case presentation power point

Acromioclavicular Joint Disruption

Acromioclavicular Joint Disruption

INTRODUCTIONINTRODUCTION

The ultimate goal of this study is to increase our awareness as student nurses and have a proper knowledge of this case – Acromioclavicular Joint Disruption. We decided to have this case because it is related to where we are assigned to have our Head Nursing which is the Orthopedic Ward and the fact that this is a military hospital and is close to the patient’s field of work where most have encountered this type of injury, and to be able to be of help to get our patient’s back to their preinjury state through our health teachings. It also aims to further enhance our analytical and critical thinking about the said case.

The ultimate goal of this study is to increase our awareness as student nurses and have a proper knowledge of this case – Acromioclavicular Joint Disruption. We decided to have this case because it is related to where we are assigned to have our Head Nursing which is the Orthopedic Ward and the fact that this is a military hospital and is close to the patient’s field of work where most have encountered this type of injury, and to be able to be of help to get our patient’s back to their preinjury state through our health teachings. It also aims to further enhance our analytical and critical thinking about the said case.

The acromioclavicular joint, or AC joint, is a joint at the top of the shoulder. It is the junction between the acromion (part of the scapula that forms the highest point of the shoulder) and the clavicle. Several ligaments surround this joint, and depending on the severity of the injury, a person may tear one or all of the ligaments. Torn ligaments lead to acromioclavicular joint sprains and separations. There are two mechanisms of injury, direct or indirect. Direct force: Which is the most common. Falls on to the point of the shoulder, with the arm usually at the side and adducted. The force drives the acromion downwards and medially, 70% of acromioclavicular joint injuries are the result of a direct injury.

The acromioclavicular joint, or AC joint, is a joint at the top of the shoulder. It is the junction between the acromion (part of the scapula that forms the highest point of the shoulder) and the clavicle. Several ligaments surround this joint, and depending on the severity of the injury, a person may tear one or all of the ligaments. Torn ligaments lead to acromioclavicular joint sprains and separations. There are two mechanisms of injury, direct or indirect. Direct force: Which is the most common. Falls on to the point of the shoulder, with the arm usually at the side and adducted. The force drives the acromion downwards and medially, 70% of acromioclavicular joint injuries are the result of a direct injury.

Indirect force: Falls onto an outstretched arm. The force is transmitted through the humeral head to the acromion, therefore the acromioclavicular ligament is disrupted and the coracoclavicular ligament is stretched. The magnitude of applied force determines the degree of injury.

Indirect force: Falls onto an outstretched arm. The force is transmitted through the humeral head to the acromion, therefore the acromioclavicular ligament is disrupted and the coracoclavicular ligament is stretched. The magnitude of applied force determines the degree of injury.

Injuries to the AC joint are graded according to the amount of injury to the AC and coracoclavicular ligaments and how badly they are torn. . Type III injuries are complete and involve disruption of the acromio- and coracoclavicular ligaments.

With the case of our patient, admitted at AFP General Hospital last September 28, 2009, Patient was performing an obstacle exercise in a wet floor due to rainy weather and accidentally slipped away thus causing his left shoulder directly hit unto the ground. Patient noticed increase severity of pain and deformity on his left shoulder. Initial Diagnosis as AC Joint Disruption Left Grade III.

Injuries to the AC joint are graded according to the amount of injury to the AC and coracoclavicular ligaments and how badly they are torn. . Type III injuries are complete and involve disruption of the acromio- and coracoclavicular ligaments.

With the case of our patient, admitted at AFP General Hospital last September 28, 2009, Patient was performing an obstacle exercise in a wet floor due to rainy weather and accidentally slipped away thus causing his left shoulder directly hit unto the ground. Patient noticed increase severity of pain and deformity on his left shoulder. Initial Diagnosis as AC Joint Disruption Left Grade III.

Acromioclavicular (AC) joint injuries are common and often seen after bicycle wrecks, contact sports, and car accidents. Athletes who participate in contact sports, such as hockey, football, rugby, and soccer. Exercise that may involve falls are particularly susceptible to such injuries. These injuries, however, also occur during noncontact sports such as baseball, volleyball, skiing, equestrianism, cycling and gymnastics.. Most common injuries are related to falls onto the shoulder and repetitive use of the shoulder such as heavy labor. A fall onto an outstretched hand (FOOSH injury) and a downward force on the upper extremity have been implicated in acromioclavicular joint injuries.The majority of acromioclavicular injuries occur in men during the second decades of life. Males are more commonly affected than females, with a male-to-female ratio of approximately 5:1 to 10:1 and is more often incomplete than complete (approximately 2:1).

Acromioclavicular (AC) joint injuries are common and often seen after bicycle wrecks, contact sports, and car accidents. Athletes who participate in contact sports, such as hockey, football, rugby, and soccer. Exercise that may involve falls are particularly susceptible to such injuries. These injuries, however, also occur during noncontact sports such as baseball, volleyball, skiing, equestrianism, cycling and gymnastics.. Most common injuries are related to falls onto the shoulder and repetitive use of the shoulder such as heavy labor. A fall onto an outstretched hand (FOOSH injury) and a downward force on the upper extremity have been implicated in acromioclavicular joint injuries.The majority of acromioclavicular injuries occur in men during the second decades of life. Males are more commonly affected than females, with a male-to-female ratio of approximately 5:1 to 10:1 and is more often incomplete than complete (approximately 2:1).

Morbidity and mortality rates

Good to excellent outcomes usually follow shoulder joint replacement surgery, including pain relief and a functional range of motion that provides the ability to dress and perform the normal activities of daily living. In the hands of experienced orthopedic surgeons, such outcomes occur 90% of the time. Shoulders with artificial joints are reported to function well for more than 20 years. No death has ever been reported for shoulder joint replacement procedures.

Morbidity and mortality rates

Good to excellent outcomes usually follow shoulder joint replacement surgery, including pain relief and a functional range of motion that provides the ability to dress and perform the normal activities of daily living. In the hands of experienced orthopedic surgeons, such outcomes occur 90% of the time. Shoulders with artificial joints are reported to function well for more than 20 years. No death has ever been reported for shoulder joint replacement procedures.

PATIENT’S PROFILEWard 3D E7-Male Orthopedic Ward

Patient’s Initial RSG

Address Brgy. Lopayon Leganes,

Age 22 years old

Gender Male

Birthdate September 29, 1986

Educational Status College Level – Aircraft Mechanic

Religion Roman Catholic

Nationality Filipino

Civil Status Single

Occupation Military

Health Care Financing Employed

Informant Patient

Reliability 100%

Next of Kin BSG

Admission Data:

Date of Admission September 28, 2009

Time of Admission 1650H

Type of Admission FM CESH, HID, PA

Chief Complaint Pain at Left Shoulder

Initial Diagnosis AC Joint Disruption Left Grade III

Final Diagnosis

Attending Physician Capt. Chua

Nursing HistoryNursing History

History of Present Illness

One year prior to admission, while patient is performing obstacle exercise in a wet ground, due to rainy weather, patient accidentally slipped away thus causing his left shoulder directly hit unto the ground, patient experienced pain due to tolerable pain. Patient continue to perform such acivities. Patient was referred to Armed Forces Medical Center for further evaluation and management hence advised for admission. Still scheduling for OR surgery.

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History of Present Illness

One year prior to admission, while patient is performing obstacle exercise in a wet ground, due to rainy weather, patient accidentally slipped away thus causing his left shoulder directly hit unto the ground, patient experienced pain due to tolerable pain. Patient continue to perform such acivities. Patient was referred to Armed Forces Medical Center for further evaluation and management hence advised for admission. Still scheduling for OR surgery.

•

Past Medical History

August 19, 2008, patient accidentally slipped away on the ground while performing obstacle exercise in a wet ground, at 3 JD Training Village Jamindan, Capiz, patient was not given any first aid. He only took mefenamic acid to relieve pain. 2 days after the accident he experienced chills and fever grading 38°C.

11 months prior to admission, due to regular exercises patient noticed that the pain increase in severity and noted his left shoulder deformity. Patient sought consult to station hospital were x-ray was done.

The patient had no known allergies to any kind of food and drugs. No hypertension, T.B, cancer and asthma.

Past Medical History

August 19, 2008, patient accidentally slipped away on the ground while performing obstacle exercise in a wet ground, at 3 JD Training Village Jamindan, Capiz, patient was not given any first aid. He only took mefenamic acid to relieve pain. 2 days after the accident he experienced chills and fever grading 38°C.

11 months prior to admission, due to regular exercises patient noticed that the pain increase in severity and noted his left shoulder deformity. Patient sought consult to station hospital were x-ray was done.

The patient had no known allergies to any kind of food and drugs. No hypertension, T.B, cancer and asthma.

Family Health History

The patient is Ilonggo. He is living at Marawi Lanao del Norte with his family. The patient is single. He is the eldest of the family, he has one brother and two sisters. They don’t have any heredo familial disease.

Family Health History

The patient is Ilonggo. He is living at Marawi Lanao del Norte with his family. The patient is single. He is the eldest of the family, he has one brother and two sisters. They don’t have any heredo familial disease.

Personal and Social History

The patient eats almost any kind of food, he usually ate plenty of rice, meat and specially vegetables like chopsuey,pinakbet and have no any dietary restrictions. He has an average intake of food 4 times a day including merienda and an average of 7 - 8 glasses, but sometimes 5-6 glasses fluid intake. His day diet recall was bread and juice in breakfast, pinakbet and 2 cup of rice in lunch and 1 cup of rice and pork sinigang in dinner. He usually has regular exercise and body is always in good condition. But during hospitalization patient’s movements and activities are limited, but he is still exercising regularly like walking and jogging.

He is a smoker and he also drink alcohol but occasionally. The patient is a Roman Catholic. The client copes up with stress by walking, praying, listening to music and relaxing.

Personal and Social History

The patient eats almost any kind of food, he usually ate plenty of rice, meat and specially vegetables like chopsuey,pinakbet and have no any dietary restrictions. He has an average intake of food 4 times a day including merienda and an average of 7 - 8 glasses, but sometimes 5-6 glasses fluid intake. His day diet recall was bread and juice in breakfast, pinakbet and 2 cup of rice in lunch and 1 cup of rice and pork sinigang in dinner. He usually has regular exercise and body is always in good condition. But during hospitalization patient’s movements and activities are limited, but he is still exercising regularly like walking and jogging.

He is a smoker and he also drink alcohol but occasionally. The patient is a Roman Catholic. The client copes up with stress by walking, praying, listening to music and relaxing.

Organizing Data According to Gordon’s 11 Functional Health Patterns

Organizing Data According to Gordon’s 11 Functional Health Patterns

Functional Health Pattern

Before Hospitalization During Hospitalization Analysis

Functional Health Pattern Before Hospitalization During Hospitalization Analysis

Health Perception / Health Management

Active physical activity. Health conscious

The patient is aware of his condition. He said that he was scheduled for an operation said by his doctor. He slipped in the middle course of the obstacle (the part after the climbing activity). He knew the benefits and consequences of his upcoming surgery. The patient has health care assistance by AFP Medical Center.

The patient is conscious and coherent as per assessment. Has been informed and understood the technicalities of his upcoming surgery. He perceived himself in a state of health deficit and that his health condition must be resolved accordingly and immediately.

Nutritional / Metabolic The patient weighs 70 kg before hospitalization. He was aware with the food that he ate. He knew the proper nutrition. He doesn’t have any allergies with food. Fruits and vegetables are his favorites. (Any fruits) (Chopsuey, Amplaya, Pinakbet)

The patient is 5’7 in height and weighs 78 kg. He gained 8 kg in the past mos. He has fair appetite and tolerated in eating fatty food and no dietary restriction. He has an average intake of food 4 times a day including merienda and an average of 7 - 8 glasses, but sometimes 5-6 glasses fluid intake. He has no problem in swallowing and digestion and not experienced nausea and vomiting during admission at the AFP Medical Center. His day diet recall was bread and juice in breakfast, pinakbet and 2 cup of rice in lunch and 1 cup of rice and pork sinigang in dinner.

He gained 8 kg because of his eating habits. He ate more fruits and vegetables because he knows the benefits of it. He knew the proper nutrition.

Elimination The patient was defecated at least 1- 2 times a day.

The patient has 1 - 2 usual frequency and no strain of bowel movement. The character of his stool is soft in consistency brown in color and no history of constipation, diarrhea and incontinence. His voiding frequency is 5 - 6 times a day, no pain during urination and yellow color of urine.

The patient has good digestion process because he has regular intake of fibers from fruits and vegetables. He also follows the 8-glasses a day intake of fluid.

Activity - Exercise The patient has regular exercise. His 24 hr.-activity were exercising, playing volleyball, basketball, watching television and reading newspaper.

The patient is completely independent in terms of feeding, hygiene, dressing, toileting and ambulation. He exercises regularly like walking, jogging, abduction and adduction of his arms. He usually experienced weakness, on left arm. His usual leisure time activities are watching DVD’s and walking.

The patient is completely independent in the hospital because he has no relatives who are available to take care of him. He can perform his hygiene well. He exercises regularly. He sometimes experienced weakness on his left arm because of his case.

Cognitive Perceptual

Before hospitalization, he constantly looks forward on the following day and thinks of a way on how he will be able to survive.

The patient points the location of pain in his left shoulder. He rates the intensity of pain from 8 in the pain scale. His way of managing the pain is by taking a rest. The patient has a good memory and makes decision easily. He is a positive thinker; always thinks of a happy thought.

The patient seriously suffers from the pain due to the accident happened to him but in spite of that, he still stays to be a positive thinker.

Sleep - Rest The patient sleeps 5 - 6 hours a day, and usually takes a nap in the afternoon for 30 minutes.

The patient sleeps 5 - 6 hours a day and usually takes a nap in the afternoon for 30 mins. He has difficulty in sleeping @ night because of the plaster. He irritated by it. He’s not suffering from insomnia though he sleeps @ 12am or 1am because according to him, he is watching DVD’s and wakes up early. He uses 2 pillows every time he sleeps.

The patient experienced difficulty in sleeping at night because he always take a nap every afternoon. He uses 2 pillows as a remedy on his affected arm. In that way, he feels much comfortable when he sleeps.

Self - Perception / Self - Concept

The patient’s self perception is good. He always thinks that he is a strong man and ready to serve the country.

The patient is comfortable with his body and gives a good eye contact and good voice tone. His major concern is to have surgical operation as soon as possible and he hopes to have a successful one so that he’ll be able to come back to work. He actually thought that what happened to him was a hindrance with the kind of work that he has.

He wants to have operation early to be able to come back to work. He also thought that what happened to him was a hindrance with the kind of work that he has.

Role Relationship The patient was assigned in Jamindan, Capiz, but he doesn’t have any problem in communicating with his family and in fact every weekend, he’s been given the incentive of going home.

The patient doesn’t have any problem in terms of communicating with his co - workers and family because they are allowed to use cellular phones. He has comfortable social activities.

The patient doesn’t have any problems in the aspect of communicating with his loved ones and co - workers because cell phones are allowed and he is also allowed to go home every weekend.

Sexuality / Reproductive

His sex life is said to be poor because of the kind of work that he has.

The patient has no history of any prostate problems and penile discharges, bleeding and lesions.

According to his elimination pattern, voiding is normal so no prostate problems occur.

Coping Stress Tolerance

When he is experiencing stress, listening to music is his way of relaxing.

He handles his stress by walking, praying, listening to music and relaxing.

Music therapy is one of his relaxation techniques to reduce stress and anxiety.

Value - Belief Pattern

The patient is a Roman Catholic. He is a religious person but doesn’t have the chance of hearing mass every week but he constantly pray, give thanks and ask for grace.

The patient is a catholic and satisfied with the way his life has been changing. He is waiting for his operation so that he’ll be able to comeback to service soon. No any religious restriction.

The patient is capable of having blood transfusion. He always thinks positive for the improvement of his life for the service to others and his country.

PHYSICAL ASSESSMENTPHYSICAL ASSESSMENT

The following data are taken October 6, 2009

GENERAL APPEARANCE

Patient is male, brown in complexion, black eyes, black hair 78 kg in weight. 172 in height. Patient is conscious, coherent. Ambulatory.

Heart Rate 60 - 100bpm 80bpm Normal

Respiratory Rate 16 - 20cpm 17cpm Normal

Temperature 36.5 - 37.5ºC 36.4 ºC Normal

Blood Pressure 100 - 120 Systolic 120/80 mmHg Normal

60 - 80 Diastolic

The following data are taken October 6, 2009

GENERAL APPEARANCE

Patient is male, brown in complexion, black eyes, black hair 78 kg in weight. 172 in height. Patient is conscious, coherent. Ambulatory.

Heart Rate 60 - 100bpm 80bpm Normal

Respiratory Rate 16 - 20cpm 17cpm Normal

Temperature 36.5 - 37.5ºC 36.4 ºC Normal

Blood Pressure 100 - 120 Systolic 120/80 mmHg Normal

60 - 80 Diastolic

Vital Signs Normal Values

Actual Findings

Interpretation

Body Parts Techniques Actual Findings Analysis

Left Shoulder Inspection, Palpation It is asymmetrical, with deformity on left shoulder, with positive tenderness upon palpation. The patient is able to do ROM with limitations.

The left shoulder is drooping and there is prominence of the left distal clavicle.

Normal AnatomyNormal Anatomy

Functional Anatomy

The normal width of the acromioclavicula joint is 1-3 mm in younger individuals; it

narrows to 0.5 mm or less in individuals older than 60 years.

The normal joint width measures 1-3mm. It is regarded as abnormal if it is greater than 7mm in men, and 6mm in women.

The acromioclavicular joint is made up of 2 bones (the clavicle and the acromion), 4 ligaments, and a meniscus inside the joint.

The acromioclavicular joint is surrounded by a thin joint capsule and 4 small ligaments. These ligaments mostly give joint stability to anterior and posterior translation, as well as provide horizontal stability to the joint.

Another set of ligaments also provides vertical stability to the acromioclavicular joint. These ligaments are called the coracoclavicular ligaments, which are found medial to the acromioclavicular joint and go from the coracoid process on the scapula to the clavicle.

Functional Anatomy

The normal width of the acromioclavicula joint is 1-3 mm in younger individuals; it

narrows to 0.5 mm or less in individuals older than 60 years.

The normal joint width measures 1-3mm. It is regarded as abnormal if it is greater than 7mm in men, and 6mm in women.

The acromioclavicular joint is made up of 2 bones (the clavicle and the acromion), 4 ligaments, and a meniscus inside the joint.

The acromioclavicular joint is surrounded by a thin joint capsule and 4 small ligaments. These ligaments mostly give joint stability to anterior and posterior translation, as well as provide horizontal stability to the joint.

Another set of ligaments also provides vertical stability to the acromioclavicular joint. These ligaments are called the coracoclavicular ligaments, which are found medial to the acromioclavicular joint and go from the coracoid process on the scapula to the clavicle.

Actual picture of our patient who has a direct complete grade III dislocation

of the left AC joint. The left shoulder is drooping and there is prominence of the left distal clavicle.

Actual picture of our patient who has a direct complete grade III dislocation

of the left AC joint. The left shoulder is drooping and there is prominence of the left distal clavicle.

PATHOPHYSIOLOGYPATHOPHYSIOLOGY

LABORATORYLABORATORY

URINALYSISDate of Examination:September 29, 2009

URINALYSISDate of Examination:September 29, 2009

COMP. RESULT NORMAL ANALYSIS REFERENCE

Color yellow Yellow,amber The urine color is within the normal

range

Medical & Surgical by Brunner &

Suddarth

Transparency Clear clear The transparency is within the normal

range


Suddarth

Reaction 5.0 4.8-7.8 The urine is within the acidity range


Suddarth

Sp. Gravity 1.025 1.015-1.025 The patient specific gravity of the urine is within the normal

range


Suddarth

Sugar Negative Negative The presence of glucose is within the normal range


Suddarth

Protein Negative Negative The presence of protein in the urine is within the normal

range


Suddarth

MicroscopicMicroscopicRBC 1 0-1/HPF The RBC of the specimen

tested is within the normal range

Medical & Surgical by Brunner & Suddarth

Pus Cells 1 0-2/HPF The Pus Cells count of the patient is within the normal

range


Epithelial Cells few Few The epithelial cells specimen is within the

normal range


Mucus Thread few few The mucus thread specimen is within the

normal range


FECALYSISDate of Examination:September 29, 2009

FECALYSISDate of Examination:September 29, 2009

COMP. RESULT NORMAL ANALYSIS REFERENCE

Color Brown Brown The Stool color is within the normal range


Consistency Soft Soft and The Stool consistency is within the normal range


RBC Negative

(Not found)

Negative The patient RBC is not present in the stool


Pus Cells Negative

(not found)

Negative The Pus Cells specimen of the patient is not present in

the stool


Ova No ova nor parasite seen Negative No presence of parasite in the stool of the patient


HEMATOLOGICAL EXAMINATION

(Complete Blood Count)Date of Examination:September 28, 2009

HEMATOLOGICAL EXAMINATION

(Complete Blood Count)Date of Examination:September 28, 2009

COMP RESULT NORMAL ANALYSIS REFERENCE

Hemoglobin 147 140-170gms/L for males The hemoglobin level of the patient is within the normal

range


Hematocrit 0.43 0.42-0.51gms/L for males The hematocrit level of the patient is within the normal

range


RBC Count 4.7 4.6-5.2/L The patient RBC count is within the normal range


WBC Count 8.1 5-10/L The WBC count of the patient is within the normal range


Platelets Count 218 150-400/L The platelet count of the patient is within the normal

range


Segmenters 0.71 0.55-0.65 The Segmenters count of the patient is above within the

normal range


Lymphocytes 0.25 0.25-0.35 The lymphocytes count of the patient is withinthe

normal range


Eosinophils 0.02 0.02-0.04 The Eosinophils count of the patient is


MCV 88.6 80-100/L The average of blood cell size of the patient is within the

normal range


MCH 31 27-31pg The hemoglobin amount per RBC of the patient is within

the normal range


MCHC 35.2 31-38g/dL The mean corpuscular hemoglobin concentration

count of the patient is within the normal range


Clotting Time 2 2-7min The clotting time of the patient is within the normal

range


Bleeding Time 1’34 2-4min The bleeding time is below to the normal range there is

a chance that the patient platelets function may slow


COURSE IN THE WARDCOURSE IN THE WARD

Patient’s Initials: RSG

PROGNOSIS: Patient is scheduled for Acromioclavicular construction or surgical repair of affected ligament therefore there is a good prognosis and a possibility for spontaneous recovery and no other underlying condition seen.

Initial Diagnosis: AC joint disruption (L) shoulder

Patient’s Initials: RSG

PROGNOSIS: Patient is scheduled for Acromioclavicular construction or surgical repair of affected ligament therefore there is a good prognosis and a possibility for spontaneous recovery and no other underlying condition seen.

Initial Diagnosis: AC joint disruption (L) shoulder

September 28, 2009 Received patient awake and coherent at 4pm and reactive to painful stimuli at his left shoulder. Etirocoxib was ordered as PRN for pain. Vital signs taken & recorded as: BP:130/80 T: 36.9 RR:18 PR:80, they were all normal with slight elevation of the BP, advised to have rest. No other complaints noted. He was put on a regular diet and laboratory and X-ray for diagnostic exam.

September 29, 2009 Received patient awake and coherent and was noted a pain of 5 to 10, on left shoulder but he can control, encouraged to do deep breathing exercises.

September 30, 2009 Received patient awake in bed with limited movement at left shoulder, encouraged to do ROM at affected part.

October 5, 2009 Received patient awake with limited movement left shoulder, encouraged to avoid heavy activities like push-ups and extraneous exercise to prevent potential damage to ligament.

October 6, 2009 Received patient at 4pm awake and coherent, x-ray results and laboratory were followed up. Instructed to maintain armsling at left upper extremities and to have adequate rest to promote healing.

NURSING CARE PLANNURSING CARE PLAN

ASSESSMENT MINI PATHOPHYSIOLO

GY

NURSING DIAGNOSIS

GOAL/PLANNING INTERVENTION RATIONALE EVALUATION

Subjective:“Masakit ang kaliwang balikat ko” as verbalized by the patient.Objective:-(+) guarding behavior-(+) irritability-identified pain as 8 from the pain scale of 0-10.Vital Signs:BP – 120/80 mmhgT- 36.4RR-17 cpmPR-80 bpm

Fall from 15 ft high and landed

with his left shoulder.

AC joint disruption

Bump / protrusion of distal clavicle

Scapula and shoulder

complex droop.

Pain

Alteration of comfort related to lack of joint continuity.

After 4 hours of nursing interventions the patient will be able to identify reduction of pain from 6-7 to 2 of pain scale of 0-10.

-Established rapport to the patient-Assessed pain by using pain scale of 0-10.-Encouraged the patient to have deep breathing exercise.-Encouraged patient to have adequate rest periods.-Encouraged patient to have socialization with others.-Monitored vital signs every 4 hours.-Administered medication as ordered by the physician.

-To gain trust and cooperation from the patient.-To determine the severity of pain and if the pain is tolerable.-To promote relaxation of the muscle.-To prevent fatigue.-To divert attention.-Usually alters the vital signs during the episode of pain.-To alleviate the pain.

Goal Met. After 4 hours of nursing interventions the patient had identified reduction of pain from 8 to 2 from the pain scale of 0-10.

ASSESSMENT MINI PATHOPHYSIOLO

GY

NURSING DIAGNOSIS

GOAL/PLANNING INTERVENTION RATIONALE EVALUATION

Subjective:“Hindi ko na maigalaw ng maayos itong kaliwang braso ko.” As verbalized by the patient.Objective:-Limited ROM at the left arm.-Stiffness of the arms.BP – 120/80 mmhgT – 36.4RR- 17cpmPR -80bpm

Fall from 15 ft high and landed

with his left shoulder.

AC joint disruption

Bump / protrusion of distal clavicle

Scapula and shoulder

complex droop.

Pain

Limited body movement

Decrease activities of daily

living

Impaired physical mobility possibly evidenced by limited range of motion.

After 8 hours of nursing interventions the patient will be able to demonstrate participation in activities.

-Assisted and instructed the patient to move his arms and fingers frequently.-Supported the affected body parts with pillow.-Encouraged the patient to increase oral fluid intake and eat nutritional foods.-Educated the patient about the importance of participation in such activities.-Encouraged patient to participate in self care.

-To prevent contracture.-To maintain position of function.-To promote well being and maximizes energy production.-To enhance his knowledge so he will participate in the activities.-To enhance his sense of independence.

Goal Met. After 8 hours of nursing interventions the patient had participated in activities.

Assessment Diagnosis Inference Planning Intervention Rationale Evaluation

SubjectiveObjective

Risk for disturbed body image related to injury

Injury on left shoulder

Shoulder joint damage

Decrease muscle strength

Loss of integrity of bone

structuresRisk for impaired physical mobility

After series of nursing intervention, patient will verbalize acceptance of self in situation

Determine whether condition is permanent/ no expectation for resolution.

Evaluate level of client’s knowledge of anxiety, related to situation observe emotional changes.

Discuss meaning of change in client.

Identify previously used coping strategies and effectiveness.

To enhance acceptance and to hold out the possibility of living a good life.It may indicate acceptance or no acceptance of situation.A change in function may be more difficult for some to deal with a change in appearance.To promote optimal health adaptation.

After series of nursing intervention, patient will verbalize acceptance of self in situation.

Assessment Diagnosis Inference Planning Intervention Rationale Evaluation

SubjectiveObjective

Risk for bed mobility related to impaired physical mobility

Injury on the left shoulder

Shoulder joint damage

Inability to move the

affected part

Risk for impaired bed

mobility

At the end of the shift, patient will demonstrate behaviours/ techniques to mobilize the affected area.

Assess the patient routinely, to assess functional ability.

Note presence of conditions/ situations.

Use proper positioning turning and transferring techniques when moving client

Provide protection by use of cushion and pillows.

Emphasize importance of adequate nutritional.

To indicate particular vulnerability To note factors that impaired skin integrity To prevent friction or shear injuryTo increase circulation and limit/ eliminate excessive tissue pressureTo maintain good general health.

At the end of the shift, patient was able to demonstrate behaviours/ techniques to prevent muscle breakdown.

DRUG STUDYDRUG STUDY

Name of Drug Classification and Action

Indications and Contraindications

Side Effects Nursing Consideration

Generic Name:EtoricoxibBrand Name:ArcoxiaDosage:120mg/ tab, itab OD PRN

CLASSIFICATION:Non-steroidal Anti-inflammatory drugsACTION:Etoricoxib is a member of a class of arthritis/analgesia medications called coxibs. It is a highly selective inhibitor of cyclooxygenase-2 (COX-2).

INDICATION:Treatment of the signs and symptoms of osteoarthritis (OA) and rheumatoid arthritis (RA). Treatment of acute gouty arthritis. Treatment of ankylosing spondylitis (AS). Relief of acute pain. The decision to prescribe a selective COX-2 inhibitor should be based on an assessment of the individual patient's overall risksCONTRAINDICATION:Inflammatory bowel disease, severe congestive heart failure, active peptic ulceration, cerebrovascular disease, CrCL <30 ml/min; lactation. Children and adolescent < 16 yr.

GI disorders; ischemic cardiac events; hypersensitivity reactions, headache, dizziness, nervousness, depression, drowsiness, insomnia, vertigo, tinnitus, photosensitivity; blood disorders, fluid retention, hypertension; dry mouth, taste disturbance, mouth ulcers; appetite and wt changes; chest pain, fatigue, paraesthesia, influenza-like syndrome, myalgia. Renal toxicity.

>Note for the drugs, dosage, time ,route, client.>have a history check of stroke or mini stroke, on patient.>Check for the blood pressure of the patient.>Monitor fever and other signs of infection.>Monitor concurrent use and increase the dose of diuretic if needed.>Monitor renal function.

.>Note the side effects of the drugs> Should be taken with the food.

Presented by:Section 14Group C

Presented by:Section 14Group C

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