Close Right Arm Fracture

OUR LADY OF FATIMA UNIVERSITY

COLLEGE OF NURSING

JENNIFER CARULLA RN,MAN.

CLINICAL INSTRUCTOR

JOSE R. REYES MEMORIAL MEDICAL CENTER- E.R DEPT.

JOHN TIMOTHY D.G CASTRO

BSN 4Y1-2B

LEARNING OBJECTIVES:

General:

This case study aims to identify and determine the general health problems and

needs of a patient suffering from fracture secondary to vehicular accident. This

also intends to help patient promote health and understanding of such condition

through the application of nursing skills.

SPECIFIC OBJECTIVES:

To gain knowledge and acquire more information regarding to the cause of

the disorder, anatomy , pathophysiology.

To identify the different signs and symptoms and even complications.

To identify appropriate nursing interventions by using of nursing skills and

knowledge.

INTRODUCTION:

This is a case of 35 year-old male from manila city. The patient rushed to the

hospital (emergency dept.) after hitted by a motorcycle. He was diagnosed with a

closed right arm fracture.

A fracture is a break in the continuity of bone and is defined according to its type

and extent. Fractures occur when the bone is subjected to stress greater that it

can absorb. Fractures are caused by direct blows, crushing forces, sudden twisting

motions, and even extreme musc le contract ions . When the bone i s

broken, ad jacent s t ructures are a l so affected, resulting in soft tissue

edema, hemorrhage into the muscles and joints, joint dislo cation,

ruptured tendons, severed nerves, and damaged blood vessels. Body

organs maybe injured by the force that cause the fracture or by the fracture

fragments.There are d i f ferent types of f ractures and these inc lude,

complete f racture , incomplete fracture, closed fracture, open fracture

and there are also types of fractures

t h a t m a y a l s o b e d e s c r i b e d a c c o r d i n g t o t h e a n a t o m i c

p l a c e m e n t o f f r a g m e n t s , particularly if they are displaced or

nondisplaced. Such as greenstick fracture, depressed fracture, oblique fracture,

avulsion, spinal fracture, impacted fracture, transverse fracture and compression

fracture. A comminuted fracture is one that produces several bone fragments and

a closed fracture or simple fracture is one that not cause a break in the skin.

Patient’s Profile:

Name: P.C

Age: 35y/o

Sex: Male

Civil Status: Married

Address. Manila City.

Religion: Catholic

Date of Admission: Sept. 22, 2015

Admitting Dx: Close Right Arm Fracture

Chief Complaint: Pain of the right Arm

Family Hx: (-)DM, (-)HPN

Personal Hx: (+) Smoker, (+) Alcoholic Drinker

Anatomy&Physiology:

The word skeleton comes from the Greek word meaning “dried- up body”, our internal framework is so beautifully designed and engineered and it puts any modern skyscraper to shame. Strong, yet light, it is perfectly adapted for its functions of body protection and motion. Shaped by an event that happened more than one million years ago – when a being first stood erect on hind legs – our skeleton is a tower of bones arranged so that we can stand upright and balance ourselves. The skeleton is subdivided into three divisions: the axial skeleton, the boned that form the longitudinal axis of the body, and the appendicular skeleton, the bones of the limbs and girdles. In addition to bones, the skeletal system includes joints, cartilages, and ligaments (fibrous cords that bind the bones together at joints). The joints give the body flexibility and allow movement to occur. Besides contributing to body shape and form, or bones perform several important body functions such as support, protection, movement, storage and blood cell formation. Classification of Bones The diaphysis, or shaft, makes up most of the bones length and is composed of compact bone. The diaphysis is covered and protected by a fibrous connective tissue membrane, the periosteum. Hundreds of connective tissue fibers, called Sharpey’s fibers, secure the periosteum to the underlying bone. The epiphyses are the ends of the long bone. Each epiphyses consist of a thin layer of compact

bone enclosing the area filled with spongy bone. Articular cartilage, instead of periosteum, covers its external surface. Because the articular cartilage is glassy hyaline cartilage, it provides a smooth, slippery surface that decreases friction at joint surfaces. In adult bones, there is a thin line of bony tissue spanning the epiphyses that looks a bit different from the rest of the bone in that area. This is the epiphyseal line. The epiphyseal line is a remnant of the epiphyseal plate (a flat plate of hyaline cartilage) seen in young, growing bone. Epiphyseal plates cause the lengthwise growth of the long bone. By the end of puberty, when hormones stop long bone growth, epiphyseal plates have been completely replaced by bone, leaving the epiphyseal lines to mark their previous location. In adults, the cavity of the shaft is primarily a storage area for adipose (fat) tissue. It is called the yellow marrow, or medullary, in infants this areas forms blood cells, and red marrow is found these. In adult bones, red marrow is confined to the cavities of spongy bone of flat bones and the epiphyses some long bones. Bone is one of the hardest materials in the body, and although relatively light in weight, it has a remarkable ability to resist tension and other forces acting on it. Nature has given us an extremely strong and exceptionally simple (almost crude) supporting system without up mobility. The calcium salts deposited in the matrix bone its hardness, whereas the organic parts (especially the collagen fibers) provide for bone’s flexibility and great tensile strength.

Pathophysiology:

Predisposing Factors: Precipitating:

Trauma Falls

Vehicular Accident Osteoporosis

Damage to the bld. Supply of entire bone

Circulatory Compromise

Avascular (ischemic) necrosis may lead to:

Pain

Loss of Function

Deformity

Swelling

Paresthesia

DRUG STUDY

Drug/Class ActionIndicatio

nContraindicated

Adverse Rxn

Intervention

PARACETAMO

L

Antipyretic

Acts directly

on heat-

regulating

center to

cause

vasodilation

& sweating

Reduction

of fever,

back and

muscle

aches

Allergy to

acetaminophen

u/c impaired

hepatic, chronic

alcoholism

Headache,

Dyspnea,

hepatotoxicit

y and liver

failure

- Perform

skin test

- Give drug

with food

- DC if

hyper-

sensitivity

occurs

NURSING CARE PLAN

Assessment Diagnosis Planning Intervention Rationale Evaluation

Subjective:“Nilalagnat ako kagabi pa” as verbalized by the Pt. Objective:(+) weak(+) flushed skin(+) warm to touch

(+) headacheT 38.4 °CP 97 R 18 BP 120/80

Hyperthermia r/t the body response to disorderAEB: Increased body temp, weakness, skin flushed and warm to touch.

After 4 hours of nursing care, the patient will appear more relaxed and display reduced body temp.

Establish rapport. Monitor VS carefully

Place patient in low-back rest, change position frequently

Provide Tepid Sponge Bath

Instruct to increase oral fluid intake

Monitor urine output and skin turgor

Instruct to avoid dark-colored foods

Encourage high calorie diet

Encourage adequate rest or sleep

Instruct to wear loose-fit clothing

Provide bedside care (side rails up)

Build trust while making comparative data

To maximize breathing effort

To promote surface cooling

To replace fluid loss

To identify signs of dehydration

To identify signs of bleeding

To meet metabolic demands

To conserve body energy

To limit contributing factors

For comfort and bed safety

After 4 hours of nursing care, the patient appeared more relaxed and displayed reduced body temp.AEB:Less weakness, skin less warm to touch (+) cold sweat

T 37.9P 95R 19BP 120/80

Goal is partially met.

DISCHARGE PLAN

Medication: Advise the client or significant other to take paracetamol as indicated.

Exercise and Activity: Instruct patient to take adequate rest breaks when tired, do not

over exert. Advice to perform ADL’s as tolerated and do range of motion and repetitive

body movements for promotion of exercise.

Treatment: Instruct to client or significant others to follow treatment regimen.

Health Teaching: Instruct client or significant others to watch out for or report any sign

of 4P’s (Pain, Pallor, Pulselessness, Paresthesia,) also watch out for yellowish

discharge that may indicate infection and report any signs of compartment syndrome.

Out-patient: Instruct for a return checkup as advised by the physician

Diet: Advice Patient to Increase fluid intake.

Encourage patient to eat high calcium foods/drinks and nutritious foods for faster and better bone healing.

Medical Management:

Temporary skin traction

Open or Closed of fracture or internal fixation

Cast

NSAID for Pain