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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.
name of drug Generic Name: Cefuroxime Axetil Cefuroxime Sodium Brand Name: Cefuroxime Axetil (Ceftin [P.O.]) Cefuroxime Sodium (Zinacef [Parenteral])
Classification
Adverse effect
Indication
Contraindication
Nursing consideration
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
Classification
Adverse effect
Indication
Contraindication
Nursing consideration
Antypiretic, analgesics
Hematologic: hemolytic anemia, neutropenia, leukopenia, pancytopenia Hepatic: jaundice Metabolic: hypoglycemia Skin: rash, urticaria
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).
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
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.
Ulna
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.
Nutritional Metabolic
Elimination
Activity Exercise
Sleep rest
Cognitive-perceptual
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
Value pattern .
Case study
Submitted by: Cristalyn M. Macalino
assessment
Diagnosis
Planning
Intervention
Rationale
Evaluation
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
>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
Assesment
Diagnosis
Planning
Intervention
Rationale
Evaluation
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
>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
-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.
Intoduction
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 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.
Pathophysilogy
Stress place on the bone , Exceeds the bone to absorb it
Disruption of marrow and blood vessels attached to the ends of the bone
bleeding
Hematoma forms
Inflammatory response
pain