PHILIPPINE ORTHOPEDIC CENTER

NURSING AFFILIATION 2011

COLEGIO de DAGUPAN
College of Nursing
S.Y. 2010-2011

EPIPHYSEAL SEPARATION
OF THIRD DISTAL TIBIA

Submitted by:
DEMATAWARAN, Charmaine B

Submitted to:
Mrs. Edita M. Placido
INTRODUCTION
 P A T I E N T ‘S P R O F I L E

 Name:
QGYUINNE TRYSTANNE AMONGO
·1 Age:
9 years old
·2 Birth Date:
August 5, 2001
·3 Sex:
Male
·4 Civil Status:
Single
·5 Nationality:
Filipino
·6 Religion:
Roman Catholic
·7 Address:
 42 A Batis St. Bayanihan Drive St., Maligaya
Project 8 Quezon City
 Date of Admission:
 April 9, 2011
 12 Midnight
 Chief Complaint:
Pain on right ankle
 Diagnosis:
 Epiphyseal Separation D/3 Tibia ® Salter Harris II
 Intervention:
Closed Reduction Planning
 Case No. :
  641277
 Course in the Ward:
 Patient was admitted and underwent application
of cast with pins
 Condition on Arrival:
 Good
·8 Doctor-in-charge:
Dr. Moreno
BRIEF CLINICAL HISTORY AND PERTINENT
Physical Examination
Patient’s foot was caught in the spike of the bicycle wheel.
Brief History
Seven (7) days prior to consultation the patient’s right foot got
stucked inside the bicycle wheel.
Time of Incident
3:00 P.M.
Place of Incident
Road (Batangas)

HISTORY OF PRESENT ILLNESS

Eight (8) days prior to consult, patient’ foot was caught in a bicycle wheel.
Patient sought consent in nearby hospital and was advised daily wound care.
Persistence of pain prompted consult.

PAST MEDICAL HISTORY

Completed vaccination
(+) previous hospitalization for Dengue

FAMILY HISTORY
(+) Diabetes Mellitus –mother side
(+) Hypertension (HPN) – mother side
(+) Asthma –mother side

PERSONAL & SOCIAL HISTORY

Primary care given by his grandmother.
PHYSICAL EXAMINATION
General-Survey
Patient is conscious, coherent not in distressed.
Laboratory Findings
Laboratory exam was unremarkable
Examination of Systems
→ Pink palpable conjunctival anicteric sclera
→ (-) Refraction
→ AP normal heart breath
→ (-) Murmur
→ Abdomen soft, non-tender

Other Physical Examination Findings

→ (-) Abrassion medial aspect right ankle

Discharge:
 April 13, 2011
 4:00 P.M.
 LABORATORY RESULT
Component
Hemoglobin Mass 124
Hematocrit 0.41
Leucocyte Count 7.90

Differential Count
Segmenters 0.72
Lymphocytes 0.22
Monocytes 0.03
Eosinophils 0.03

Platelet Count: 459

Coagulation Studies
PTT 12.1
% Activity 107
INR 0.88

Activated PTT: 24.3

Blood Type: “A”
RH Typing: (+)

Indices
MCV 81
MCH 25
MCHC 31

RBC Morphology:
ESR Westerngren Method
Children:
Clotting Time
(Lee & White) 6’ 00”
Bleeding Time
(Ivy’s Method) 2’ 30”
________________________________________________________________

URINALYSIS
Physical Characteristics
Color Yellow
Transparency Hazy
Reaction 6.0
Specific Gravity 1.030

Cells
RBC 0-2/hpf
Renal Cells Few
Epithelial Cells Few
Pus Cells 4-6/hpf
Bacteria Few

Crystal
Amorphous Few
Calcium Oxalate Few

Chemistry Test
Sugar Negative
Protein Trace

ANATOMY & PHYSIOLOGY

 DRUG STUDY

Drug Name Route/Dosage Therapeutic Adverse Contraindication Nursing Consideration

Action Reaction
Serious infections Inhibits protein CNS:  Contraindicated in  Obtain specimen for
Brand Name:
caused by sensitive synthesis by neuromuscular patients culture and sensitivity
Amikin strains of binding directly blockade hypersensitive to tests before giving first
Pseudomonas into the 30S EENT: ototoxicity drug or other dose. Therapy may
aeruginosa, ribosomal GU: azotemia, aminoglycosides. begin while awaiting
Escherichia coli, subunit; nephrotoxicity,  Use cautiously in results.
Proteus, Klebsialla, bactericidal. possible increase patients with  Evaluate patient’s
or Staphylococcus. in urinary impaired renal hearing before and
Generic  Adults and excretion of casts. function or during therapy if he
Name:
children: Musculoskeletal: neuromuscular will be receiving drug
Amikacin 15mg/kg/day arthralgia disorders, in for longer than 2
Sulfate
I.M. or I.V. Respiratory: neonates and weeks. Notify
infusion, in apnea infants, and in prescriber if patient
divided doses q elderly patients. has tinnitus, vertigo,
8 to 12 hours. or hearing loss.
 Neonates:  Weigh patient and
Initially, loading review renal function
dose of studies before therapy
10mg/kg I.V.; begins.
then 7.5 mg/kg  Obtain blood for peak
q 12 hours. amikacin level 1 hour
after I.M. injection and
3o minutes to 1 hour
 after I.V. infusion
ends; for trough
levels, draw blood just
before next dose.
Don’t collect blood in
a heparinized tube;
heparin is
incompatible with
aminoglycosides.
 Peak drug level more
than 35mcg/ml and
trough levels more
than 10 mcg/ml may
be linked to a higher
risk of toxicity.
 Monitor renal function:
urine output, specific
gravity, urinalysis,
BUN and creatinine
levels, and creatinine
clearance. Report to
prescriber evidence of
declining renal
function.
 Watch for signs and
symptoms of
 superinfection
(especially of upper
respiratory tract), such
as continued fever,
chills. And increased
pulse rate.
 Therapy usually
continues for 7 to 10
days. If no response
occurs after 3 to 5
days, stop therapy
and obtain new
specimen for culture
and sensitivity testing.

Drug Name Route/Dosage Therapeutic Adverse Contraindication Nursing Consideration

Action Reaction
 Moderate to Unknown. Binds CNS: H/A,  Contraindicated in • Reassess pts. level of pain
Brand Name: severe pain with opiate sedation, pts. hypersensitive @ least 15 to 30 minutes after
 Adults: receptors in the dizziness, vertigo, to drugs. parenteral administration.
Nalbuphine For a pts. of CNS, altering nervousness, • Drug acts as an opioid
 Use cautiously in
Hydrochloride
about 70kg perception of and depression, pts. with history of antagonist and may cause
{154lb}, 10 to emotional restlessness, drug abuse and in withdrawal syndrome. For pts.
Generic 20 mg S.C., response to pain. crying, euphoria, those with emotional who have received long-term
Name: I.M., or I.V. q 3 hostility, opioids, give 25% of the usual
instability, head
Nubain to 6 hours, confusion, injury, increased dose, initially. Watch for signs of
p.r.n. unusual dreams, intracranial withdrawal.
maximum, 160 hallucinations, pressure, impaired • Alert: Drug causes
mg daily. speech d/o., ventilation, MI respiratory depression, which @
delusions. accompanied by 10 mg is equal to respiratory
CV: HPN, N/V, upcoming depression produced by 10 mg of
hypotension, biliary surgery, and morphine.
tachycardia, hepatic or renal dse. • Monitor circulatory and
bradycardia. Alert: Certain respiratory status and bladder and
EENT: blurred commercial bowel function. Withhold dose and
vision, dry mouth. preparations contain notify physician if respirations are
GI: cramps, Na metabisulfate. shallow or rate is below 12
dyspepsia, bitter breaths/min.
taste, N/V, • Constipation is often
constipation, severe with maintenance therapy.
biliary tract Make sure stool softener or other
spasms. laxative is ordered.
GU: urinary • Psychological and physical
 urgency. dependence may occur with
Respiratory: prolonged use.
respiratory • Alert: Don’t confuse Nubain
depression, with Navane.
dyspnea, asthma,
pulmonary
edema.
Skin: pruritus,
burning, urticaria,
clamminess,
diaphoresis.

Drug Name Route/Dosage Therapeutic Adverse Reaction Contraindication Nursing Consideration

Action
Perioperative First-generation CNS: headache,  Contarindicated  Before administration,
Brand Name: prevention in cephalosporin confusion, seizure. in patients ask patient if he is allergic
contaminated that inhibits cell- CV: phlebitis, hypersensitive to penicillins or
Ancef surgery wall synthesis, thrombophlebitis with to drug to other cepahlosporins.
 Adults: promoting I.V. injection. cephalosporins.  Obtain specimen for
Generic 1 g I.M. or osmotic GI:  Use cautiously culture and sensitivity
Name:
I.V. 30 to 60 instability; pseudomembranous in patients tests before giving first
Cefazolin minutes usually colitis, nausea, hypersensitive dose. Therapy may begin
Sodium
before bactericidal. anorexia, vomiting, to penicillin while awaiting results.
surgery; then diarrhea, glossitis, because of the  Expect to adjust dosage
0.5 to 1 g dyspepsia, possibility of and dosing interval if
I.M. or I.V. q abdominal cramps, cross-sensitivity creatinine clearance falls
6 to 8 hours anal pruritus, oral with other beta- blow 55ml/minute.
for 24 hours. candidiasis. lactam  After reconstitution, inject
In operations GU: genital pruritus, antibiotics. drug I.M. without further
lasting candidiasis, vaginitis.  Use cautiously dilution. This drug isn’t as
longer than 2 Hematologic: in breast- painful as other
hours, give nuetropenia, feeding women cephalosporins. Give
another 0.5- leucopenia, and in patients injection deep into a large
1g dose I.M. eosinophilia, with a history of muscle, such as the
or I.V. thrombocytopenia. colitis or renal gluteus maximus or
intraoperativ Skin: maculopapular insufficiency. lateral aspect of the thigh.
ely. Continue and erythematous  If large doses are given,
treatment for rashes, urticaria, therapy is prolonged, or
3 to 5 days if pruritus, pain, patient is at high risk,
life induration, sterile monitor patient for signs
threatening abscesss, tissue and symptoms of
 infections is sloughing at injection superinfection.
likely. site, Stevens-  Alert: Don’t confuse drug
Johnson syndrome. with other cephalosporins
that sound alike.

NURSING CARE PLAN

Assessment Explanation of the Planning/Objectives Intervention Rationale Evaluation
Problem
After 2 hours of Independent:  To gain After 2 hours of
Nursing Dx: Individuals normally nursing 1. Establish rappoirt trust and nursing
have defenses that intervention the cooperation of intervention
Risk for
infection protect the body from patient will gain the patient the patient will
infection. These knowledge in 2. Teach patient to wash  Hand be
defenses can be infection control hands often,especially washing reduces able to gain
categorized as as evidenced by before toileting, the risks for knowledge in
nonspecific and specific. discussing the before meals and before infection. Lowers infection control
Nonspecific defenses wound care. and after administering the risk of skin or as
protect the person  Patient will attain timely self-care. tissue breakdown evidenced by
against all healing of wounds or and infection. his discussion in
microorganisms, lesions. 3. Talk about  Helps in wound care.
regardless of prior  Patient will exhibit necessitate for sufficient liquefying Therefore, the
exposure. Specific methods, lifestyle nutritional intake. respiratory goal was met.
(immune) defenses, by changes to uphold safe secretions to
contrast, are directed environment. make possible
against identifiable  Patient will keep a safe the expectoration
bacteria, viruses, fungi, aseptic environment. and avoid stasis
or other infectious  Patient will recognized of body fluids.
agents. Persons at risk Infection promptly to 4.Discuss to patients the  To impart
for infection are those allow for early following signs of to the patient
whose natural defense management. infection - redness, when the wound
mechanisms are  Patient will remain free swelling, increased pain, become infected
inadequate to protect of infection, as or purulent drainage on and when to
them from the inevitable manifested by normal the site and fever. sought medical
injuries and exposures vital signs and care.
that occur throughout nonexistence of 5. Demonstrate and  To know if
the course of living. An purulent drainage from allow return he patient really
infection happens when wounds, incisions, and demonstration of wound understand the
there is an invasion of tubes. care. principle of
body tissue by  Patient will take part in proper wound
microorganisms and behaviors to decrease care.
when they grow there. risk of infection. 6. Monitor visitors or  This
Such microorganism is  Patient will verbalize staff for signs of decreases the
called an infectious awareness of individual infection. Manage visitor amount of
agent. If the causative or risk factors. adherence to protocol as organisms in
microorganism produces necessary. patient’s
no clinical evidence of surroundings and
disease, the infection is limits visitation by
called asymptomatic or individuals with
subclinical.exogenos any kind of
sources. infection to
decrease the
transmission of
pathogens to the
patient at risk for
infection. It also
decreases
potential of
patient
contracting a
nosocomial
infection. The
 most frequent
modes of
transmission are
by means of
direct contact
and by droplet.
Dependent:
1. Give  Antimicrob
antimicrobial/antib ial drugs
iotic drugs as comprise
ordered. antibacterial,
antifungal,
antiparasitic, and
antiviral agents.
Every of these
agents are either
toxic to the
pathogen or
retard the
pathogen’s
growth.
2. Grant for infection  Lowers
precautions or the risk of cross-
isolation as contamination to
necessary. staff, visitors, and
other patients.
HEALTH TEACHING