Hip Dislocation

Patient Profile:
NAME: AGE: SEX: ADDRESS: RELIGION: NATIONALITY: DATE AND TIME OF ADDMISSION: DR. INCHARGE: DIAGNOSIS M.G 7 YEARS OLD FEMALE xxxxx ROMAN CATHOLIC FILIPINO OCTOBER x, 2xxx; x AM Dr. X. Posterior hip dislocation, right

NURSING HISTORY: 10/9/08

The patient is playing luksong baka together with her friends whom are much older than her and most of them are boys. She stated that upon jumping on her friends back, she accidentally slipped her hand and fell on the ground with her lateral thigh getting the impact. She experienced severe pain. At 8 am, came in for consultation in ambulatory, conscious and coherent with chief complaint of deformity of hip due to fall and was advised for admission.

ANATOMY & PHYSIOLOGY

Bones of the Lower Extremities

From proximal to distal, the leg begins with the femur, the longest and strongest bone in the body. Proximally, the head of the femur extends from the pelvic girdle

at the acetabulum. The major ligaments that provide integrity to this joint are the pubofemoral ligament, tendon of the rectus femoris muscle and the strongest and most important, the iliofemoral ligaments. Bone structures are as follows, head of femur, greater and lesser trochanter, body of the femur, the medial and lateral femoral condyles and the intercondylar fossa. Continuing distally are the tibia and fibula. The tibia is the weight bearing bone between the knee and the ankle. The fibula has no weight bearing function, it's usefulness is more to provide attachment for muscles. Portions of the fibula shaft have been removed, on occasion, for bone grafting without any loss of function to the fibula. Beginning with the lower aspects of the femur are the structures of a synovial joint the knee. Bone structures here consist of the medial and lateral condyles and the intercondylar fossa of the femur. Anteriorly is the patella and at the superior surface of the tibia is the tibial lateral and medial condyles and the intercondylar area. Note that the fibula does not take part in the knee joint. This more common ligaments supporting this joint are the patellar ligament, tibial and fibular collateral ligaments, the cruciate ligaments and the quadriceps tendon. Other structures that aid in articulation are the medial and lateral meniscus, prepatellar and infrapetallar bursa and the articular cartilages.

PATHOPHYSIOLOGY
Trauma: Accident in game such as luksong baka

Fell on her right hip

Impact on right hip

Stress to the joint when applied by force Hip dislocation S/sx: Pain, deformity of affected side, slow to walk, allis sign

DIAGNOSTIC PROCEDURE:
Physical examination 10/9/08 Result 129 0.36 27 77 36 26.62 0.85 0.42 0.01 0.05 0.5 Reference Value 110-158 g/L 0.32-0.54 28-32 pg 82-92 fl 31-38 % 4.5-10.5 10^3/uL 0.50-0.70 0.20-0.40 0.0-0.07 0.0-0.05 0.2-1.0% Analysis Normal Normal Slightly decreased Decreased Normal Elevated Elevated Slightly elevated due to trauma Normal Normal Normal CBC Specimen: Blood Examination Hemoglobin Hematocrit Mean Corpuscular Hematocrit Mean Corpuscular Volume Mean Corpuscular Hemoglobin Concentration White Blood Cells Segmenters Lymphocytes Monocytes Eosino Baso REMARKS: Platelets adequate 384 Prothrombin Time % Activity INR Activated PTT RBC morphology Children Clotting time Bleeding Blood Type O 14 800 130 11.7 110 .85 23.1 22-45 secs 0-10mm/hr 5-15 1-7mins. 11-15 secs

MEDICAL MANAGEMENT

10/9/08 VS monitoring qshift This will serve as a baseline data as the patient stays in the hospital Meds: ibuprofen 100/5 5ml q8 for pain This drug is for relieving the pain prn Xray of pelvis AP lateral To visualize the location, severity of the dislocation IVF D50 . 3NacL For the patients hydration Steinman pin inserted distal of femur, Used to correct the dislocation and right deformity thus relivieng pain Balanced skeletan Traction Indicated for hip and femur affection

Assessment

Nursing Diagnosis

Inference Accident: fall Impact on right hip Stress to the joint when applied by force Hip dislocation Activity intolerance

Objective

Nursing Intervention Independent: - Promote bed rest.

Rationale

Evaluation

S - Hindi na ko Activity makakapglaro ngayon, as reported by the client. O - unable to get out of bed alone - Boredom - Lack of interest in activities. intolerance related to dislocation on right hip

After 4-5 hours of nursing interventions, the patient will demonstrate a decrease in physiologic signs of intolerance.

Goal met, - To prevent over exertion. patient demonstrated a decrease in physiologic signs of intolerance as evidence by participating in some activities.

- Plan care with - To reduce rest periods fatigue. between activities. - Protects client - Assist the from injury. patient with his activities. - To know if - Instruct the activity level client in needs to be monitoring changed. response to activity and in recognizing signs and symptoms.