FRACTURE

A CASE PRESENTATION OF BSN 3YB-7

GROUP 2
Objective/Purpose of the
Case Scenario
study & Background
Lacuarin
De borja
De Ocampo
Etiology Evangelista
Lacuarin
Junio Anatomy & Physiology
Guilas Dela Cruz
Duran
Delmar
Jumao-as
CASE
SCENARIO
PATIENT PROFILE: A 19 years old male from Angeles, Pampanga was electively
Name: M.J admitted for operative procedure. Patient was apparently
well until 4 months ago, where he sustain an injury to the
Age: 19 years old
medial side of his right leg, where he was tackled during a
Sex: Male rugby match. Afterwards, there is deformity in the form of
Occupation: Student dent at medial side of lower 1/3rd of his right leg. His right
Date of Admission: 5th June 2012 foot dorsiflexion was restricted but all other movement are
intact. No wound at the injury site
He also complain of pain at the site of injury,
which is sudden onset. It was intermittent,
throbbing in nature , aggravated on
movements especially on movement of the
right leg and foot, relieved by rest and pain
killers. Pain scale was 7/10. There is swelling
at the site of fracture afterwards, start
insidiously, increasing in size and resolve
spontaneously in 3 days time. He was then
sent to Angeles Pampanga Medical Centre,
where x-ray of his right leg was taken and
he was told that there is fracture of tibia
while the other bone is intact. Above knee
plaster of paris cast was applied and he was
told to come for follow up once in a month.
 On examination by the doctor

He was told that the fracture

site is mobile and there is no
pain. He was put on elective
surgery appointment on 6th
June 2012 to close the gap at
the fracture site

No history suggestive of
tuberculosis
No osteomyelitis
Not an intravenous drug
user
Not alcoholic
Doesn't smoke or do sexual
promiscuity
No loss of weight or appetite.
 Local examination of right lower
limb

On inspection
Attitude: hip flexed and
adducted, knee extended, foot
dorsiflexed and inverted
Deformity at lower 1/3rd of
medial side of right leg
Apparent shortening of the right
lower limb – Atrophy of the right
thigh
On palpation
Deformity: bony consistency
Mobile on lateral plane
Crepitus
No tenderness
No local rise in temperature
 Sensory Neurovascular
Galeazzi’s sign on thigh, leg and examination
Right knee lower
foot are intact. normal . Power on
and forward No functional right lower limb is
impairment. 4/5.

Range of Movement
 Objective/Purpose of the study &
Background

To further understand and gain knowledge regarding fractures, and also to

figure out the reference values and the implications or interpretations of the
diagnostic procedures done to the patient with fracture. This case study also
intends to improve students' ability to use critical thinking skills and analysis
regarding the application of the nursing process in giving care to patients.

- To provide the client with fracture the required nursing care and duties.

-To create an effective nursing care plan and to deliver health education
regarding fractures to the client.
 Objective/Purpose of the study &
Background
Fracture A fracture is a break, usually in a bone. If
Injury called an open or compound fracture.
the broken bone punctures the skin, it is

Fractures commonly happen because of car accidents, falls, or sports

injuries. Other causes are low bone density and osteoporosis, which
cause the weakening of the bones.

CLASSIFICATION OF FRACTURES;
by the extent of the by the extent of associated
break soft-tissue
damage
 by the extent of associated
by the extent of the
soft-tissue
break
damage

COMPLETE Closed / Simple

FRACTURE
involves a break across the
entire cross-section of the bone.
INCOMPLETE
FRACTURE
the break occurs through only
part of the cross-section of the
bone
The bone is broken, but the
skin is intact.
Open / Compound /
Complex
The bone pokes through the skin
and can be seen, or a deep
wound exposes the bone through
the skin.
 Background
PREVALENCE RATE
Filipino men aged from 50 to 69 have the same prevalence of osteoporosis and
fracture as those aged 70 years and above. In another study among Japanese
men, the prevalence of vertebral fracture for younger (65 to 74 years) and older
≥
( 75 years) were 36.6% and 37.6%, respectively.

Worldwide, osteoporosis causes

more than 8.9 million
fractures annually, resulting
in an osteoporosis fracture
every 3 seconds

 Background

PROGNOSIS
For most fractures, the whole

process can take up to 18

months, but in adults the

strength of the healing bone is

usually 80% of normal by 3

months after the injury.

ETIOLOGY
Junio Lacuarin Guilas
 Direct Trauma Sports
Injury (Rugby)

Modifiable Risk Non-Modifiable

Factors Risk Factors
High risk of injury /

rugby Personal history of

Low body weight fracture as an athlete.
Low Calcium Intake History of fracture in a
first-degree relative
Poor health or
fragility.

ANATOMY &
PHYSIOLOGY
Dela Cruz Del Mar
Duran Jumao-as
VIDEO
 A fracture is a complete or an incomplete disruption in the continuity of
bone structure and is defined according to its type and extent. Fractures
occur when the bone is subjected to the stress greater than what it can
absorb. Fractures can be caused by a direct blow, crushing force, sudden
twisting motion, or even an extreme muscle contraction. When the bone
is broken, adjacent structures are also affected, resulting in soft tissue
edema, hemorrhage into the muscles and joints, joint dislocations,
ruptured tendons, severed nerves, and damaged blood vessels. Body
organs may be injured by the force that caused the fracture or by the
fracture fragments.
How to classify types of fracture?
Location (proximal, midshaft, distal)
Type

How to describe the types of fracture?

Degree of break
Character of any fractured bone fragments
 TYPE OF
FRACTURE
GROUP 4
Pathophysiology Clinical Manifestation
THEORETICAL Plaza
Rasco Seat
Ulson Roxas
CLIENT-BASED
Pulmones Pertinent Findings
Ramirez
Rodriguez
Ramores
Sarasua
 Theoretical
Pathophysiology
Christian Lendell Rasco
Dencel Ulson
 Theoretical
Immediate or Severe pain at the site of
injury
An obvious deformity of the tibia/leg (an
unusual angle, twisting, or shortening of
the leg
Swelling
Bony pieces that may be pushing on the
skin
Instability (some patients may retain a
degree of stability if the fibula is not broken
or if the fracture is incomplete)
Bruises and Discoloration
Crepitus
Occasional loss of feeling in the foot
Client-Based
Pain at the site of injury
Aggravated on movements especially on
movements of the right leg.
Swelling at the site of the fracture
Crepitus
Deformity: Bony consistency
Galeazzi's sign
Atrophy of the right thigh
Shortening of the right lower limb
 PERTINENT FINDINGS
Pain at the site of injury (Pain scale of 7/10)

the result of x-ray in his right leg was taken and

he was told there is comminuted fracture of
tibia.
Deformity at lower 1/3rd of medial side of right leg
(distal part of tibia)

Deformity: bony consistency and crepitus in palpation

Apparent shortening of the right lower limb – Atrophy

of the right thigh -> Positive Galeazzi Sign.
An inequality in the height of the knees, caused by hip

disclocation or congenital femoral shortening

GROUP 3
Laboratory & Diagnostic Medical Surgical Management
Lao, Kim Alexis Mastrilli, Bea Bianca
Onrubia, Maria Ana Olbis, Sophia Nicole
Orbista, James Otero, Kristine Mae
Pineda, Trixie Pidlaoan, Jam Nicole

Drug Study
Laude, Nelce Kate
Pegarum, Jazmine
 Laboratory & Diagnostic procedures
Tests Result Normal Interpretation Analysis

Client-based
01 Comminuted Fracture resulted
Intact right
X-Ray fracture of Abnormal from a high force
tibia bone trauma/impact.
right tibia

Theoretical
02 The trauma to the
A CT scan of the
Computed a compression bone resulted to
right tibia shows Abnormal
Tomography in right tibia a linear fracture
(CT) scan unmutilated bone. of right tibia.

03
Magnetic fractured right no fracture seen non-union or
Resonance abnormal malunion of the
tibia on tibia
Imaging (MRI) right tibia
X-Ray of right tibia CT scan of right tibia

X ray of the fractured right lateral XR image, arrow: a

tibia, AP and lateral view. compression in tibia (linear fracture).
 Laboratory & Diagnostic procedures
Tests Result Normal Interpretation Analysis

Theoretical
04 Male: ≤15 indicative of
Erythrocyte
17 mm/hr. abnormal inflammation
Sedimentation
Rate (ESR)

05
Osteopenia due to
Bone Abnormal reduced Bone Density
-2.0 -1 to +1 at the Medial Area of
Densitometry
the Tibia

06
No Presence of
Arteriograms 1.5:1 <1.5:1 Normal stenosis/narrowing
of blood vessels
 Laboratory & Diagnostic procedures
Tests Result Normal Interpretation

Theoretical
04 Male: ≤15 indicative of
Erythrocyte
17 mm/hr. abnormal inflammation
Sedimentation
Rate (ESR)

05
Osteopenia due to
Bone Abnormal reduced Bone Density
-2.0 -1 to +1 at the Medial Area of
Densitometry
the Tibia

06 Hemoglobin: Hemoglobin:
19 grams/dL 132-166 grams/L Signifies
Complete blood hemorrhage at the
WBC count:
Abnormal
count (CBC) WBC count: fracture site and
14,000 cells per 4.5 to 11.0 × 109/L possible infection.
microliter
 Laboratory & Diagnostic procedures
Tests Result Normal Interpretation

Theoretical
08
C-reactive Sign of acute
protein 100 mgL Less than 10mg/L Abnormal
inflammation in the
blood
Medical and Surgical
Management

Mastrilli, Bea Bianca

Olbis, Sophia Nicole
Otero, Kristine Mae
Pidlaoan, Jam Nicole
FIBULAR
OSTEOTOMY
- An osteotomy is any surgery that cuts and reshapes your bones. You
may need this type of procedure to repair a damaged joint. It's also
used to shorten or lengthen a deformed bone that doesn't line up with
a joint like it should.
- Most used in the combination with other surgical procedures to
stabilize the tibia in the case of tibia shaft nonunion that produce
significant malalignment.
- is an alternative treatment to high tibial osteotomy (HTO).
FIBULAR OSTEOTOMY
FIBULAR OSTEOTOMY

Procedure
1. Place the patient in a supine position under anesthesia.
2. Use Pneumatic Tourniquet
3. Lateral incision of 3 to 5 cm was made at the proximal third of the
fibula.
4. The fascia was then incised in line with the septum between the
peroneus and soleus, the muscles were separated, and the fibula was
exposed.
5. A 2-cm section of the fibula was removed 6 to 10 cm below the
fibular head with the use of an oscillating saw or fret saw.
6. Following resection, the fibula ends were sealed with bone wax. The
muscles, fascia, and skin were then sutured separately.

FIBULAR OSTEOTOMY

Visual Analog Scale

FIBULAR OSTEOTOMY
ADVANTAGES DISADVANTAGES

1. During the procedure, the surrounding

1. SIMPLE, SAFE AND LESS COSTLY. nerves or blood vessels around the knee
might be damaged

2. Patients should use crutches for a couple

2. LESS INVASIVE WITH SHORT INCISION.
of weeks during the healing period.

3. There is a possibility of knee replacement

3. DOES NOT REQUIRE IMPLANT.
if the surgery fails.

4. FAST RECOVERY OR EARLY

REHABILITATION IS POSSIBLE.

5. IT HAS A LOW COMPLICATION AND EASY

TO EXECUTE.
FIBULAR OSTEOTOMY

Nursing Interventions
PRE OPERATIVE RATIONALE

- Facilitates planning of preoperative teaching

1. Assess the patient's level of understanding and
obtained Informed Consent.
program, identifies content needs. Provides
knowledge base from which patient can make
informed therapy choices and consent for
procedure, and presents opportunity to clarify
misconceptions.

2. Preoperative instructions: NPO time, shower or skin

- To help reduce the possibility of postoperative
preparation, which routine medications to take and
complications and promotes a rapid return to
hold, prophylactic antibiotics, or anticoagulants,
normal body function.
anesthesia premedication.

- The patient's vital signs should monitor regularly

such as heart rate, blood pressure, respirations and
3. Monitor Vital signs.
temperature to establish data for comparison in
the intraoperative and postoperative period.
FIBULAR OSTEOTOMY

Nursing Interventions
1. Maintain bed rest or limb rest as indicated. Provide - Provides stability, reducing the possibility of
support of joints above and below the fracture site, disturbing alignment and muscle spasms which
POST OPERATIVE

especially when moving and turning. enhances healing.

2. Avoid the use of plastic sheets and pillows under - Can increase discomfort by enhancing heat
limbs in the cast. production in the drying cast.

3. Assess and record the patient’s level of pain. Take

- Pain assessment determines the effectiveness of
note of the relieving and aggravating factors and
interventions. Many factors, including the level of
nonverbal pain cues such as changes in vital signs,
anxiety, may affect the perception of pain.
emotions, and behavior.

- Promotes venous return, decreases edema, and

4. Elevate and support injured extremity.
may reduce pain.

- Improves general circulation; reduces areas of

5. Provide alternative comfort measures.
local pressure and muscle fatigue.
FIBULAR OSTEOTOMY

How does it work?

1. AFTER THE PFO SURGERY, THE PROXIMAL FIBULAR SEGMENT BECOMES

FREE FROM TIBIOFIBULAR SYNDESMOSIS AND DISTAL FIBULA, LEADING TO
INCREASE ROM OF THE PROXIMAL TIBIOFIBULAR JOINT.

2. THE LATERAL JOINT SPACE OF THE KNEE IS NARROWED TO COUNTERACT

THE VARUS DEFORMITY DURING WEIGHT BEARING.
FIBULAR OSTEOTOMY
 COMPRESSION PLATING

A plate for internal fracture fixation

with screw holes so designed that
insertion of screws draws bone more
firmly together.
COMPRESSION PLATING

The objective of compression plating

is to produce fracture stability.
It is useful in two-part fracture
patterns, where the bone can be
compressed.
COMPRESSION PLATING
COMPRESSION PLATING

NURSING CONSIDERATIONS:
Verify that the imaging studies have been completed, as ordered.
- This is to make sure that the right procedure is done to the patient.
Maintain immobilization of affected part using bed rest.
- Immobilization relieves pain and prevents bone displacement and extension of
tissue injury.
Administer medications, as indicated:
- Given to reduce pain or muscle spasms. Studies of Ketorolac (Toradol) have
proven effective in alleviating bone pain, with longer action and fewer side effects.
ADJUNCTIVE THERAPY

Antibiotic bone-cement/
bone substitute beads
- is an inert product for the purpose of stopping or controlling
infection in the vertebral column and other orthopedic uses.

-made of biocompatible and bioresorbable polymer materials.

-are an alternative to antibiotics or steroids use in the treatment of

internal fixation fractures.
WARNING: SENSITIVE CONTENT
Antibiotic bone-cement/ bone
substitute beads

Procedure
1. As per usual procedure, prepare the cavity through which a redone
work is to be done by cleaning it with a high-speed air stone and
water jet.
2. Perform rough shaping of the prepared bone cavity by the use of
high-speed hand-piece or bur with carbide tips
3. Now fill up the prepared bone cavity with even layer of antibiotic
bone-cement
4. Use a high intensity light source like LED or fiber optic torch
5. Air cure it for 6 hours at 37 degree Celsius temperature
Antibiotic bone-cement/ bone substitute beads

Advantages

1. Has a strong microbiological effect and resistant to external friction.

2. Has a unique mechanism of action. and remain sterile for years.
3. Easy to implant, versatile and durable.
4. Biocompatible, non-absorbable, and biodegradable.
5. Easy to use and provides immediate results.
Antibiotic bone-cement/ bone substitute beads

Disadvantages
1. May lead to disease and resistance development.
2. Unable to integrate into the surrounding bone, poor mechanical
stability and high cost.
3. Cannot be used for load-bearing indications (compression
fractures).
4. Non-resorbable in nature.
5. No evidence that it can achieve a more rapid radiological
resolution.
Antibiotic bone-cement/ bone substitute beads

Nursing Interventions
The patient must be assessed for allergies and medical condition that could

P
Nursing Assessment.
interfere with a safe procedure.

r Monitoring Vital Signs.

The patient's vital signs should monitored regularly such as heart rate, blood

e
pressure, respirations and temperature.

Pain medication should be given as needed prior to surgery as well as

Pain Management.
intraoperatively if needed.

p Prevent wound infection. Antibiotics prevent the growth of bacteria, which can cause wound infections.

o
s
Antibiotics reduce the body's inflammatory response, which can help prevent post-
Reduce inflammation.
operative pain, swelling and infection.

t Promote healing.
Promote healing of hardware devices used to replace bones when a fracture
cannot be fixed with pins or screws.
Antibiotic bone-cement/ bone substitute beads

How does it work?

1. It can be used as a shield that prevents bacterial growth

2. It also helps prevent bony overgrowth while simultaneously speeding up
healing
3. serves to inhibit the growth of bacteria in and around the prosthetic
implant.
 CASTS
PLASTER OF PARIS
A cast is a rigid external immobilizing device
that is molded to the contours of the body.
The cast must fit the shape of the injured
limb correctly to provide the best support
possible.

Casts made of plaster of Paris are less costly

and achieve a better mold than fiberglass
casts; however, they are heavy, not water
resistant, and can take up to 24 to 72 hours
to dry post application.
 PLASTER OF PARIS
NEWLY APPLIED CAST TO PREVENT COMPLICATIONS

Expose a newly applied cast to air circulation.

Provide plastic-covered pillows to support the cast along its entire
length.
Elevate the casted extremity.
Check the edges of the cast and all skin areas where the cast
edges may cause pressure.
Check the integrity of the cast by looking for cracks, breaks, and
soft spots.
Assess circulation by performing the blanching test and comparing
the skin temperature and blanching reaction of the affected limb to
that of the unaffected limb
Never use a coat hanger or other foreign object to "scratch"
inside the cast. This may cause skin damage and infection.
Report any danger signs to the nursing staff immediately.
Danger signs include pale, cold fingers or toes, tingling,
numbness, increased pain, pressure spots, odor, or feeling
that the cast has become too tight.
Report any damage to the cast such as cracks, breaks, or
soft spots.
Never attempt to remove or alter the cast.
REAMED
INTERMEDULLARY NAIL.
An intramedullary rod, also
known as an intramedullary
nail (IM nail) or inter-locking
nail, is a metal rod forced into
the medullary cavity of a
bone. IM nails have long been
used to treat fractures of long
bones of the body.
REAMED
INTERMEDULLARY NAIL.

PREOP POSTOP

Assess the patient's ABCs, level of consciousness

Obtain informed consent
Complete the preoperative assessment
Maintain NPO status 8 hours prior to the procedure
Establish IV line as ordered.
Check the surgical site for hemorrhage of any signs of
infection.
Keep surgical incisions clean and dry.
Maintain operative dressing, loosen bandage if swelling
of the foot and ankle occurs
Begin with clear liquids and light foods (jellos, soups,
etc.) as indicated.
 PRE-OPERATIVE MEDICATIONS
MECHANISM ADVERSE
DRUG INDICATION NURSING CONSIDERATION
OF ACTION EFFECTS

GENERIC NAME Preprocedural Confusion Assess level of sedation

bind to the
sedation. Problems with and level of consciousness
benzodiazepine site
Midazolam balance and for 2-6hrs following
on GABA-A Aids in the
induction of movement administration.
receptors, which
BRAND NAME Slowed reflexes Monitor vital sign and
potentiates the anesthesia
Buccolam Coma oxygen.
effects of GABA by
Nayzilam increasing the
CLASSIFICATION frequency of
chloride channel
benzodiazepines
opening.
CONTRAINDICATION

Stock dose:
Depressed vital
5 mg signs
Dosage & Frequency: CNS depression
0.07 to 0.08 mg IM
once, up to 1 hour
before surgery
Drug form:
Vial
 PRE-OPERATIVE MEDICATIONS
MECHANISM ADVERSE
DRUG INDICATION NURSING CONSIDERATION
OF ACTION EFFECTS

GENERIC NAME skin and skin CNS: Assess patient for

inhibit bacterial cell
structure Seizures infection at the beginning
wall synthesis by
Cefazolin GI: and during therapy.
disrupt the infections
bone and joint diarrhea Obtain history to
synthesis of the
BRAND NAME nausea determine previous use of
peptidoglycan layer infections
vomiting and reactions to
Cefazolin forming the
DERM: cephalosporins
bacterial cell wall.
Rashes Observe patient for signs
CLASSIFICATION
LOCAL: and symptoms of
Cephalosporins Pain at IM site anaphylaxis.
CONTRAINDICATION Phlebitis at IV site

Stock Dose
patients with a
500 mg known serious
hypersensitivity
Dosage&Frequency:
reaction.
250-500 mg
intravenously (IV)
every 8 hours
Drug form:
Powder
 POST-OPERATIVE MEDICATIONS
MECHANISM ADVERSE
DRUG INDICATION NURSING CONSIDERATION
OF ACTION EFFECTS

GENERIC NAME Advise patient to avoid alcohol

It is used to help It is indicated to treat CNS: dizziness, and other CNS depressants
Tramadol relieve moderate to because of the increased risk
moderate to severe headache, vertigo,
moderately severe of sedation and decreased
BRAND NAME pain in humans. It
anxiety, depression CNS function.
pain. It also works by altering how
Ultram modulates the the body perceives
CV: vasodilation, Educate patient about the
dangers of overdose;
descending pain pain. peripheral edema
encourage patient to adhere
CLASSIFICATION
pathways within the GI: constipation, to proper dosing schedule.
Analgesics central nervous nausea, vomiting, Monitor other changes in
CONTRAINDICATION mood and behavior, including
system through the diarrhea
Dosage and euphoria, confusion, malaise,
binding of parent and It is contraindicated:
GU: urine
Frequency: - in patients who have previously nervousness, and anxiety.
M1 metabolite to μ- shown hypersensitivity to the active
retention Notify physician if these
substance tramadol
50 or 100mg 4-6 opioid receptors and changes become problematic.
hourly by the iv or im
- in patients suffering from acute
Respi: bronchitis,
the weak inhibition of intoxication with alcohol, hypnotics, Be alert for excessive sedation
route
the reuptake of
analgesics, opioids, or psychotropic respiratory or somnolence. Notify
medicinal products.

norepinephrine and - in patients who are receiving depression physician or nurse

Stock dose: monoamine oxidase (MAO)
immediately if patient is
50 mg/ml serotonin. inhibitors or who have taken them
within the last 14 days unconscious or extremely

difficult to arouse.

GROUP
Nursing Care Plan 2 (RISK
Nursing Care Plan 1
FOR FALL)
Arganda
Buyoc Adriano
Cabildo Aganan
Borja
Bularon
Discharge Planning
Amat
Amin
Ampuan
Dahalan
 ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

Subjective Data: Impaired Physical SShort Term Goal: Independent: After 8 hours of

Mobility related After 2 hours of Support affected To maintain position of rendering proper

function and reduce risk nursing intervention, the

“Kapag iginagalaw to rendering proper body parts or

ko yung binti ko musculoskeletal nursing intervention, the joints using of pressure ulcers. Vera, Short Term Goal was
bigla na lang impairment patient will be able to: pillows, rolls, foot 2022 completely met, the

patient was able to:

sumasakit yung secondary to pain Verbalize a supports or shoes,
Verbalize a
gilid ng kanang as evidenced by decrease in pain gel pads, foam,
decrease in pain
tuhod ko kaya hindi imposed rating.. etc.
rating..
ko na lang restrictions and
Perform and To reduce pressure on
iginagalaw.” as limited range of Long Term Goal: After 2 days of

encourage sensitive areas and to

verbalized by the motions After 2 days of rendering proper

patient.

rendering proper

regular skin

prevent development of

nursing intervention, the

examination and problems with skin Long Term Goal was

nursing intervention, the

Objective Data: patient will be able to:

care. integrity. Vera, 2022 completely met. The

patient was able to:

Assist with self- Improves muscle strength Demonstrate the

Swelling at the Demonstrate the
care activities and circulation, ability to participate
site of fracture ability to
(bathing, shaving). enhances patient control in activities with
Reluctance to participate in
in the situation and minimal complaints
attempt activities with
promotes self-directed of discomfort .
movement; minimal complaints
wellness. Vera, 2022
limited ROM of discomfort .
Hypotonia
 ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

Con't of Objective Demonstrate Con't Independent: indicated for

Data: use of Instruct and assist To encourage patient’s individual

in position active participation while situations.

relaxation skills
Pain scale of changes and preventing stress on hip Demonstrate use
and diversional
7/10 transfers. fixation. Vera, 2022 of relaxation skills
activities as
Facial grimace and diversional
indicated for Place a pillow To support the leg:
Guarding activities as

behavior individual between the legs prevent adduction. Vera, indicated for

situations. when turning. 2022 individual

C - throbbing pain Moves with situations.

Encourage Promotes well-being and
O - sudden onset Moves with
increasing

L - medial side of

adequate intake

maximizes energy

increasing
comfort as of fluids and production. Vera, 2022
right leg comfort as
healing nutritious foods.
D - aggravated on healing
progresses.
movements
Schedule
To reduce fatigue. Vera, progresses

S - Pain scale of
activities with
2022
7/10
adequate rest
P - Intermittent
periods during the
A - swelling at the
day.
site of fracture
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

Con't Independent:
Encourage Enhances self-concept

participation in and sense of

self-care; independence. Vera,

occupational, 2022
diversional, or

recreational

activities.

Keep side rails up This promotes a safe

and the bed in a environment. Vera, 2022

low position.

Postural hypotension is a
Monitor and
common problem
assess blood
following prolonged bed
pressure (BP) with
rest and may require
the resumption of
specific interventions (tilt
activity. Note
table with gradual
reports of
elevation to the upright
dizziness.
position). Vera, 2022
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

Dependent:
Administer To permit maximal effort

medications prior and involvement in an

to the activity as activity. Vera, 2022

needed for pain

relief.

Collaboration:
Collaborate with To develop individual

physical medicine exercise and mobility

specialists and programs, identify

occupational or

appropriate mobility

physical therapists devices, and limit or

in providing reduce the effects and

range-of-motion complications of

exercise, isotonic immobility. Vera, 2022

muscle

contractions,

assistive devices,

and activities.
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

Con't of
Collaboration:
Teach the patient Effective pain

and significant intervention will enhance

others (SO) about the patient’s ability to

the use of engage in appropriate

analgesics and activity and exercises.

instruct Vera, 2022

nonpharmacologi

cal pain

management such



as imagery,

relaxation, and

distractions.
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

Subjective data: Risk for fall Short-term goal: INDEPENDENT: Short-term goal:
“Nahihirapan related to After 2-4 hours of After 2-4 hours of
akong maglakad decreased proper nursing - Keep the patient’s - Remove excess furniture and proper nursing
pakiramdam ko ay lower intervention the room free of clutter keep cords and IV lines off the intervention the
matutumba ako extremity client will be able floor to prevent falling. goals was able to
pag ako ay strength as to: fully met as
tumatayo dahil evidenced by evidenced by, the
hindi pa talaga apparent - Instruct patient to - Patient safety is number one client was:
magaling yung shortening of use the call light for priority. Want to make sure
kanang binti ko.” the right lower assistance before they have assistance to do
limb. - Free from fall anything to avoid a fall - Freed from fall
as verbalized by getting up (may put up

the patient. signs on walls/board

- Demonstrate a - Demonstrate d a
as reminders for
Objective data:: safe environment safe environment
them)
- hip flexed free from potential free from potential
and adducted hazards. - Improper use of hazards.
- Evaluate patient’s
mobility devices maycause
- knee - Demonstrate understanding of the - Demonstrated
more harm than good.
extended, foot selective use of mobility selective
dorsiflexed prevention assistive devices such prevention
and inverted measures. as zimmer frames and measures.
crutches.
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

- Maintain bed rest as - Provides stability,

- Deformity at Long-term goal: indicated. Provide reducing the possibility of Long-term goal:
lower 1/3rd of support of joints disturbing alignment and
medial side of After 6-9 weeks After 6-9 weeks of
above and below the muscle spasms, which
right leg of nursing enhances healing. nursing
fracture site.
intervention the intervention the
- Apparent client will be able long-term goals
shortening of DEPENDENT:
to: - Acts as a specific was fully met as
the right lower - Administer
inhibitor of osteoclast- evidenced by, the
limb alendronate
mediated bone resorption, client was able to:
- Atrophy of (Fosamax) as
allowing the bone formation
the right
thigh indicated

- Maintain

to progress at a
higher ratio, - Maintain

stabilization and promoting healing of stabilization and

Ø Galeazzi’s alignment of fractures. alignment of
COLLABORATIVE:
sign : right knee fractures fractures
lower and
- Referral to - Therapy services
forward - display callus - display callus
physiotherapist and should be utilized to assist
- No callus formation/ formation/
occupational therapist the patient in increasing their
formation beginning union beginning union at
- Decrease bone strength and balance as well
at fracture site as fracture site as
as instructing on the proper
density at distal appropriate. appropriate.
use of new equipment such
end of tibia
as crutches.
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