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URDANETA CITY UNIVERSITY

COLLEGE OF NURSING
_______________________________________________________________________

Submitted by:
Efrain S. Espiritu
BSNursing-III

Submitted to:
Mr. Rodney E. Salagubang, PTRP., RN., MAN.
Clinical instructor

Manila Affiliation: Philippine Orthopedic Center


July 8, 2019 – July 19, 2019
URDANETA CITY UNIVERSITY
COLLEGE OF NURSING
_______________________________________________________________________

General Objectives

This case study aims to discuss and analyze the condition called fracture in accordance to
the patient’s profile, treatments and health status.
This study also aims:
 To collect the necessary information that can contribute to understanding on how the
condition occurs.
 To improve knowledge and gather more data about fracture.
 To provide an idea on how to provide appropriate nursing care for clients with this
condition.
 To determine possible treatments that can be used for this condition.

Student Nurse Centered Objective

This case study will be able to help the future student nurses to gain knowledge and
further information related to this condition which can be applied for the students’ future
exposure on their major internship.

Patient Centered Objective

This study will be able to empower patients to become active participants in their care.
URDANETA CITY UNIVERSITY
COLLEGE OF NURSING
_______________________________________________________________________

Patient’s Profile
a. Patient’s Name: Patient ABC
b. Age: 10
c. Gender: Male
d. Civil Status: Single
e. Religion: Catholic
f. Birth Place: Cainta Rizal
g. Date of Admission: June 13, 2019
h. Admitting Diagnosis: Fracture Open 3B Complete Displaced Comminuted Distal
Tibia- Fibula, Right
i. Attending Physician: Dr. Mon Distor

Patient’s History
a. History of Present Illness:
Date of Incident: June 7, 2019
Time of Incident: 2:00 pm
Place of Incident: Masbate
Mode of Incident: Vehicular Accident
b. Past Medical History: None
c. Personal and Social History/ Socio-Cultural Background: Patient ABC is a 10
years old resident of Cainta, Rizal. The patient is a Grade 3 student. He is living with
his parents and four brothers. He likes to play outside with his friends and classmate.
He spends most of his free time playing games on his cellphone.

13 Areas of Assessment
1. Physiologic Status

• Patient is a 10 years old resident of Cainta, Rizal. The patient is a Grade 3 student.
He is living with his parents and four brothers. The patient is able to move his
body. He is also slightly able to move the affected extremity.

2. Mental and Emotional

• Patient was seen awake and responsive to all questions asked. He is well oriented
to time, place and person. He is able to initiate limited activities and is able to
show response to pain stimuli. Patient appears neat and wearing clean clothes. He
can read, write and understand tagalog. He wants to be discharged from the
hospital as soon as possible and go back to his home.
URDANETA CITY UNIVERSITY
COLLEGE OF NURSING
_______________________________________________________________________

3. Environmental Status

• Patient was admitted at Philippine Orthopedic Center, Children’s Ward. The ward
that he’s admitted was composed of several beds, watchers can pass by easily. His
bed was placed near the door. Her bedside table was composed of foods and
medications. The room has only one ceiling fan.

• In their house, the rooms are well ventilated. They have 2 electric fans and 1
aircon.

4. Sensory Status

a. Visual Status
• The patient was able to respond to visual stimuli. The patient verbalized the he
doesn’t feel any pain.

b. Auditory Status
• The patient has no lumps and lesions noted on both ears, and can easily respond
toward many questions.

c. Olfactory Status
• The patient’s nose is bilaterally symmetrical, no lesions and discharges noted.

d. Gustatory Status

• The patient’s lips are symmetrically in shape. No dentures noted and has one tooth
seen with presence of tooth carries. The patient has slightly moist mucosa.

e. Tactile Status
• The patient’s facial sensations are intact and symmetrical on both sides. He was
able to perceive heat, cold and pain sensations. He responded appropriately to
stimuli like nursing interventions such as checking vital signs.

f. Language Perception and Formation


• The patient was able to understand and answer the questions given by the student
nurse.

g. Sensory Environment
• The patient’s room is poorly ventilated, non-spacious and distractive noises were
observed.

5. Motor status

• Upper extremities are symmetrical. Lower extremity with the affected part has
limited motion. Peripheral pulse was present such as radial pulse. Extremities are
warm to touch.
URDANETA CITY UNIVERSITY
COLLEGE OF NURSING
_______________________________________________________________________

6. Nutritional status

• He doesn’t have any food allergies and ordered to have soft diet when she was
admitted.

7. Elimination status

• The patient defecates 1-2 times a day and urinates adequate amount 3 times a day.
One reported formed-stool. No pain was reported to be felt during urination.

8. Fluid Electrolyte Status

• The patient has ongoing D5LR’s 1L that is regulated to 20gtts/min.

9. Circulatory Status

• The patient’s pulse rate is 80 bpm while in a capillary refill of 2-3 seconds.

10. Respiratory Rate

• The patient has a respiratory rate of 22 bpm.

11. Temperature Status


I. The patient’s temperature is 36.5 degree Celsius taken through axilla and he never
had any increase in body temperature upon hospitalization.

12. Integumentary Status

• The patient’s skin is dry and brownish in complexion without pigmentations, no


pallor, jaundice or cyanosis. His hair is dry, well-distributed, no parasites seen, and
well-trimmed.

13. Comfort and Rest Status


The patient verbalized that he experienced some disturbance in sleeping when the nurses
are taking his vital signs and administering medications.
URDANETA CITY UNIVERSITY
COLLEGE OF NURSING
_______________________________________________________________________

Dianostic Evaluation
1. X-ray – to determine the integrity of the bones and confirms presence of fracture.
2. Hematology tests include laboratory assessments of blood formation and blood disorders
3. Blood typing is a test that determines a person's blood type. Knowing your blood type is
important for blood donations and transfusion.
URDANETA CITY UNIVERSITY
COLLEGE OF NURSING
_______________________________________________________________________

Anatomy and Physiology

Skeletal System

The skeletal portion of the system serves as the main storage system for calcium and
phosphorus. The importance of this storage is to help regulate mineral balance in the bloodstream.
When the fluctuation of minerals is high, these minerals are stored in bone; when it is low, minerals
are withdrawn from the bone.

The skeleton also contains critical components of the hematopoietic (blood production)
system. Located in long bones are two distinctions of bone marrow: yellow and red. The yellow
marrow has fatty connective tissue and is found in the marrow cavity. In times of starvation, the
body uses the fat in yellow marrow for energy.

The red marrow of some bones is an important site for hematopoiesis or blood cell
production that replaces cells that have been destroyed by the liver. Here, all erythrocytes,
platelets, and most leukocytes form in bone marrow from where they migrate to the circulation.

The Axial Skeleton

The axial skeleton functions to support and protect the organs of the dorsal and ventral
cavities and serves as a surface for the attachment of muscles and parts of the appendicular
skeleton.

The word axial is from the word axis, and refers to how the bones of the axial skeleton
are located along the central axis of the body.

The axial skeleton functions to support and protect the organs of the dorsal and ventral
cavities. It also serves as a surface for the attachment of muscles and parts of the appendicular
skeleton.
URDANETA CITY UNIVERSITY
COLLEGE OF NURSING
_______________________________________________________________________

The human’s axial skeleton is composed of 80 bones and is the central core of the body.
The primary divisions of the skeleton system are:

 Head, including the bones of the skull (cranium), face, auditory ossicles, and hyoid bone.
 Thorax, including the rib cage and sternum.
 Vertebral column.

Bones of the Head

Skull (Cranium)

The human cranium consists of the flat bones of the cranium and includes the facial
bones. The cranium protects the brain that is contained in the cranial vault. The cranium is
formed from eight bones connected by sutures.

Fourteen facial bones form the lower front part of the cranium. Important facial bones
include the lower jaw or mandible, the upper jaw or maxilla, the zygomatic or cheek bone, and
the nasal bone.

The immature cranium has separate plates to allow the flexibility needed for a newborn to
pass through the birth canal and pelvis.

These plates fuse as the skull matures (except the mandible). The human cranium
supports the structures of the face and forms the brain cavity.

Ossicle

The ossicles (also called auditory ossicles) consist of three bones (malleus, incus, and
stapes) that are the smallest in the body. These are located in the middle ear and serve to transmit
sounds from the air to the fluid-filled labyrinth.

Hyoid Bone

The hyoid bone is a horseshoe-shaped bone situated in the anterior midline of the neck
between the chin and the thyroid cartilage. It provides attachment to the muscles of the floor of
the mouth, the tongue above, larynx below, and the epiglottis and pharynx behind.

Rib Cage

The rib cage is composed of 25 bones that include the 12 pairs of ribs plus the sternum. It
functions as protection for the vital organs of the chest, such as the heart and lungs. The rounded
ends are attached at joints to the thoracic vertebrae posteriorly and the flattened ends come
together at the sternum anteriorly.

The first seven pairs of ribs attach to the sternum with costal cartilage and are known as
true ribs. The length of each rib pair increases from number one to seven. After rib seven, the
size begins to decrease. The 8th through 10th ribs have non-costal cartilage that connects them to
the ribs above.
URDANETA CITY UNIVERSITY
COLLEGE OF NURSING
_______________________________________________________________________

The last two ribs are called floating ribs because they do not attach to the sternum or to
other ribs.

Vertebral Column

There are normally thirty-three vertebrae in the human vertebral column. The upper
twenty-four articulate and are unfused, the lower nine are fused. The fused vertebrae are the five
in the sacrum and four in the coccyx.

The articulating vertebrae are named according regions:

 Cervical vertebrae (seven vertebrae).


 Thoracic (twelve vertebrae).
 Lumbar (five vertebrae).

The first and second cervical vertebrae are the atlas and axis, respectively, on which the
head rests. The cervical vertebrae make up the junction between the vertebral column and the
cranium, and the bone makes up the junction between the vertebral column and the pelvic bones.

The Appendicular Skeleton

The appendicular skeleton includes the skeletal elements within the limbs, as well as
supporting pectoral and pelvic girdles.

The appendicular skeleton of vertebrates, including humans, consists of the bones that
support and compose the appendages (for example, the arms and legs of humans). The word
appendicular is the adjective of the noun appendage.

The appendicular skeleton comprises 126 bones and is involved in locomotion and
manipulation of objects in the environment. It is unfused, allowing for greater range of motion.

Divisions of the Appendicular Skeleton


URDANETA CITY UNIVERSITY
COLLEGE OF NURSING
_______________________________________________________________________

The appendicular skeleton is divided into six major regions:

1. The pectoral girdles consist of 4 bones: The left and right clavicle (2) and the scapula (2).
2. The upper arms and forearms are made up of 6 bones: The left and right humerus (upper
arm, 2), the ulna (2), and the radius (forearm, 2).
3. The hands have 54 bones: The left and right carpals (wrist, 16), metacarpals (10), proximal
phalanges (10), intermediate phalanges (8), and the distal phalanges (10).
4. The pelvis has 2 bones: The left and right hip bone (2).
5. The thighs and legs have 8 bones: The left and right femur (thigh, 2), patella (knee, 2),
tibia (2) and fibula (leg, 2).
6. The feet and ankles have 52 bones: The left and right tarsals (ankle, 14), metatarsals (10),
proximal phalanges (10), intermediate phalanges (8), and distal phalanges (10).

Pectoral Girdle

The bones of the pectoral girdle consist of two bones (scapula and clavicle) and anchor
the upper limb to the thoracic cage of the axial skeleton.

The three regions of the upper limb are: arm (humerus), forearm (ulna medially and
radius laterally), and the hand.

The base of the hand contains eight bones (carpal bones), and the palm is formed by five
bones (metacarpal bones). The fingers and thumb contain a total of 14 bones, called phalanges

Pelvic Girdle

The pelvic girdle is formed by a single bone, the hip or coxal bone, and serves as the
attachment point for each lower limb. Each hip bone is joined to the axial skeleton by its
attachment to the sacrum of the vertebral column. The right and left hip bones attach to each
other anteriorly.

The lower limb contains 30 bones and is divided into three regions, the thigh, leg, and
foot. These consist of the femur, patella, tibia, fibula, tarsal bones, metatarsal bones, and
phalanges.
URDANETA CITY UNIVERSITY
COLLEGE OF NURSING
_______________________________________________________________________

Pathophysiology

Medical Management

Doctors can diagnose bone fractures with x-rays. They may also use CT scans (computed
tomography) and MRI scans (magnetic resonance imaging).

Broken bones heal by themselves – the aim of medical treatment is to make sure the
pieces of bone are lined up correctly. The bone needs to recover fully in strength, movement and
sensitivity. Some complicated fractures may need surgery or surgical traction (or both).

Depending on where the fracture is and how severe, treatment may include:

 Splints – to stop movement of the broken limb


URDANETA CITY UNIVERSITY
COLLEGE OF NURSING
_______________________________________________________________________

 Braces – to support the bone


 Plaster cast – to provide support and immobilize the bone
 Traction – a less common option
 Surgically inserted metal rods or plates – to hold the bone pieces together
 Pain relief.

Surgery - if there was damage to the skin and soft tissue around the affected bone or joint
surgery may be required.

Medications:

Narcotic pain relievers, such as acetaminophen/codeine (Tylenol with Codeine®),


hydrocodone/acetaminophen (Lorcet®, Lortab® or Vicodin®), or oxycodone (OxyContin® or
Roxicodone®), may be prescribed to treat bone fracture pain.

Nursing Management

Instruct and teach the patient or family about the following:

 Until the cast has set properly, avoid direct heat such as hot water bottles.
 Rest the limb as much as possible.
 Teach the techniques how to walk or manage day-to-day activities. For example, how to use the
crutch properly.
 Avoid any lifting or driving until the fracture has healed.
 If the skin under the cast is itchy, don’t poke anything between the cast and your limb (such as a
coat hanger or pencil). Instead, relieve the itchiness by tapping the itchy part.
 Don’t get the cast wet, as wet plaster becomes soft and does not provide the necessary support.
Wet plaster can also irritate skin. When showering, wrap the cast in a plastic bag and tape it
directly to skin, to keep the area watertight.
 See your doctor immediately if you have swelling, blueness or loss of movement of the fingers
or toes, pins and needles, numbness or increased pain.

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