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Patients Profile Name: Barredo, Gabriel Sex: male Age: 11 y/o Address: 1774 Milagros St. Sta.

Cruz Hospital #: 2345774 Bed #: 42 Nationality: Filipino Religion: Catholic Date of admission: 02-20-12 Diagnosis: Distal Left Upper fracture Chief complaint: severe wrist pain

Past History:

Present History : 2 hour prior to PTC, hanging on a barracks, clients stopped and fell, severe pain on the left noted, associated with deformity hence consult.

Course in the ward

name of drug Generic Name: Cefuroxime Axetil Cefuroxime Sodium Brand Name: Cefuroxime Axetil (Ceftin [P.O.]) Cefuroxime Sodium (Zinacef [Parenteral])


Adverse effect



Nursing consideration

anti-infective antibiotic, second generation cephalospori n

CV: phlebitis, thrombophlebitis GI: pseudomembranou s colitis, nausea, anorexia, vomiting, diarrhea Hematologic: transient neutropenia, eosinophilia, hemolytic anemia, thrombocytopenia Skin: maculopapular and erythematous rashes, urticaria, pain, induration, sterile abscesses, temperature elevation, tissue sloughing at intramuscular injection site Other: hypersensitivity reactions, serum sickness, anaphylaxis.

* Pharyngitis, tonsillitis, infections of the urinary and lower respiratory tracts, and skin and skinstructure infections caused by Streptococcus pneumoniae and S. pyogenes, Haemophillus influenzae, Staphylococcu s aureus, Escherichia coli, Moraxella catarrhalis (including betalactamaseproducing strains), Neisseria gonorrheae, and Klebsiella and Enterobacter species.

Contraindicate d in patients hypersensitive to drug. * Use 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 in patients with history of colitis or renal sufficiency.

Before administering, make sure patient is not allergic to penicillins or cephalosporins. * Absorption of cefuroxime axetil is enhanced by food. * Cefuroxime axetil tablets may be crushed if swallowing is a difficulty. Cefuroxime axetil tablets may be dissolved in small amounts of apple, orange or grape juice, even chocolate milk. However, drugs bitter taste is difficult to mask even with food. * High-fat meals increased drug bioavailability. * ALERT! Cefuroxime axetil film-coated tablet and oral suspension are not bioequivalent. * If large doses are given, therapy is prolonged, or patient is at high risk, monitor patient for signs and symptoms of superinfection. * Unlike other second generation cephalosporins, cefuroxime can cross the blood-brain-barrier. * ALERT! Do not confuse with other cephalosporins that

Name of drug


Adverse effect



Nursing consideration

GENERIC NAME: acetaminophe n BRAND NAME: Tylenol

Antypiretic, analgesics

Hematologic: hemolytic anemia, neutropenia, leukopenia, pancytopenia Hepatic: jaundice Metabolic: hypoglycemia Skin: rash, urticaria

* relief of fevers * aches * mild to moderate pain

Contraindicate d in patients hypersensitive to drug. * Use cautiously in patients with long term alcohol use because therapeutic doses cause hepatotoxicity in these patients.

ALERT! Many OTC and prescription products contain acetaminophen; be aware of this when calculating total daily dose. * Use liquid form for children and patients who have difficulty swallowing. * In children, dont exceed 5 doses in 24 hours. * Consult prescriber before giving drug to children younger than age 2. * Advise that drug is only for short-term use and to consult prescriber if giving to children for longer than 5 days or adults for longer than 10 days. * Do not to use for marked fever (temperature higher than 103.1 F [39.5 C]), fever persisting-longer than 3 days, or recurrent fever unless directed b y prescriber. * ALERT! High doses or unsupervised long-term use can cause liver damage. Excessive alcohol use may increase the risk of liver damage. Caution longterm alcoholics to limit the use of acetaminophen intake to less than or equal to 2 g/ day. * For breast-feeding women: acetaminophe n appears in breast milk in low levels (less than 1% of dose).

Anatomy and physiology

Arm Bones | Bones of the Arm and Forearm

In anatomy, the entire arm is divided into two regions, the upper portion above the elbow known as the upper arm and the lower portion below the elbow known as the forearm. Sometimes the the entire arm is referred to as the upper limb and the two portions are the arm and forearm. However, for our purposes we will use the terms upper arm and forearm. Below are detailed diagrams and information regarding the arm bones (upper arm bones and forearm bones). Learn the names of the arm bones and arm anatomy trough the arm bones diagram. List of all Arm Bones

Humerus (2) Radius (2) Ulna (2)


The humerus is the bone of the upper arm extending from the shoulder to the elbow. This long bone is essential for movement and support of the arm (upper extremity). The humerus exists on both arms and thus accounts for 2 bones of the human body.

The humerus is divided into three portions, the rounded head, the narrow neck, and the processes known as the tubercles. The humerus is essential for movement because it is the site of many muscle and ligament attachments. Examples of muscles attaching to the humerus include the deltoid, pectoralis major, teres major, latissimus dorsi, biceps brachii, brachialis, coracobrachialis, and the brachioradialis. Radius

The radius is the bone of the forearm or lower arm, extending from the elbow to the wrist. This bone is relatively

long and curved, extending parallel to the ulna. Like the humerus, the radius primary function includes motion of the arm and support of the arm. The radius connects to many muscles, such as the biceps, supinator, flexor digitorum superficialis, flexor pollicis longus muscles, extensor ossis metacarpi pollicis, extensor primi internodii pollicis, and the pronator teres muscles. Furthermore, the radius is found on each arm thus contributing a total of two bones to the human body skeleton.


The ulna is the third and final bone of the arm. This bone runs parallel to the radius from the elbow to the wrist. Like the other arm bones, the ulna is relatively long and slightly curved. The primary function of the ulna is allowing motion and supporting the arm. An ulna exists on each arm and thus contributes two bones to the total human body skeleton.

Gordons Functional health pattern

Health perception and Management Before the accident, the client is fully loaded powerful playing with his friends, he ignored the pain he feels while he was playing ,as a child playing with friends sometimes forget the pain. The patient is love eating junk foods rather than vegetables, but sometimes he eats fruits. He loves drinking juices and soft drinks rather than milk. He has no any multivitamins supplements He urinates more than 4x in a whole day, and defecates twice a day. His urine is yellowish-orange in color and his stool is formed brown. Playing with his friends he represent his exercise everyday, after from schooling such as (tumbang preso , habulan), He usually sleep for 8-10 hours, he had some dreams and nightmares. He wakes up early for get ready in his school and also he sleep early because of his long day in his school and tiredfull playing with his friends. My patient follows direction with his cooperation and understanding, he has no hearing , seeing difficulties he cooperates smoothly and retain some informations. He had a discomfort in his left arm fractured he felts some pain. My patient shows he sad and fear about his condition that he thinks he cannot played anymore and he cannot used his one armed.

Nutritional Metabolic


Activity Exercise

Sleep rest


Self perception/self concept

Role relationship . . Sexually reproductive

He lived with his complete and happy family, he was the youngest. he was actively played with his peers and in their school.

Genital stage -Puberty in other words. Glandular, hormonal, and physical changes in the adolescent child's body cause a resurgence of sexual thoughts, feelings and behaviours. My patient I interviewed and observe, at his age he is not more seriously dealed about stress because of his stage is centered to his peers playing with them and start of his puberty. My client is a Roman catholic he usually goes to a church sometimes, he believes in GOD

Coping stress tolerance

Value pattern .

Case study
Submitted by: Cristalyn M. Macalino

Submitted to: Mrs. Vilma Miguel







subjective: nahihirapan akong gawin ang mga ibang bagay na magisa

Objective: Limited range of motion ,limited to perform fine motor skills, slowed movement

Impaired physical mobility r/t impaired musculoskeletal as manifested by limited range of motion, perform fine motor skills and slowed movement

After 1-2 hours of nursing intervention the patient will able to verbalize understanding of situation individual treatment regimen and safety measures

-Instruct the patient use of side rails,overhead trapeze,and roller pads -support affected parts using pillows

>for position changes and or to transfer

>to maintain position comfortable and reduce pressure >to reduce fatigue and promotes safety >promotes well being and maximizes energy production

After 1-2 hours of nursing intervention the patient able to verbalized understanding of situation individual treatment regimen and safety measures

-guide activities w/ adequate rest periods during the day -encourage adequate intake of fluids and nutritious foods







subjective: uuwi na ako at gagaling na rin ako as verbalized by the patient.

Objective: Express confidence in abilities Actions are congruent w/ express feelings and thoughts

Readiness for enhanced self concept r/t develop in the illness as manifested by express willingness to enhance self concept and confidence in abilities

After 1-2 hours of nursing intervention the patient will able to demonstrate behaviours lifestyle changes to promote positive selfsteem

-determine current status of individuals belief concept

>information about clients current thinking about self provides a beginning for making changes to improve self >presence of supportive people who reflect positive attitudes promotes a positive self sense of self >promotes trusting situation >positive words of encouragement Support development of effective coping behaviours >promotes socialization

After 1-2 hours of nursing intervention the patient able to demonstrated behaviours lifestyle changes to promoted positive selfsteem

-determine availability of family and s/o

-develop therapeutic relationship -give reinforcement for progress noted

-involve in activities /exercise program of choice -encourage participation in classes/activities/ Hobbies that clients enjoy

>provides opportunity for learning skills that enhance feelings of success, and self-steem

an xray of a normal wrist, looking at it from the front (left) and from the side (right). In the left picture the radius is the larger bone in the photograph

This is an xray of a typical distal radius fracture, looking at it from the front (left) and from the side (right). In the pictures, the fracture (broken bone) is indicated by the arrows. The other black spaces are the joints.


The bones of the forearm are the radius and the ulna. If you hold your arm naturally by your side, the ulna is the bone closer to you and the radius is farther away. Fractures of the forearm can occur near the wrist at the farthest (distal) end of the bone, in the middle of the forearm, or near the elbow at the top (proximal) end of the bone. A child's bones are also subject to a unique injury called a growth plate fracture. Growth plates are made of cartilage near the ends of children's bones. They help determine the length and shape of the mature bone.

Fractures of both bones in the forearm.

Fractures in a child's bones begin to heal much more quickly than an adult's bones. If you suspect a fracture, you should obtain prompt medical attention for the child so that the bones can be set for proper healing. Statistics Forearm fractures account for 40% to 50% of all childhood fractures. About three out of four forearm fractures in children involve the wrist-end of the radius. Cause Children love to run, hop, skip, jump and tumble. But if a child falls onto an outstretched arm, he or she might break one or both of the bones in the forearm. Symptoms In most cases, a broken forearm causes severe pain. Your child's forearm and hand may also feel numb.

Any type of deformity about the elbow, forearm, or wrist Tenderness Swelling An inability to rotate or turn the forearm

Your doctor will also test to make sure that the nerves and circulation in your child's hand and fingers have not been affected.

Investigation, Tests The hand, wrist, arm, and elbow can all be injured during a fall on an outstretched arm. To determine exactly what injuries have occurred, your doctor will probably want to see x-rays of the elbow and wrist, as well as the forearm. Nonsurgical Treatment Treatment depends on the type of fracture and the degree of displacement.

Casts support and protect broken bones while they heal. Some mild fractures, such as buckle fractures, may simply need the support of a splint or cast until they heal. For more severe fractures that have become angled, your doctor may be able to push (manipulate) the bones into proper alignment without surgery, as long as the bones have not broken through the skin. A stable fracture, such as a buckle fracture, may require 3 to 4 weeks in a cast. A more serious injury, such as a Monteggia fracture-dislocation, may need to be immobilized for 6 to 10 weeks.

Surgical Treatment Surgery to align the bones and secure them in place may be required if: The skin is broken The fracture is unstable the ends of the broken bones will not stay lined up Bone segments have been displaced The bones cannot be aligned properly through manipulation alone The bones have already begun to heal at an angle or in an improper position

Discharge plan

-Until the cast has properly set, avoid direct heat such as hot water bottles. -Rest the limb as much as possible to promote healing. -Use the techniques shown to you by nursing staff to walk or manage day-to-day activities. For example, you risk further injury if you use crutches incorrectly. -Avoid any lifting or driving until the fracture has healed. --If you experience an itch, dont poke anything between the cast and your limb (such as a coat hanger or pencil). Instead, use a hairdryer to blow cool air into the cast. -Avoid getting your cast wet, as wet plaster becomes soft and does not provide the necessary support. Wet plaster can also cause skin irritation. When showering, wrap the cast in a plastic bag and tape it directly to the skin, keeping the area water-tight. -See your doctor immediately if you experience swelling, blueness or loss of movement of the fingers or toes, pins and needles, numbness or increased pain.

Stress place on the bone , Exceeds the bone to absorb it

Injury in the bone

disruption in thcontinuity of the bone

Disruption of marrow and blood vessels attached to the ends of the bone

Soft tissue damage


Hematoma forms

Bone tissue surround the fractured site dies

Inflammatory response