Nursing Management 1

Running head: FRACTURE CLOSE COMPLETE COMMINUTED DISPLACED MIDDLE 3RD FEMUR (LEFT) FRACTURE CLOSE DISPLACED TRANSVERSE DISPLACED MIDDLE 3RD METATARSALS FOOT (LEFT) FRACTURE CLOSE CANTUS COMPLETE DISPLACED BURSA 1ST METATARSALS FOOT (LEFT)

Nursing Management of a Patient with Tibial Fracture

Vismonte, Grytyl Kaye Tajan, Nadine Villabroza, Annablle Suarez, Sarah Jane Andres, Mary Jane Tallada, Rachelle 4y1-9D

Clinical Instructor: Mrs. Vilma Miguel RN. MAN

Our Lady of Fatima University September 2011

Nursing Management 2 Nursing Management of a Patient with Tibial Fracture A.B.C., a 26 year old male, with a medical history of hypertension was admitted to Jose Reyes Memorial Medical Center on September 9, 2011 complaining pain on his left thigh and left foot with swelling and tenderness upon assessment. Few hours prior to admission, patient had history of vehicular accident (motor). Upon admission, she was diagnosed with Fracture closed complete on left thigh and was applied with external fixators (tibial pin) on September 9, 2011. Brunner (2010) stated that a complete fracture involves a break across the entire cross- section of the bone and is frequently displaced (removed from its normal position). After the fracture has been immobilized and maintained in proper position and alignment until union occurs. Immobilization may be accomplished by external or internal fixation. Methods of external fixation include bandages, casts, splints, continuous traction, and external fixators. Pathophysiology Mozo- Bonifacio (2010) explained that a bone fracture is a break in the continuity of a bone. A broken bone or bone fracture occurs when a force exerted against a bone is stronger than the bone can structurally withstand. It is pathology that can be caused by a variety of traumas, including blunt force, sharp force, projectiles (such as bullets), and rapid deceleration (such as car accidents or plane crashes) Brunner (2010) stated that when the bone is broken, adjacent structures are also affected, resulting in soft tissue edema, hemorrhage into the muscles and joints, joint dislocations, ruptured tendons, severed nerves, and damaged blood vessels. Body organs may be injured by the force that caused the fracture or by fracture fragments.

Nursing Management 3 History A.B.C., a 26 year old male, with a medical history of hypertension was admitted to Jose Reyes Memorial Medical Center on September 9, 2011 complaining pain on his left thigh and left foot with swelling and tenderness upon assessment. Few hours prior to admission, patient had history of vehicular accident. Upon admission, she was diagnosed with Fracture closed complete on left thigh and was applied with external fixators (tibial pin) on the same day September 9, 2011. Nursing Physical Assessment A.B.C. was alert and oriented to person, place and time and in distress and on her Glasgow Coma Scale she scored a total of 15 consisting of: eyes=4 means spontaneous movement, motor=6 means obeys command & verbal=5 means he is oriented. Brunner (2010) defined Glasgow Coma Scale as an assessment that includes determining the patients level of consciousness, response to tactile stimuli (if unconscious), papillary response to light, corneal and gag reflexes, and motor function. The patients temperature was 37.1 C, pulse rate was 85, respirations were 18, and blood pressure was 120/80. The patient has no IV contraptions has external fixators on her left thigh. The patients skin was warm and dry with a moderate bilateral hand grip. The patient has good appetite with regular bowel movement and urination. The patient experiences no pain on any part of her body except on his injury on his left thigh and foot. The patient was on a Diet As Tolerated diet with no restrictions or limit on her oral intake. A.B.C appeared normal with no signs weakness. The patient was nonambulatory and was able to perform independent activities of daily living except from activities involving her left thigh. Based on his lab results on CBC, the patient had mild decrease of normal hemoglobin of 111.0 g/L compare to the normal, 135-180 g/L and a decrease of hematocrit of 0.33gfrom the normal 0.40-0.54g. The mild decrease and in came from the internal hemorrhage on her injury.There is also an increase in WBC count

Nursing Management 4 of 11.90 x 109/L from the normal range of 5-10 x 109/L. the increase show that her body is fighting the foreign microorganisms invading her wound or site of injury. Related Treatments The patient has no allergies to latex, iodine, or any adhesives. The patient has no IV contraptions and has external fixators on her left thigh. The patient was nonambulatory and was able to perform limited independent activities of daily living because of his injury. Bonifacio (2010) stated that External Fixation is a technique of fracture immobilization in which series of transfixing pins is inserted through bone and attached to a rigid external metal frame. The patient experiences no pain on any part of her body except on her injury on left thigh and left foot. Brunner (2010) stated that after a fracture, the extremity cannot function properly because normal function of the muscles depends on the integrity of the bone to which they are attached. The physicians discharge orders were to remain Diet As Tolerated diet with no restrictions or limit on her oral intake. The patients medications were Cefuroxime 500 mg cap TID that acts as an antibiotic; & Celecoxib 200 g tab TID for pain.

Nursing Management 5 Nursing Care Plan XXs nursing diagnosis is Activity Intolerance related to injury secondary to external fixators as evidence by inability to do activities of daily living (ADL), altered level of functioning of affected extremity, and was nonambuatory. Patients appearance was normal, with dry skin with swelling and tenderness on her site of injury. The short term goal is to lessen the patients anxiety towards her activity intolerance and make other options regarding what she can and cannot do & his long term goal is to return her back to normal way living or functioning after his injury was healed. Nursing interventions for the patient include assessment of patient's perception of causes of activity intolerance, verbalization of feelings, , provide bedside care or assist, anticipate patients needs (telephone calls, bathroom privileges) assist patient to plan activities, active and passive range of motion exercises (ROM) and health teaching includes cleanliness of site and fixators (pins), including personal hygiene, provide comfort and active Range Of Motion of the fingers should be perform to reduce swelling and prevent stiffness, Instruct use of relaxation exercise such as listening to music, and instruct patient to do energy conservation task or activities he can perform in his state like sitting to do task (activities he can perform while sitting. The patient was responsive to management and education.

Nursing Management 6 Recommendations The patient should follow up with his physician regarding her fracture, removal of her external fixator and therapy for normalization of arm motor function. The patient should also follow her medications on antibiotics for prophylaxis should follow her diet. Health teaching about prober hygiene and sanitation should be imposed: external fixators form an opening on her arm. Patient should have regular active Range Of Motion of the fingers and shoulder to reduce swelling and prevent stiffness Patient should have a positive outlook in life and be supported by his family and friends. Fitch (2006) has pointed out that nurses can teach patients how to advocate for themselves with their healthcare providers by helping them formulate and write down questions about their treatment to bring to appointments and by encouraging them to bring a supportive person with them to their medical appointments. Kozier (2007) has also stated pointed out that sometimes a nurse can be a teacher, the nurse helps client learn about their health and the health care procedures they need to perform to restore or maintain their health. The nurse assess the clients learning needs and readiness to learn, sets specific learning goals in conjunction with the client, enacts teaching strategies, and measure learning.

Nursing Management 7 References Ignatavicius, D., & Workman, M. (2006). Medical-surgical nursing (5th ed.). St. Louis: Elsevier Saunders Fitch, M., & Turner, F. Ovarian Cancer. (2006). Canadian Nurse, 102(1), p. 18-19. Kozier & Erb's Fundamentals of Nursing, 8th Edition Brunner & Suddarth (2010). Textbook of Medical- Surgical Nursing (12th ed.) Lippincott Williams &Wilkins Mozo- Bonifacio(2010). My Ortho Book, Guide in Orthopedic Nursing. C & E Publishing