NURSING CASE STUDY:

Fracture, Closed, Complete, Displaced Mid

to Distal 3rd, Femoral Shaft, Left

Submitted by:
Dominic P. Bristol

Submitted to:
Prof. Nancy D. De Los Santos, RN, MAN

June 28, 2019

 DE LA SALLE MEDICAL AND HEALTH SCIENCES INSTITUTE
COLLEGE OF NURSING
LEVEL III
NURSING CARE PLAN

Patient Name: J.K.L. Age: 4 years old Sex: M CS: S

Medical Diagnosis: Fracture, Closed, Complete, Displaced Mid to Distal 3rd, Femoral
Shaft, Left
Attending Physician: Dr. Cañete

I. Chief Complaint/ Other Complaints:

Left thigh pain

II. Nursing History

The patient was engaged in an accident involving a vehicle.

III. Pathophysiology (pathophysiological events) and Explanation

 Synthesis:
Hip fracture can occur at any age. Common causes include severe impact
(e.g., a car accident), falls, and weak bones or bone loss (osteoporosis). The risk
of hip fracture from falls and bone loss increases with age. Persons over age
65 may be unsteady on their feet, and their balance can be affected by
medications, dementia, and frailty. Aging is also often associated with bone loss,
particularly in women. Persons whose bones are weak may suffer a hip fracture
when attempting to support their weight on one leg or when moving the hips in a
twisting motion.
Treatment usually consists of surgery to insert a bone plate or, in some cases, to
perform a hip replacement. Patients often are encouraged to move and to begin
to walk with aids as soon as possible in order to prevent potential complications.
Generally, rehabilitation presents few difficulites for younger patients. Some older
people, however, because of frailty or other conditions, may not be able to take
full advantage of rehabilitation programs. In other cases, rehabilitation programs
may not be available. When rehabilitation is incomplete or lacking, recovery from
a hip fracture may be limited. Older persons, for example, may experience a
permanent decrease in mobility and a diminished quality of life. They also are at
increased risk of complications from hip factures, including thrombosis (formation
of a blood clot), pneumonia, and infections after surgery. Some young patients
may require a hip replacement later in life despite rehabilitation and recovery.

IV. Laboratory/ Diagnostic Result, Interpretation and Nursing Implication

Procedure/ Indication Normal Actual Nursing
Date Values/Findings Findings Responsibilities/
Implications (PRE,
INTRA, POST)
Hematology To aid in CBC PRE:
06/22/2019 diagnosing Hgb: 127 – 183 g/L 115 L - Verify doctor’s
anemia, Hct: 0.37 – 0.57 0.35 L order.
certain WBC Count: - Ask pt.’s consent.
cancers of 4.8 – 10.8 x 109/L 7.18 - Explain test
the blood, RBC Count: procedure.
inflammatory 4.0 – 6.0 x 1012/L 4.52 - Explain that slight
diseases, Differential Count discomfort may be
and to Segmenters: felt when the skin is
monitor 0.40 – 0.74 0.51 punctured.
blood loss Lymphocytes: INTRA:
and infection 0.19 – 0.48 0.35 - Clean the puncture
Monocytes: site with alcohol.
0.03 – 0.09 0.06 - Allow area to air
Eosinophils: dry.
0.00 – 0.07 0.07 H - Apply manual
Basophils: pressure and
0.00 – 0.02 0.00 dressing over
Platelet Count: puncture site on
150 – 450 x 109/L 539 H removal of dinner.
Red Cell Indices POST:
MCV: 82 – 92 fl 78 L - Document results.
MCH: 28 – 32 pg 26 L
MCHC: 32 – 38% 33
 Interpretation:
-High hemoglobin can also be
caused by dehydration,
smoking, or living at high
altitudes, or it can be linked to
other conditions, such as lung
or heart disease.
- Causes of low hematocrit, or
anemia, include bleeding
(ulcers, trauma, colon cancer,
internal bleeding) Destruction of
red blood cells (sickle cell
anemia, enlarged spleen).
- A high platelet count may be
referred to as thrombocytosis.
- The MCV will be lower than
normal when red blood cells are
too small. This condition is
called microcytic anemia.
- Low amounts of iron in
the blood can also cause low
MCH levels. The body uses iron
to make hemoglobin.

Chemistry Used to Sodium: PRE:

06/17/2019 evaluate 135 – 145 mmol/L 139.2 - Verify doctor’s
electrolyte Potassium: order.
balance 3.5 – 5.5 mmol/L 3.77 - Ask pt.’s consent.
Chloride: - Explain test
98 – 108 mmol/L 103.9 procedure.
- Explain that slight
discomfort may be
felt when the skin is
punctured.
INTRA:
- Clean the puncture
site with alcohol.
- Allow area to air
dry.
- Apply manual
pressure and
dressing over
puncture site on
 removal of dinner.
POST:
- Document results.
Urinalysis To screen Color: Pale Yellow Light PRE:
06/17/2019 for, help to Yellow Yellow
diagnose - Verify doctor’s
and/or Character: Clear to Clear order.
monitor Slightly Hazy
- Identify pt.’s name.
several
Specific Gravity:
diseases 1.025 - Explain test
and 1.010 – 1.025 procedure, purpose
conditions, 7.0 and preparation.
such as pH: < 7 (ave. 6.0)
kidney - - Collect urine early
disorders or Albumin: (-) morning.
-
urinary tract Sugar: (-)
infections - Use sterile
-
(UTIs) container.
WBC: 0 – 5 hpf
-
INTRA:
RBC: 0 – 3 hpf
Few
Instruct pt. to
Bacteria: (-) or < 3
hpf 0 – 2 /hpf
- Observe proper
hand hygiene.
Epithelial Cells:
Few - Clean perineal
area before urine
collection.
- Discard 1st flow of
urine and collect
midstream urine.
- Collect 30-50 ml
for routine UA.
POST:
- Label properly.
- Send to lab.
immediately.
- Document results.

V. Medications and Treatment

 BN/ GN Dosage/Frequenc Indication/ CI S/E and AR Nursing
y/ Responsibilitie
Route s
Cefuroxim 125mg / 5ml BID Indication: Body as a -Determine
e Axetil PO Pharyngitis, Whole: history
(Cefurox) tonsillitis, Thrombophlebit of hypersensitivit
infections of the is (IV site);pain, y reactions to
urinary and burning, cephalosphorins
lower respiratory cellulitis( IM , penicillins and
tracts, and skin site); history of
and skin- superinfections, allergies
structure positive particularly to
infections Coombs 'test. drugs before
caused by GI: therapy is
Streptococcus Diarrhea,
initiated.
pneumonia and nausea, -Report onset of
S. pyogenes, antibiotic- loose stools
Haemophillus associated -Absorption
influenzae, colitis. of cefuroxime is
Skin: enhanced by
Staphylococcus
Rash, pruritus,
aureus, food.
urticaria. -Notify
Escherichia coli. Urogenital:
Contraindicate prescriber about
Increased
d: rashes or
serum cretonne
Contraindicated superinfections
and
in patients
BUN, decrease
hypersensitive
d creatinine
to drug.* Use
clearance
cautiously in
patients
hypersensitive
to penicillin
because of
possibility of
cross-sensitivity
with other beta-
lactam
antibiotics.* Use
with caution
in breast-
feeding women
 and inpatients
with history of
colitis or renal
sufficiency.

VI. Nursing Priorities

Problem No. Problem Date Identified
1 Impaired Physical Mobility June 25, 2019
 VII. Nursing Care Plan
Assessment Nursing Diagnosis Short Term Goal Long Term Goal Intervention Rationale Evaluation/
Subjective/ Expected
Objective Outcomes
O > GCS = 10/15 Impaired Physical Within the shift, the Within Changed positions at Reduces risk of Goal met.
> (+) post-stroke Mobility related to patient will maintain hospitalization, the least every 2 hours. tissue injury.
> (+) hemiparesis hemiparesis (stroke) skin integrity patient will maintain
> CT Scan results: strength and function Elevated arm and Promotes venous
- Large of unaffected body hand. return and helps
intraparenchymal part prevent edema
hemorrhage, right formation.
basal ganglia
extending to the right Inspected skin Pressure points over
frontal and temporal regularly, particularly bony prominences
lobes, with over bony are most at risk for
perilesional edema, prominences. decreased perfusion.
intraventricular
extensions,
subfalcine herniation
and mild obstructive
hydrocephalus
- Subarachnoid
hemorrhages, right
frontal and temporal
lobes and right
sylvian fissure
VIII. Discharge Plan
Content Strategy

1. Medication Encourage the patient for Health teaching on effects

continuous and regular of proper medicine and
intake of prescribed proper intake and
medications. importance of compliance.

2. Diet Encourage the patient to Health teaching on

adhere and maintain different foods for
DASH and DM diet. hypertension and diabetes
and its importance to
control HTN and DM.

3. Exercise Encourage the patient to Health teaching on the

ambulate and exercise as effects of exercise to the
tolerated as ordered by the body and its importance to
physician. control HTN and DM.

4. Activity/Lifestyle Encourage the patient to Health teaching on the

Changes adhere therapeutic plan importance of therapeutic
and to change sedentary plan to avoid complications
lifestyle. of HTN and DM.

5. Follow up/Check up Check-ups on a regular Health teaching on the

basis or according to importance of regular
physician advice. check-ups help in the
prevention of complications
due to early detection.