Introduction

Mr. M.E. from Sangandaan Caloocan City, single, 34 years old, male, 5 ft. and 5 inches tall in height, weighs 120 lbs. he was admitted on February 12, 2012 at around 10:30 a.m. due to lacerated wound secondary to stab wound. Patient was stab by a known person that caused him a multiple stab wound at the forearm. (Wikipedia) The human skin has a somewhat elastic property as a self-defense; when the human body is stabbed by a thin object such as a kitchen knife, the skin often closes tightly around the object and closes again if the object is removed, which can trap some blood within the body. It has thus been speculated that the fuller, an elongated concave depression in a metal blade, functions to let blood out of the body in order to cause more damage. This misconception has led to fullers becoming widely known as "blood grooves". The fuller is actually a structural reinforcement of the blade similar in design to a metal I-beam used in construction. However, internal bleeding is just as dangerous as external bleeding; if enough blood vessels are severed to cause serious injury, the skin's elasticity will do nothing to prevent blood from exiting the circulatory system and accumulating uselessly in other parts of the body. He was admitted on February 12, 2012 at Philippine Orthopedic center. Patient has a lacerated wound volar aspect of ulnar left forearm. He was diagnosed with FIT (EDC) at left ring finger and FIT (FDF) at left long finger at about 5 cm. lacerated wound. He undergoes a surgery of Tenorraphy on February 12, 2012 using a GETA anesthesia. (www.stoneclinic.com ) Surgical Intervention: Positioning. Position during procedure. Depends on site of injury. Achilles tendon: Prone; if surgical assistant not available, position so that dorsum of forefoot remains on the table (not dangling) so that foot can be held in equinus during the tendon repair. Supplies and equipment. Esmark and Tourniquet upper thigh. Special considerations: high risk areaschest rolls and padding for bony prominences, proper head alignment. Next surgeon closes paratenon over the site of the tendon repair to aid in healing and preventing adhesions from forming. Wound closed in layers and splint dressing is applied while in equinus position. (WebMD) General anesthesia uses intravenous and inhaled agents to allow adequate surgical access to the operative site. A point worth noting is that general anesthesia may not always be the best choice;

depending on a patients clinical presentation, local or regional anesthesia may be more appropriate. Anesthesia providers are responsible for assessing all factors that influence a patient's medical condition and selecting the optimal anesthetic technique accordingly. Attributes of general anesthesia include the following: Reduces intraoperative patient awareness and recall. Allows proper muscle relaxation for prolonged periods of time. Facilitates complete control of the airway, breathing, and circulation. Can be used in cases of sensitivity to local anesthetic agent. Can be administered without moving the patient from the supine position. Can be adapted easily to procedures of unpredictable duration or extent. Can be administered rapidly and is reversible. Patient complaints that he was not able to extend his ring finger of his left hand and unable to bent his middle finger of his left hand.

Pathophysiology

History Mr. Montoya, Elmer a 34 years old, male, has a medical history of hypertension of both sides parents. Patients compliance to medication maintenance of a Calci-Blocker for his hypertension. (WeBMD.com) Calcium channel blockers are used to lower high blood pressure. This medicine can be taken either alone or with other blood pressure medicines such as a diuretic. Patient has no history of diabetes mellitus, no history of bronchial asthma. He has been a smoker for 17 years and he consumes 10 sticks per day. On 1992 he was admitted at Tondo General Hospital secondary to stab wound and exploratory surgery procedure was performed. Nursing Physical Assessment During the initial assessment, Mr. Montoya, Elmer physical examination reveals him to be alert and oriented to person, place and time. He was conversant and coherent. His speech and vision are intact. The physical examination is normal except for left forearm. He has an equal grip bilaterally and can move all his extremities, though he has a feeling of discomfort. His peripheral pulses are strong and equal. He is on a regular diet. His appetite has been good. The patient is voiding appropriately. His skin is warm, dry in appearance and fast to comply nursing instructions. Capillary refill is less than two seconds for all digits and two point discrimination is less than 5 mm on both the radial and ulnar aspects of each digit. Capillary refill is a clinical sign popularized in the past 15 years. Intuitively it is a measure of peripheral perfusion which is likely to be a function of cardiac output and peripheral vascular resistance. (Larry J. Baraff) It is a semi quantitative test, with a value of < 2 seconds generally considered to be normal. The examination of the hand, elbow, upper arm, and shoulder are normal. As verbalized by the patient, he has an altered ability to continue previous activities and unable to extend his middle finger of her left hand and unable to bent his ring finger of his left hand. Patient also claims that he feels numbness on his middle finger and ring finger. Presence of cyanosis was also noticed on his middle finger and ring finger nails. Initial vital signs are as follows. Temperature of 35.7, Respiratory Rate of 76 and Blood Pressure of

140/90. The patient cast was dry and intact. Diagnostic Test includes laboratory examination of GS-RBC, Hematology and the component Indices. Laboratory results are as follows, for RBC result, no microorganism seen and no spore forming bacilli seen. Esonophils reveals of 0.07 and a normal value is 0.06-0.05. MCV is 103 and the normal count is 82-92 fl., MCH is 33 and the normal is 28-32 pg. Patient experienced sleep disturbance in the hospital because of frequency distractions of the interventions done for recovery. Related Treatments

The patient has no allergies to latex, iodine. The patient has an I.V fluid of D5LR. The patient receives medications of Cefuroxime750 mg. /I.V. (MedicineNet.com) Cefuroxime is used to treat a wide variety of bacterial infections. This medication is known as a cephalosporin antibiotic. It works by stopping the growth of bacteria. This antibiotic treats only bacterial infections. It will not work for viral infections. PenG 5 ml/vial for every 8 hours. (Mosby publishing, 1996) Drug action: Inhibits enzymes responsible for cell wall synthesis of susceptible organisms. This creates an osmotically unstable cell wall that swells and bursts from osmotic pressure. It is a bactericidal drug in normal doses. This drug is excreted through the renal system. Celecoxib 200 mg. per tablet as needed to relieve pain. Lanzoprazole 30 mg. per tablet. (MedicineNet.com) Lansoprazole is in a class of drugs called proton pump inhibitors (PPI) which block the production of acid by the stomach. Paracetamol 500 mg. as needed to alleviate fever for 30C above.

Diagnosis Planning Subjective: Patients verbalized of: -Numbness of middle and ring finger -Cyanosis on affected finger nail. -Unable to extend ring finger. -Unable to bend middle finger. -Sleep disturbance. -Altered ability continue activity. Objective: BP- 140/90 RP- 20 PR- 76 Temp.- 35.7 to

Intervention

Evaluation

Recommendation The patient should follow instructions in caring for his wounds. Always follow the doctors instructions in caring a wound. And take medications on time. (www.surgeryencyclopedia.com) The goal of postoperative care is to prevent complications such as infection, to promote healing of the surgical incision, and to return the patient to a state of health. Postoperative care is the management of a patient after surgery. This includes care given during the immediate postoperative period, both in the operating room and post anesthesia care unit (PACU), as well as during the days following surgery. Keep dressings in a clean, dry place. Tell to the Doctor or Nurse if t the wound gets larger or deeper, more fluid drains from the wound, or the wound does not begin to show signs of healing in 2 to 4 weeks. And notify if theres a signs of infection. It is helpful to eat a balanced diet and drink fluids. (www.medicalnewstoday.com) Two liters of fluid intake per day is needed as the body eliminates this quantity of fluid every day through the skin, lungs, bladder and intestines. As water is the body's most important component it cannot go without it for more than about three days. The amount of body fluid is regulated via the skin and the kidneys. Perspiration maintains internal temperature at a constant 37 degrees Celsius and the kidneys filter poisons and waste metabolic products from the blood by eliminating them via urine.