking around their house as his e*ercise. 0e usually help his mother
in house chores$ but now$ he1s !ust on bed lying assisted by his nurses.
Cognitive. Perce+tual Pattern
-he patient before$ can hear$ smell$ taste and feel well and correctly. 0e
speaks slowly -agalog and waray languages as of now but before he speaks
fluently all of those languages. 0e easily communicates$ understands .uestions$
instructions and be able to follow and answer them correctly.
Rest. Slee+ Pattern
&efore the hospitaliCation$ the patient usually sleeps late at night at around
1< o1clock pm and wakes up early in the morning at @ o1clock am with an hour of
sleep of 6 hours. 'ow$ he usually sleeps early at night E6-9 o1clock pmF and
wakes up at around 7 o1clock am with an hour of sleep of 1< hours.
Sel-/ Perce+tion Pattern
5
-he patient1s most concern about right now is his rehabilitation care. -he
patient wants to go home until he impro,es his mobility so he would be able to
stand and walk all alone by him self. -he patient ne,er loses the support of his
mother.
-hrough this$ he maybe able to cope up easily from his unhealthy condition. -he
treatment$ managements$ medications and all out care rendered by the hospital
to the patient assured his for the impro,ement of his condition.
Se0ualit,. Re+roduction
-he patient1s still single. 0e ne,er engaged to premarital se*
Co+ing/ Stress "olerance Pattern
-he patient1s mother usually makes his decision as for now. 0is mother is
the one that helps him cope with his present condition
!alue/(elie- Pattern
-he patient find source strength and hope with 4od and his mother. 4od
is ,ery much important to the patient. &efore$ he rarely goes to church. -hey
were not in,ol,ed in any religious organiCations or practices. -he patient knows
how to pray and praise 4od for all the nice things he had gi,en.
Relations)i+ Pattern
-he patient understands more on Waray languages but a little only in
-agalog language. -he patient was li,ing his mother at home. -he patient can
easily communicate$ cooperate$ listen and follow instructions easily.
"atho"hysiology
"redisposing +actors5 "recipitating +actors5
-+all
- -rauma - osteoporosis
- /omorbidity -functional disability
6
- 8alnutrition - impaired ,ision and balance
-neurologic problems
- Obesity
-slower refle*es
=amage to the blood supply to an entire bone.
Se,ere circulatory compromise
),ascular EischemicF necrosis may result
Surgical nter,ention5
0ip "inning
0ip 0emiarthroplasty
"atients with hip osteonecrosis may re.uire 0ip
#eplacement Surgery
7
Clinical Manifestations:
- Pain (right up)
- Loss of function
- efor!it"
- Crepitus
- #$elling an% %iscoloration
- Paresthesia
- &en%erness
'ursing Manage!ent:
- (epositioning the patient
- Pro!oting strengthening e)ercise
- Monitoring an% !anaging co!plications
- *ealth pro!otion
- (elie+ing pain
- Pro!oting ph"sical !o,ilit"
- Pro!oting positi+e ps"chological response to
trau!a
- Patient teaching
Me%ical Manage!ent:
- &e!porar" s-in traction
- .uc-/s e)tension
- 0pen or close% re%uction of the fracture an%
internal fi)ation
- (eplace!ent of the fe!oral hea% $ith prosthesis
(he!iarthr!oplast")
- Close% re%uction $ith pereutaneous sta,ili1ation
for an intracapsular fracture2


3