closed supracondylar fracture type iii secondary to fall

PERCEPTION AND COORDINATION: CLOSED SUPRACONDYLAR

FRACTURE TYPE III SECONDARY TO FALL A CASE STUDY

IN DAVAO REGIONAL HOSPITAL

APOKON, TAGUM CITY

_____________________

A Case Study Presented To BSN-Students

And Clinical Instructors

_____________________

In Partial Fulfilment for the Requirement of BSN 3

Related Learning Experience:

Concept Perception and Coordination

By:

Van Kyssel R. Reyes

February 23, 2013

Chapter I

1

Background of the Study

A supracondylar fracture is a fracture, usually of the distal humerus just above

the epicondyles, although it may occur elsewhere. While relatively rare in adults it is one

of the most common fractures to occur in children and is often associated with the

development of serious complications. It may be of a flexion type or an extension type,

depending upon the displacement of the distal fragment of bone. The most common

type is extension type, accounting for 80% of all supracondylar fractures. The distal

fragment is displaced posteriorly. Flexion type the least common variety is the distal

fragment displacing anteriorly relative to the proximal segment. The displacements may

present in one of a number of ways the posterior shift, posterior tilt, lateral or medial

shift, proximal shift or internal rotation.

This is the most common elbow fracture in children, about 60% of fractures in

children. It is most common in children below 10, peak incidence is between the ages of

5-8 years of age. Primarily in children who are around age 7 years, which is often a

period of maximum ligamentous laxity therefore, the elbow hyperextends when the child

tries to catch himself or herself during a fall. The presenting complaint is that the child

presents with history of a falling on an outstretched hand followed by pain, swelling and

inability to move the affected elbow.

Other injuries of closed supracondylar is commonly brachial artery injury, if left

untreated could lead to Volkmann's contracture which is permanent flexion contracture

of the hand at the wrist, resulting in a claw-like deformity of the hand and fingers.

2

On Philippines it is most common below 10 years, peak age 5-8 y.o. 80% of all

pediatric distal humerus fractures, on the survey 2 is to 1 males prone on having this

supracondylar fracture . Extension type accounts for 90-98% of all supracondylar

fractures.

On Davao Regional hospital there are patient who has fracture but not the same

as supracondylar fracture, if there is the same case it is usually on the children since as

the stated earlier it is most common to the children .

This study aims to provide the readers information about the disease process of

the case chosen by the researchers, its clinical manifestations, nursing,

pharmacological and medical interventions. This also provides a clear picture of the

whole disease process through giving description about the manifestations of a real

client and the management he had undergone.

3

OBJECTIVES

Upon completion of this study and after data gathering, research and analysis,

the researchers shall have devised objectives that will guide them for the proper

understanding and fair interpretation of the case of their chosen patient and they will be

able to:

Gain knowledge about the disease process, predisposing factors, clinical

manifestation and the disease management and gain skills and appropriate

attitudes needed to function as a student nurse in the community.

Be able to use the nursing process as framework for care of the patient and

develop teaching plan and strategies appropriate for the goal attainment.

Prevent and manage potential complications that might occur and emphasize

health teachings and dietary instructions and restrictions as well as performing

appropriate exercises

I. Background of the Patient

4

BIOGRAPHICAL DATA

Name : Patient sipat

Address :Prk. 2 Tibanban, Gov. Genoroso Davao Oriental, Philippines

Age : 6 years old

Occupation : N/A

Admitting Physician : Dr. Louvette P. Donayre, M.D

Admitting Diagnosis : Closed Supracondylar Fracture Type III secondary to fall

Religion : Roman Catholic

Nationality : Filipino

Educational Attainment: Pupil

Date/Time of Admission : 11/17/12 8:00 pm

CHIEF COMPLAINT

Fall

HISTORY OF PRESENT ILLNESS

At 4:30 pm of November 17, 2012 the patient was playing and eventually

fall from an 8 ft. height causing the injury. His father and mother brought him to the

nearest hospital on their place then they transferred him to Davao Regional

Hospital at 8:00 pm.

PAST MEDICAL AND NURSING HISTORY

5

Patient received complete immunizations. He also experienced common

illness such as colds, cough, and fever during his childhood. He did not

undergone any surgery, no allergy and did not take any aspirin.

PERSONAL, FAMILY AND SOCIO-ECONOMIC HISTORY

Patient sipat is an elementary pupil. His father and mother are

both laborer. They have an income of Php 3,000 – 4,000 per month.

His father has no vices and their family has no history of

diabetes, hypertension, tuberculosis, bronchial asthma and malignancy.

PATIENT NEED ASSESSMENT

Name : Patient sipat Age : 6 y.o. Sex : M Status : Child

Admission Date / Time : Novenmber 17, 2012 / 8:00 pm____________

Admitting Medical Diagnosis : Closed Supracondylar Fracture Tpe III

secondary to fall

Arrived on unit by : Wheel chair_________ From : Emergency Room

Accompanied by : Mother

*VS : BP = 90/70 mmHg____ CR = 110 bpm___

RR = 29 cpm_________ Temp. = 37 ºC__

Client’s Perception of Reason for Admission: “, Nahulog ni siya kay nisaka man

ni siya sa pultahan .”, as verbalized by the mother.____

How was the problem being managed at home? :Supporting arm by splint_

Medication taken at home : none_

6

PHYSIOLOGICAL NEEDS

Oxygenation *BP : 90/70 mmHg__ *PR : 110 bpm__

*RR : 29 cpm__

*Lungs (per auscultation: character; lung sound; symmetry of chest expansion;

breathing character and pattern): No adventitious sounds / clear lung sounds

heard upon auscultation; equal rise and fall of chest / chest expansion and with

normal depth of respiration; breathing in eupnic pattern.____

*Cardiac Status (per auscultation: sound, character; chest pain : Normal “lub

dubb” sound is heard upon auscultation, no murmurs noted; no chest pain felt.__

*Capillary Refill : Capillary refill returns before 2 second upon blanching.___

*Skin Character and Color : Pallor, dry skin.___

*Life-supporting apparatus : IVF = D5LR 1L @ 55cc/hour .

Temperature Maintenance

*Temperature : 37 ºC__

*Skin Character: Upper and lower extremities normally warm to touch.

Nutritional Fluids

*Amt. of Food Consumed : Able to consume the meal served. ____

*Prescribed Diet : Diet as Tolerated

*Problem (nausea, vomiting: no. of times & amount): None

*Eating Pattern (frequency, amount, character) : 3x a day; whole meal served.

*Intake (IVF; fluid / water) : IVF = D5LR 1L @ 55cc/hour; H20 = 1000cc.

Elimination

7

*Last Bowel Movement (frequency, amount, character) : The patient has

defecated for about 320 grams and has a brownish color.

*Normal Pattern : Once a day, every morning.______

*Urination (frequency, amount, character, sensation) : Able to urinate at least 4x

a day with a yellowish colored urine; at least 100cc per urination.___

Rest and Sleep

*Bed Time : 07:00 pm_____ *Waking Up : 05:00 am______

*Sleep (pattern, amount of sleep) : 10 hours every night, undisturbed. 1-2 hours

sleep every afternoon.

*Problem (as verbalized): none.__

Stimulation-Activity

*Work : none_____________

*Recreation/Pastime: Playing with his brother

*Hobbies / Vices : Cellphone game,watching television.

SAFETY AND SECURITY NEED

Patient sipatfeels safe and secure in terms of his condition because of

hisparents who took care of him and that these people will never leave him even

though he has a skin traction.

LOVE-BELONGING NEED

Patient sipat feels the love and belongingness from his family. They are

always there for him. He was always being visited by hismother and father was

always the one who took care of her in the hospital and even at home.

SELF-ESTEEM NEED

8

The patient’s situation is hard for him and for his family since he was a

child then absent for almost 3 weeks, he will be having his operation also to

reform his arm and his activity will be disturbed.

SELF-ACTUALIZATION NEED

The patient together with his family thinks positively and entrust to God

everything. He feels accepted and loved by others and feels deep loving bonds

with the people around him.

PHYSICAL ASSESSMENT

GENERAL SURVEY

The patient is a 6-year old male, stands 3 ft in height and 16 kg. in

weight, and with the following VS as monitored and recorded upon

admission BP=90/70mmHg, PR=110bpm, RR=29cpm, Temp.=37ºC. He is

conscious, coherent, and responsive to the questions asked and

procedures done by the health care team providers.

VITAL SIGNS

9

Date Shift Time Temp BP RR PR I O

10

11-17-12 3-11 8 pm 37 90/70 29 110 ---- -----

11-18-12 11-7 1:30 am 36.8 90/60 28 105 ---- U-1 S-0

11-18-12 7-3 9:10 am 36.4 90/60 25 112 ---- U-1 S-1

11-18-12 3-11 6:40 pm 36.6 100/60 17 65 ----

8:50 pm 36 90/60 18 67 ---- U-1 S-0

11-19-12 11-7 1:15 am 36.9 90/60 20 97 ---- U- 1 S-0

11-19-12 7-3 9:20 am 36.6 90/60 22 105 ---- U-1 S-0

11-19-12 3-11 6:05 pm 37.2 90/60 23 110 ---- U- 1 S-0

11-20-12 11-7 1:20 am 37 100/70 24 102 ---- U-2 S-0.

11-20-12 7-3 9:20 am 37.2 90/70 25 104 ---- U-2 S-0

11-20-12 3-11 6:35 pm 37.4 90/60 23 100 ---- U-1 S-0

11-20-12 11-7 1:20am 36.5 90/60 24 101 ---- U- 1 S-0

11-21-12 7-3 4:20 am 36.6 90/60 24 104 ---- U-1 S-1

11-21-12 3-11 6:10 pm 37.2 90/60 25 102 ---- U-1 S-0

11-22-12 11-7 6:30 am 37 90/60 25 102 ---- U-1 S-0

11-22-12 7-3 9:00 am 37.2 90/60 26 102 ---- U-1 S-0

11-22-12 3-11 6:30 pm 37.2 90/60 23 100 ---- U-1 S-0

11-23-12 11-7 1:00 am 37.1 90/60 24 101 ---- U- 1 S-0

11-23-12 7-3 8:00 am 36.5 90/60 30 104 ---- ----

12:00 nn 36.4 90/60 28 102 H2O-500ccU-300cc

S- 2

11-23-12 3-11 5:00 pm 36 90/60 27 105 ---

11

11-24-12 11-7 4:30 am 37.2 90/70 24 101 ---

11-24-12 7-3 8:00 am 36.6 90/60 28 110 ----

12:00 nn 37 90/60 26 105 H2O-700ccU-500cc

S-1

11-24-12 3-11 7:20 pm 36.7 90/70 28 102 --- U-1 S-1

11-25-12 11-7 3:10 am 36.6 100/60 24 104 --- U-1 S-0

11-25-12 7-3 9:30 am 36.4 100/70 26 108 ---- U-1 S-1

11-25-12 3-11 6:15 pm 37 90/70 23 100 ---- U-1 S-0

11-26-12 11-7 2:20 am 36.7 90/60 24 101 ---- U-1 S-1

11-26-12 7-3 8:20 am 37.2 90/60 26 104 ---- U-1 S-0

11-26-12 3-11 6:30 pm 36.4 90/60 25 105 ---- U-1 S-0

11-27-12 11-7 1:30 am 36.5 90/70 27 104 ---- U-1 S-0

11-27-12 7-3 9:00 am 36.2 90/60 23 101 ---- U-1 S-1

11-27-12 3-11 7:20 pm 36.7 90/70 28 102 ---- U-1 S-0

11-28-12 11-7 3:10 am 36.6 100/60 24 104 ---- U-1 S-1

11-28-12 7-3 8:10 am 37 90/60 27 102 ---- U-1 S-0

11-28-12 3-11 7:20 pm 36.5 90/70 24 107 ---- U-1 S-0

11-29-12 11-7 2:10 am 36.5 90/60 25 102 ---- U-1 S-0

11-29-12 7-3 8:00 am 36.5 90/60 30 110 ---- ----

12:00 nn 36.3 90/60 28 104 H2O-750ccU-300cc

S-1

NUTRITIONAL STATUS

12

The patient is 3ft. in height and weighs 16 kg. He is on Diet as

Tolerated. He is able to consume the food served. He eats 3 meals a day

with small snacks in between meals; able to consume 1000mL of water a

day. With D5LR 1L @ 55cc/hour.

NEUROLOGIC STATUS

Patient is alert, attentive, and follows commands. If asleep, he

responds promptly to external stimulation and, once awake, remains

attentive.

INTEGUMENTARY SYSTEM

Skin is pale and slightly dry with brown patches. Hair is fine and evenly

distributed. With a short, clean and well-trimmed fingernails and toenails.

HEENT (Head, Eyes, Ears, Nose and Throat)

Head is normocephalic. Eyes has fine, coordinated movements and are

symmetrical. Ears are patent and bilaterally hears sounds; both are symmetrical.

Nose is midline, patent and sinuses are non-tender. Lips are moist; gums are

pinkish, intact and non-bleeding with midline uvula and non-inflamed tonsils.

Some teeth are missing and some have caries. Tongue is pink and even; dorsal

surface rough with papillae.

PULMONARY SYSTEM

13

Clear lung sounds are heard upon auscultation. Chest is bilateral

symmetry in general shape. There’s an equal rise and fall of the chest and

with normal depth of respiration.

CARDIOVASCULAR SYSTEM

Normal “lub dubb” sound is heard upon auscultation, with no chest pain

felt.

GASTROINTESTINAL SYSTEM

Abdomen has an equal color as the rest of the body, hassoft and flat

abdomen. Normal clicks heard upon auscultation 25 clicks per minute.

MUSCULOSKELETAL SYSTEM

Hands are medium in size, has supracondylar fracture at left arm, has

overhead skin traction, bruises noted at left arm, skin is slightly dry but with

no lesions noted. Right arm is able to move through active ROM. The size of

the feet is about 4 inches; symmetrical in shape. Upper and lower extremities

are normally warm to touch. Skin peeling on both hands and feet noted.

GENITO-URINARY SYSTEM

Patient urinates at least 4 times a day without difficulty with yellowish

colored urine at about 100cc per urination.

COURSE IN THE WARD

14

Date/Shift Nurse’s

Assessment

Nurse’s Intervention Medical Management

11-17-12

3-11

Admitt

ed

this 6

years

old;

male ;

awak

e and

respo

nsive

came

in due

to fall

V/S taken

and recorded.

® To obtain baseline

data.

Started with

D5LR 1L

regulated @

55cc/hr.

® For venous access.

Laboratory

exams

requested

(x-ray)

done.

® To obtain

baseline data and

identify

abnormalities and

underlying causes.

11-17-12

3-11

Received

from ER per

wheelchair;

awake and

responsive;

V/S checked and

recorded.


data.

Per application of

overhead skin

traction.

® To maintain limb

aligned to the body

surface and to prevent

complication.

15

On diet as

tolerated.

® To maintain and

continue tolerated

diet.

11-17-12

11-7

Received on

bed; awake

and

responsive;

with #1

D5LR

regulated @

55cc/hr.

V/S checked and

recorded


data.

Watched and cared

for

® To identify

appropriate

interventions if there

are unusualities.

Still for overhead

skin traction.

® To maintain limb

aligned to the body


complication.

On diet as

tolerated

® To maintain and

continue tolerated

diet.

11-18-12

7-3

Received on

bed; awake

and

responsive;

With D5LR

@900cc

regulated

V/S checked and

recorded.


data.

Watched and cared

for.

Overhead skin

traction a left arm.

® To maintain limb

aligned to the body


complication.

On diet as

16

@55cc/hr ® To identify

appropriate


are unusualities.

tolerated.

® To maintain and

continue tolerated

diet.

11-18-12

3-11

Received

patient on

bed; awake

and

responsive;

with IVF of

D5LR @

800cc level

@55cc/hr.

V/S taken and

recorded.


data.

Due meds given.

® To treat underlying

cause.

Watched and cared

for.

® To identify

appropriate


are unusualities.

On diet as

tolerated.

® To maintain and

continue tolerated

diet.

11-18-12

11-7

Received on

bed; Awake.

with IVF #1

D5LR @

55cc/hr.

V/S checked and

recorded.


data.

17

11-19-12

7-3

Received on

bed; awake

and

responsive;

on diet as

tolerated;

with IVF

D5LR

@900cc

level

regulated

@55cc/hr.

V/S taken and

recorded.


data.

Due available meds

given.


cause.

Maintain on

overhead skin

traction.

® To maintain limb

aligned to the body


complication.

refer to

orthopedics.

11-19-12

3-11

Received on

bed; awake

and

responsive;

on moderate

high back

rest. with IVF

#2 D5LR

@700cc

level

regulated

V/S taken and

recorded.


data.

Due available meds

given.


cause.

Needs attended.

® To provide comfort.

Maintain on

overhead skin

traction.

® To maintain limb

aligned to the body


complication.

On diet as

tolerated.

® To maintain and

continue tolerated

18

@55cc/hr. Health teachings

rendered.

® To have accurate

knowledge and prevent

more complication.

diet.

11-19-12

11-7

On bed

awake. with

IVF #2 D5LR

@700cc

level

regulated

@55cc/hr.

V/S checked and

recorded.


data.

Overhead skin

traction at left

arm.

® To maintain limb

aligned to the body


complication.

11-20-12

7-3

Received on

bed; awake

and

responsive;

on diet as

tolerated.

IVF #2 D5LR

@55cc/hr.

V/S monitored.


data.

Due med given.


cause.

Kept safe and

comfortable.

® To provide security

and comfort.

19

Needs attended.


11-20-12

3-11

Received on

bed; awake

and

responsive;

on diet as

tolerated. On

moderate

high back

rest with IVF

#3 D5LR

@55cc/hr.

V/S checked and

recorded.


data.

followed up meds

and pending labs.

Watched and

monitored.

® To identify

appropriate


are unusualities.

Due meds given.


cause.

11-21-12

11-7

Received on

bed awake

and

responsive;

V/S checked and

recorded.


data.

Overhead skin

traction at left arm.

® To maintain limb

aligned to the body

20

IVF #4 D5LR

@55cc/hr

Followed up meds

and pending labs.

® To take medication

and identify underlying

cause.

Due available meds

given.


cause.

Watched and cared

for.



complication.

On diet as

tolerated

® To maintain and

continue tolerated

diet.

11-22-12

7-3

Received

patient on

bed; awake

and

responsive;

#4 D5LR 1L

@55cc/hr.

V/S taken and

recorded.


data.

Follow up availability

of meds.


Overhead skin


® To maintain limb

aligned to the body


complication.

On diet as

tolerated.

21

cause.

Health teachings

rendered.

® To have accurate


more complication.

Watched and cared

for.


® To maintain and

continue tolerated

diet.

11-22-12

3-11

Received on

bed awake

and

responsive;

with IVF #5

D5LR 1L

@55cc/hr.

V/S checked and

recorded.


data.

Followed up

pending meds.


as ordered.

Needs attended.


Overhead skin


® To maintain limb

aligned to the body


complication.

On diet as

tolerated.

® To maintain and

continue tolerated

diet.

22

Watched and cared

for.

® To identify

appropriate


are unusualities.

11-22-12

11-7

On bed

awake;

D5LR @

55cc/hr.

V/S checked and

recorded.


data.

Needs attended.


Meds given.


cause.

Overhead skin


® To maintain limb

aligned to the body


complication.

On diet as

tolerated.

® To maintain and

continue tolerated

diet.

11-23-12

7-3

Received

patient on

bed; awake

and

V/S taken and

recorded.


data.

Overhead skin


® To maintain limb

aligned to the body

23

responsive;

IVF #5 D5LR

1L @

55cc/hr.

Followed up of

unavailability of

meds.


as ordered.

Health teachings

rendered.

® To have accurate


more complication.

Watched and cared

for.


complication.

On diet as

tolerated.

® To maintain and

continue tolerated

diet.

11-23-12

3-11

Received

patient on

bed; awake

and

responsive;

IVF #5 D5LR

500cc level

regulated @

55cc/hr.

V/S taken and

recorded.


data.

Followed up of

unavailability of

meds.


as ordered.

Overhead skin


® To maintain limb

aligned to the body


complication.

On diet as

tolerated.

® To maintain and

continue tolerated

24

Watched and cared

for.

® To identify

appropriate


are unusualities.

diet.

11-24-12

11-7

Received

patient on

bed; awake

and

responsive.

V/S taken and

recorded.


data.

Needs attended.


Overhead skin


® To maintain limb

aligned to the body


complication.

On diet as

tolerated.

® To maintain and

continue tolerated

diet.

11-24-12

7-3

Received

lying on bed;

responsive

and

coherent.

V/S checked and

recorded.


data.

Health teachings

Overhead skin


® To maintain limb

aligned to the body


complication.

25

imparted.

® To have accurate


more complication.

Provided with restful

environment.


On diet as

tolerated.

® To maintain and

continue tolerated

diet.

11-24-12

3-11

Received on

bed awake;

responsive

and

coherent.

V/S checked and

recorded.


data.

Due meds followed

up.


cause.

Watched and cared

for.

® To identify

appropriate


are unusualities.

Overhead skin


® To maintain limb

aligned to the body


complication.

On diet as

tolerated.

® To maintain and

continue tolerated

diet.

11-24-12 On bed; V/S checked and Overhead skin

26

11-7 sleep. recorded.


data.

Needs attended.



® To maintain limb

aligned to the body


complication.

11-25-12

7-3

Received on

bed; awake

and

responsive

V/S checked and

recorded.


data.

Watched and cared

for.

® To identify

appropriate


are unusualities.

Health teachings

imparted.

® To have accurate


more complication.

Overhead skin


® To maintain limb

aligned to the body


complication.

11-25-12 Received on V/S monitored. Overhead skin

27

3-11 bed; awake

and

responsive.

Seen by Dr.

Donayre


data.

Due meds given.


cause.

Watched and cared

for.

® To identify

appropriate


are unusualities.

traction at left arm

kept limb aligned.

® To maintain limb

aligned to the body


complication.

11-25-12

11-7

Received on

bed; awake

and

responsive

V/S checked and

recorded.


data.

Watched and cared

for.

® To identify

appropriate

Overhead skin


® To maintain limb

aligned to the body


complication.

28


are unusualities.

Health teachings

imparted.

® To have accurate


more complication.

11-26-12

7-3

On bed;

sleep.

V/S checked and

recorded.


data.

Needs attended.


Overhead skin


® To maintain limb

aligned to the body


complication.

11-26-12

3-11

Received on

bed; awake

and

responsive

V/S checked and

recorded.


data.

Watched and cared

Overhead skin


® To maintain limb

aligned to the body


complication.

29

for.

® To identify

appropriate


are unusualities.

Health teachings

imparted.

® To have accurate


more complication.

11-26-12

11-7

Received

lying on bed;

responsive

and

coherent.

V/S checked and

recorded.


data.

Health teachings

imparted.

® To have accurate


more complication.


environment.

Overhead skin


® To maintain limb

aligned to the body


complication.

On diet as

tolerated.

® To maintain and

continue tolerated

diet.

30


11-27-12

7-3

On bed;

sleep.

V/S checked and

recorded.


data.

Needs attended.


Overhead skin


® To maintain limb

aligned to the body


complication.

11-27-12

3-11

Received on

bed; awake

and

responsive

V/S checked and

recorded.


data.

Watched and cared

for.

® To identify

appropriate


are unusualities.

Health teachings

imparted.

® To have accurate

Overhead skin


® To maintain limb

aligned to the body


complication.

31


more complication.

11-27-12

11-7

Received

lying on bed;

responsive

and

coherent.

V/S checked and

recorded.


data.

Health teachings

imparted.

® To have accurate


more complication.


environment.


Overhead skin


® To maintain limb

aligned to the body


complication.

On diet as

tolerated.

® To maintain and

continue tolerated

diet.

11-28-12

7-3

On bed;

sleep.

V/S checked and

recorded.


data.

Needs attended.


Overhead skin


® To maintain limb

aligned to the body


complication.

32

11-28-12

3-11

Received on

bed awake;

Seen by Dr.

Donayre.

V/S taken and

recorded.


data.

On diet as

tolerated.

® To maintain and

continue tolerated

diet.

Overhead skin


® To maintain limb

aligned to the body


complication.

For pedia

clearance.

11-28-12

11-7

Received on

bed; awake

and

responsive;

not in

respiratory

distress;

V/S taken and

recorded.


data.

Followed up

pending lab request.

® To identify

abnormalities and

Overhead skin


® To maintain limb

aligned to the body


complication.

For pedia approval

clearance.

33

underlying causes.

Needs attended and

cared for.


11-29-12

7-3

Received on

bed; awake

and

responsive.

V/S taken and

recorded.


data.

Provided with calm

and restful

environment.


Needs attended.


On diet as

tolerated.

® To maintain and

continue tolerated

diet.

Overhead skin


® To maintain limb

aligned to the body


complication.

Doctors Order

34

Date Time Order

11-17-12 Please admit to orthowar under GS III

Secure consent for admission

Monitor VS q 4°

DAT

Start IVF with D5LR @ 55 cc/hr

Labs: CBC, BT, Serum Electrolytes, Chest X-ray, X-ray

left forearm.

Medication: Paracetamol 200 mg IVTT q4 RTC

Please apply overhead skin traction.

11-18-12 DAT

Maintain skin traction

Continue meds

11-19-12 DAT

IVF D5LR @ 55 cc/hr

Continue Meds


Refer to ortho for definitive procedure.

11-20-12 DAT

IVF @ D5LR @ 55 cc/hr

Continue Meds

Monitor skin traction

35

11-21-12 DAT


Continue Meds


11-22-12 DAT


Continue Meds


11-23-12 DAT


Continue Meds


11-24-12 DAT

Continue Meds


11-25-12 DAT

Continue Meds


11-26-12 DAT

Continue Meds

11-27-12 DAT

Continue Meds

For pedia clearance

36

11-28-12 DAT

Continue Meds

11-29-12 Pedia Notes

Patient seen and examined, History on PE reviewed

Cc: fall, pt. was accidentally fall while playing left

arm (-) fever (-) cough.

Skin traction at left arm.

Closed supracondylar fracture type III secondary to

fall.

Rpt. CBC, PC, Protime,

Rpt. S. elec.

Rpt. CXR

UA

Please ref lab result once available

LABORATORY AND DIAGNOSTIC EXAMINATIONS

37

Serum ElectrolytesDate: November 17, 2012

LAB EXAM

NORMAL RESULT

RESULT INTERPRETA-TION RATIONALE

S. Sodium135-148 mmol/L

139.4

The result is normal .

Transmission of

nerve impulses can

be altered and

lethargy, headache

and dizziness are

some signs and

symptoms for

hyponatremia or

hypernatremia.

Tests that measure the

concentration of electrolytes are

needed for both the diagnosis and

management of renal, endocrine,

acid-base, water balance, and many

other conditions. Their importance

lies in part with the serious

consequences that follow from the

relatively small changes that

diseases or abnormal conditions

may cause. (http://www.

surgeryencyclopedia.com/Ce-Fi/Elec

trolyte-Tests.html#b ,November 29,

2012)

S. Potassium

3.50-5.00 mmol/L

3.84 The result is

normal.Contraction of

cardiac, skeletal and

smooth muscles can

be altered. Fatigue,

muscle weakness

and decreased bowel

motility are some

signs and symptoms

for hypokalemia or

hyperkalemia.

38

S. Calcium1.13-1.32 mmol/L

1.21

The result is normal.

Bone strength and

blood coagulation can

be altered. Irritability,

anxiety and

numbness are some

signs and symptoms

for hypocalcemia or

hypercalcemia.

HematologyDate: November 17, 2012

LAB EXAM NORMAL VALUES

RESULT INTERPRETATION RATIONALE

Blood group --- B positive ---Hemoglobin 115-165

g/L118 The result is normal.

Hemoglobin gives blood

its red color and carries

oxygen to the body

through the blood. This

may indicate anemia

and pallor can be

observed.

(http://en.wikipedia.org/

wiki/Hemoglobin,

November 29, 2012)

A complete blood count

(CBC) gives important

information about the kinds

and numbers of cells in the

blood, especially red blood

cells , white blood cells ,

and platelets. A CBC helps

your doctor check any

symptoms, such as

weakness,fatigue, or

bruising, you may have. A

39

http://www.webmd.com/a-to-z-guides/weakness-and-fatigue-topic-overview

http://www.webmd.com/hw-popup/platelet

http://www.webmd.com/a-to-z-guides/white-blood-cells

http://www.webmd.com/a-to-z-guides/red-blood-cells

http://www.webmd.com/a-to-z-guides/red-blood-cells

http://en.wikipedia.org/%20wiki/Hemoglobin

http://en.wikipedia.org/%20wiki/Hemoglobin

CBC also helps him or her

diagnose conditions, such

as anemia, infection, and

many other disorders.

(http://www.webmd.com/a-

to-z-guides/complete-blood-

count-cbc November 29,

2012)

Hematocrit 0.35-0.55 0.34 The result is below

normal. The hematocrit

measures how much

space in the blood is

occupied by RBCs. A

low hematocrit level is

one of the clinical

manifestations of

anemia. It coincides

with the pt’s low hgb

level.


wiki/Hematocrit

November 29, 2012)

Leucocytes 5.0-10.0 15.8 The result is above

normal. Leukocytes or

WBCs are indicators if

there is infection in the

body. WBC fights

against infection so the

patient is at risk for

infection.


40

http://en.wikipedia.org/%20wiki/White_blood_cell

http://en.wikipedia.org/%20wiki/Hematocrit

http://en.wikipedia.org/%20wiki/Hematocrit

http://www.webmd.com/hw-popup/anemia

wiki/White_blood_cell,

November 29, 2012)

Monocytes 0.02-0.6 0.03 The result is normal.

Monocytes are also a

type of Leukocytes or

WBC that fights

infections.


wiki/White_blood_cell,

November 29, 2012)

Neutrophils 0.55-0.65 0.85 The result is above

normal.The most

abundant type of white

blood cells, elevated

neutrophils usually

mean there is an

ongoing current

bacterial infection.

(

http://answers.yahoo.co

m/question/index?

qid=20080208002214A

Aaults November

41

http://answers.yahoo.com/question/index?qid=20080208002214AAaults






29,2012)

I. Review of Anatomy and Physiology

Fig. 1 Diagram of the Anatomy of Human Skeletal System

The skeletal system includes all of the bones and joints in the body. Each bone is

a complex living organ that is made up of many cells, protein fibers, and minerals. The

skeleton acts as a scaffold by providing support and protection for the soft tissues that

make up the rest of the body. The skeletal system also provides attachment points for

muscles to allow movements at the joints. New blood cells are produced by the red

42

bone marrow inside of our bones. Bones act as the body’s warehouse for calcium, iron,

and energy in the form of fat. Finally, the skeleton grows throughout childhood and

provides a framework for the rest of the body to grow along with it.

The skeletal system in an adult body is made up of 206 individual bones. These

bones are arranged into two major divisions: the axial skeleton and the appendicular

skeleton. The axial skeleton runs along the body’s midline axis and is made up of 80

bones in the skull, hyoid, auditory ossicles, ribs, sternum, and the vertebral column. The

appendicular skeleton is made up of 126 bones in the upper and lower limbs and the

pelvic and pectoral (shoulder) girdles.

Skull

The skull is composed of 22 bones that are fused together except for the

mandible. These 21 fused bones are separate in children to allow the skull and brain to

grow, but fuse to give added strength and protection as an adult. The mandible remains

as a moveable jaw bone and forms the only movable joint in the skull with the temporal

bone.

The bones of the superior portion of the skull are known as the cranium and protect the

brain from damage. The bones of the inferior and anterior portion of the skull are known

as facial bones and support the eyes, nose, and mouth.

Hyoid and Auditory Ossicles

The hyoid is a small, U-shaped bone found just inferior to the mandible. The

hyoid is the only bone in the body that does not form a joint with any other bone – it is a

43

floating bone. The hyoid’s function is to help hold the trachea open and to form a bony

connection for the tongue muscles.

Vertebrae

26 vertebrae form the vertebral column of the human body. They are named by

region – cervical (neck), thoracic (chest), lumbar (lower back), sacrum, and coccyx (tail

bone). There are seven cervical vertebrae, twelve thoracic, five lumbar, one sacrum,

and one coccyx.

Ribs and Sternum

The sternum, or breastbone, is a thin, knife-shaped bone located along the

midline of the anterior side of the thoracic region. The sternum connects to the ribs by

thin bands of cartilage called the costal cartilage.

Pectoral Girdle and Upper Limb

The pectoral girdle connects the upper limbs (arms) to the axial skeleton and

consists of the left and right clavicles and left and right scapulae.

The humerus is the bone of the upper arm. It forms the ball and socket joint of

the shoulder with the scapula and forms the elbow joint with the lower arm bones. The

radius and ulna are the two bones of the forearm.

Pelvic Girdle and Lower Limb

Formed by the left and right hip bones, the pelvic girdle connects the lower limbs

(legs) to the axial skeleton.

44

The femur is the largest bone in the body and the only bone of the thigh (femoral)

region. The femur forms the ball and socket hip joint with the hip bone and forms the

knee joint with the tibia and patella. Commonly called the kneecap, the patella is special

because it is one of the few bones that are not present at birth. The patella forms in

early childhood to support the knee for walking and crawling.

The tibia and fibula are the bones of the lower leg. The tibia is much larger than

the fibula and bears almost all of the body’s weight. The fibula is mainly a muscle

attachment point and is used to help maintain balance. The tibia and fibula form the

ankle joint with the talus, one of the seven tarsal bones in the foot.

The tarsals are a group of seven small bones that form the posterior end of the

foot and heel. The tarsals form joints with the five long metatarsals of the foot. The each

of the metatarsals forms a joint with one of the set of phalanges in the toes. Each toe

has three phalanges, except for the big toe, which only has two phalanges.

Types of Bones

All of the bones of the body can be broken down into five types: long, short, flat,

irregular, and sesamoid.

Long bones are longer than they are wide and are the major bones of the limbs. Long

bones grow more than the other classes of bone throughout childhood and so are

responsible for the bulk of our height as adults. A hollow medullary cavity is found in the

center of long bones and serves as a storage area for bone marrow. Examples of long

bones include the femur, tibia, fibula, metatarsals, and phalanges.

45

Short bones are about as long as they are wide and are often cubed or round in shape.

The carpal bones of the wrist and the tarsal bones of the foot are examples of short

bones.

Flat bones vary greatly in size and shape, but have the common feature of being very

thin in one direction. Because they are thin, flat bones do not have a medullary cavity

like the long bones. The frontal, parietal, and occipital bones of the cranium - along with

the ribs and hip bones - are all examples of flat bones.

Irregular bones have a shape that does not fit the pattern of the long, short, or flat

bones. The vertebrae, sacrum, and coccyx of the spine - as well as the sphenoid,

ethmoid, and zygomatic bones of the skull - are all irregular bones.

Finally, the sesamoid bones are formed after birth inside of tendons that run across

joints. Sesamoid bones grow to protect the tendon from stresses and strains at the joint

and can help to give a mechanical advantage to muscles pulling on the tendon. The

patella and the pisiform bone of the carpals are the only sesamoid bones that are

counted as part of the 206 bones of the body. Other sesamoid bones can form in the

joints of the hands and feet, but are not present in all people.

Parts of Bones

The long bones of the body contain many distinct regions due to the way in

which they develop. At birth, each long bone is made of three individual bones

separated by hyaline cartilage. Each end bone is called an epiphysis (epi = on; physis =

to grow) while the middle bone is called a diaphysis (dia = passing through). The

epiphyses and diaphysis grow towards one another and eventually fuse into one bone.

46

The region of growth and eventual fusion in between the epiphysis and diaphysis is

called the metaphysis (meta = after). Once the long bone parts have fused together, the

only hyaline cartilage left in the bone is found as articular cartilage on the ends of the

bone that form joints with other bones. The articular cartilage acts as a shock absorber

and gliding surface between the bones to facilitate movement at the joint

Skeletal System Physiology

Support and Protection

The skeletal system’s primary function is to form a solid framework that supports

and protects the body's organs and anchors the skeletal muscles. The bones of the

axial skeleton act as a hard shell to protect the internal organs - such as the brain and

the heart - from damage caused by external forces. The bones of the appendicular

skeleton provide support and flexibility at the joints and anchor the muscles that move

the limbs.

Movement

The bones of the skeletal system act as attachment points for the skeletal

muscles of the body. Almost every skeletal muscle works by pulling two or more bones

either closer together or further apart. Joints act as pivot points for the movement of the

bones. The regions of each bone where muscles attach to the bone grow larger and

stronger to support the additional force of the muscle. In addition, the overall mass and

thickness of a bone increase when it is under a lot of stress from lifting weights or

supporting body weight.

47

Hematopoiesis

Red bone marrow produces red and white blood cells in a process known as

hematopoiesis. Red bone marrow is found in the hollow space inside of bones known

as the medullary cavity. Children tend to have more red bone marrow compared to their

body size than adults do, due to their body’s constant growth and development. The

amount of red bone marrow drops off at the end of puberty, replaced by yellow bone

marrow.

Storage

The skeletal system stores many different types of essential substances to facilitate

growth and repair of the body. The skeletal system’s cell matrix acts as our calcium

bank by storing and releasing calcium ions into the blood as needed. Proper levels of

calcium ions in the blood are essential to the proper function of the nervous and

muscular systems. Bone cells also release osteocalcin, a hormone that helps regulate

blood sugar and fat deposition. The yellow bone marrow inside of our hollow long bones

is used to store energy in the form of lipids. Finally, red bone marrow stores some iron

in the form of the molecule ferritin and uses this iron to form hemoglobin in red blood

cells.

48

Fig. 2 Diagram of the Anatomy of Supracondylar fracture

Symptomatology

Symptomatology Actual Symptoms Implication

Pain Fracture is usually accompanied by a very severe pain. Pain from fracture is about the worst pain so far. The kind of pain sometimes is enough to make the patient go into a state of shock if not controlled.

Article Source: http://EzineArticles.com/5570773

Swelling Damage can cause inflation.

Vascular injury causing the

swelling.

Bruising Any internal damage will cause

internal bleeding.

49

http://EzineArticles.com/5570773

Inability to move Any disease or disability that

requires complete bed rest or

extremely limits your activity is

considered immobility. Patients

who have had a stroke resulting

in partial or complete

hemiparesis/paralysis, spinal

cord injury resulting in

paraplegia or quadriplegia,

fracture, or prolonged bed rest

after surgery are considered

immobilized

Deformity Deformity occurs especially with

fracture of the limbs. The part

below the affected limb can be

rotated outwards or inwards. In

some cases the affected limb is

shorter than the second.

Article Source:


Shortening In fractures of long bones, there

is actual shortening of the

50


extremity because of the

compression of the fractured

bone.

Article Source:

(Brunner and Suddarth Medical

Surgical Nursing vol. 2)

Etiology of the disease

Etiology Actual Symptoms Implication

Trauma Due to the resilience of the soft

tissue of children, fractures occur

more often than soft tissue injuries.

Age ( 3 – 12 years old ) adult ( 60 years old)

Age-related changes, such as

decreases in bone strength and

brain size, could make older riders

more susceptible to injury.

Impaired vision, delayed reaction

time, and altered balance, all of

51

which accompany the natural aging

process, could contribute to

crashes or mishaps.

(http://www.livescience.com/11012-

oldermotorcycle-riders-injured.html)

52

A. Written Pathophysiology

Closed Supracondylar fracture Type III is a severe pain, it is not necessary to

delay client to convey to the hospital and it needs immediate attention, Type 3 fracture

needs surgery since it is fully displaced.This classification remains somewhat deficient

in describing the mechanically important concept of the medial and lateral columns and

their fracture involvement. It also is somewhat deficient in describing the level through

which the fracture occurs in each column and related important surgical considerations.

Local swelling, loss of function or abnormal movement of the affected part and

deformities such as angulation, shortening or rotation of the part. Pain or local

tenderness is normally present. This is due to a temporary loss of nerve function at the

site of the fracture. Associated vascular injury causes swelling, pallor, pain, or

numbness and pulselessness These signs may not develop for several hours after

injury or may develop within an hour, depending on the severity of the fracture.

patient fall from an 8 feet high door, causing the fracture at the distal humerus

which was displaced and eventually causing vascular injury. The blood vessels also

bring fibroblasts in the walls of the vessels and these multiply and produce collagen

fibers. In this way the blood clot is replaced by a matrix of collagen. Collagen’s rubbery

consistency allows bone fragments to move only a small amount unless severe or

persistent force is applied. At this stage, some of the fibroblasts begin to lay down bone

matrix (calcium hydroxyapatite) in the form of insoluble crystals. This mineralization of

the collagen matrix stiffens it and transforms it into bone. In fact, bone is a mineralized

collagen matrix; if the mineral is dissolved out of bone, it becomes rubbery. Causing the

left arm to become immobilize.

53

Traction (skin or skeletal) may be used until the patient is physiologically stable

to undergo surgical fixation. Skin traction is used to control muscle spasm and to

immobilize an area before surgery. Skin traction is accomplished by using weight and

pull on traction tape or on a foam boot attached to the skin. The amount of weight

applied must not exceed the tolerance of the skin.

54

B. Diagram of Pathophysiology

55

Predisposing factor:

Age (6-12 years old)

Precipitating factor:

Activity- (playing)

Fall from an 8 (eight) ft. height.

Fractured the distalhumerus

Humerusdisplaced.

The blood vessels bring fibroblast in the walls of the vessels and these multiply and produce collagen fibers.

The blood coagulates to form a blood clot situated between the broken fragments.

Mineralization of the collagen matrix stiffens it and transforms it into bone.

deformity, swelling, bruising, pain, impaired sensation

Vascular injury

Fibroblasts begin to lay down bone matrix (Calcium hyroxyapatite) in the form of insoluble crystals.

Immobility

If treated:Nursing management:Health teachingsMonitor Vital SignsCollaborativeLaboratory testMedical management:Paracetamol 200 mg IVTTOverhead Skin TractionSurgery

Good Prognosis:

If not treated:

Infection

Necrosis and loss of function

Exacerbation amputation

Death

Poor prognosis

56

III. Nursing Care Management

Date/Shift

Assessment Need Nursing Diagnosis

Objective of care Nursing Intervention

Rationale Evaluation

11-23-127-3

S- “maglisod pa man ko ug lihok-lihok dili pud ko makanaog diri sa higdaanan.” as verbalized

- with overhead skin traction at left arm.- Bruise

noted at left arm

- Pain rate 7/10

- V/S- BP -90/60

Temp- 37RR – 28PR- 110

SELF-ACTUALIZATION/

ACTIVITY

Impaired physical mobility related to overhead skin traction secondary to closed supracondylar fracture

Rationale:Fall causing

injury to humerus results

tointernal bleeding

from damage ends of bone

and from surrounding

tissuewhich

stimulates intense

inflammatory response

that causesincreased capillary

After 6 hours of nursing care the patient will be able to:- Verbalize the

importance of side lying.

- Not complain for respiratory distress.

- Verbalize pain free.

- Understand importance of skin traction

Dependent:Monitor Vital Signs

Maintain Overhead skin traction.

Independent: Assisted on normal range of motion.

Positioned on Moderate High Back Rest.

Assisted on side lying position.

Health Teachings

R- to provide baseline data

R- to kept limb aligned to body.

R- to avoid muscle sprain

R- to avoid respiratory distress

R- to prevent bed sore.

R- to gain knowledge.

Goal Met:After 6 hours of nursing care the patient was able to verbalized importance of side lying position “ magtakilid na ko usahay aron dili na singoton akong likod”, respiratory distress not noted, verbalized pain free “ wala man naga sakit akong kamot”, understand importance of skin traction “ bahalag dili ko makanaog diri sa higdaanan basta dili lang magsakit akong kamot” as verbalized.

57

permeabilityand

fluid/cellular exudation

that leads toedema

that causespainto

impaired function

Ref: Mary Ellen Murray and Lesley D. Atkinson Understanding the Nursing Process in Changing Care Environment

Date/Shift Assessment Need Nursing Diagnosis



58

11-23-127-3

O- with overhead skin traction at left arm.- Bruise

noted at left arm

- Pain rate 7/10

- V/S- BP -90/60

Temp- 37RR – 28PR- 110

PHYSIOLOGIC

NEED

Risk for infection related to a site for organism invasion secondary to surgery.Rationale: Surgery there is break down of skin which gives opportunity for the bacteria and other pathogens to invade the body. The host is susceptible for infection because of the breakage of the body’s first line of defense.Ref: Mary Ellen Murray and Lesley D. Atkinson Understanding the Nursing Process in Changing Care Environment

Within 2 days of nursing care the patient will demonstrate skin integrity:- Absence of

swelling to the site

- Absence of erythema

- Dry and intact dressing will be noted

Dependent:- Monitor vital

signs- Change

dressing as ordered

Independent:- Monitor IVF

at desired rate.

- Assess for signs of infection

- Observe handwashing frequently

Collaborative- Encourage

watcher on frequent handwashing when giving direct care to the client

R- baseline dataR- to keep wound dry and intact

R- maintain adequate hydrationR- to prevent exacerbation of the disease - To

prevent cross infection

- To prevent infection and promote aseptic technique

After 2 days of nursing action, Goal met, the patient was able to demonstrate skin integrity as evidence by:- Absence of

swelling to the site.

- Absence of erythema

- Dry and intact dressing is noted.

59

Date/Shift Assessment Need Nursing Diagnosis



11-23-127-3

S- “Mahadlok man ko inig human sa opera kay dili na kayo ko makadula”as verbalized.

O- with overhead skin traction at left arm.- Bruise

noted at left arm

- Pain rate 7/10

- V/S- BP -90/60

Temp- 37RR – 28PR- 110

SELF-ESTEEM

NEED

anxiety related to actual or perceived threat to biologic integrityRationale:Fear of unknown is usually one of the factors greatly contributed to the anxiety of the person. When the health of the person is at risk or threatened anxiety will likely to occur ProperRef: Mary Ellen Murray and Lesley D. Atkinson Understanding the Nursing Process in Changing Care Environment

Within 2 days of

nursing care the

patient will be able

to:

- Understand the

importance of

surgery

- Will verbalize

decrease of

nervousness.

- Differentiate

real from

imagined

situation.

Dependent:- Monitor Vital

Signs

Independent:- Established

rapport.

- Orient to environment using simple explanation

- Speaks slowly and calmly

- Encourage expression and feelings

- For baseline data

- To gain trust and cooperation

- To easily understand the situation

- To gain cooperation

- To note the decrease of anxiety

After 2 days of nursing care, goal partially met as evidenced by patient was able to - understand the importance of surgery-verbalize decrease in nervousness “magpaopera nalang jud ko para maayo ang akong bali naa man pud sila mama ug papa diri” as verbalized.

60

B. Discharge Plan

Medications

-Educate family members concerning right drug administration as well as right time and dosage as prescribed.

-Explain the relevance of taking prescribed medications for fast and better recovery.

-Instruct patient and family to continue home medications as ordered:

Medication Dose Frequency Time

Paracetamol 200 mg Every 4 hours2-6

10-26-10

Exercise

-Explain the importance of exercise to alleviate the condition.

-Educate patient and family to have the mindset of exercise, do at least

one passive and active range of motion and physical chore each day. As little as 15

minutes of walking 3 time a week has a proven beneficial effect but never exercise that

causes fatigue.

-Remind patient and family on the warning signs of injury such as pain,

bruise, swelling and redness.

Treatment

-Instruct patient to take medication and for family tobought medical

regimen religiously as well as scheduled hospital visits for continuous monitoring.

-Encourage to take Multivitamins for immunity.

-Educate the patient to self-monitor blood sugar levels frequently at least

before meals or at bedtime.

61

Health Teachings

-Educate patient on the importance of nutrition such ascalcium, iron and

protein for his age.

-Encourage regular exercise.

-Make the patient and family understands the importance seeking medical

help in case of any complications or abnormalities.

Out-patient

-Even without the presence of any health care member, the parents must

still obey to bought the medications and the client must take his medications religiously.

All health teachings rendered monitor his arm condition and avoid junk foods.

- Encourage client and his parents to follow medical advice for follow-up

check up 1 week after discharge.

Diet

-Teach patient to eat healthy foods in moderation on a regular schedule.

Eating at the same times each day regulates.

-Educate on the maintenance of healthy diet consisting of milk, dairy

products, fruits, egg, vegetables, whole grains, fish, white meat and poultry

62

C. PHARMACOLOGICAL MANAGEMENT

Date / Shift

Generic Name

Brand Name

Classification Mechanism of Action

Indication Adverse Effect Time and Dosage

Nursing Consideration

11-17-12

7-3

PARACETAMOL

----- Antipyretic

Analgesic

Reduces fever byacting directly onthe hypothalamicheat-regulatingcenter to causevasodilation andsweating, whichhelps dissipateheat.

Siteand mechanismof action unclear

Analgesic-antipyretic inpatients with aspirinallergy, hemostaticdisturbances, bleedingdiatheses, upper GIdisease, gouty arthritis- Arthritis and rheumaticdisorders involvingmusculoskeletal pain (butlacks clinically significantantirheumatic and anti-inflammatory effects)- Common cold, flu, otherviral and bacterialinfections with pain andfever- Unlabeled use:Prophylactic for childrenreceiving DPT vaccinationto

CNS:HeadacheCV:Chest pain,dyspnea,MyocardialdamageWhendoses of 5–8 g/dayare ingested daily forseveral weeks orwhen doses of 4g/day are ingestedfor 1 yrGI: Hepatictoxicity andfailure,jaundiceGU:Acute kidney failure, renal tubularnecrosisHematologic:Methemoglobinemia—cyanosis;hemolytic anemia—hematuria, anuria;neutropenia,leucopenia,pancytopenia,thrombocytopenia,hypoglycemiaHypersensitivity:Rash, fever

Every 4° RTC 200mg

-Monitor liver function studies;may cause hepatic toxicity at doses>4g/day-Monitor renalfunction studies;albumin indicates nephritis-Monitor blood studies,especially CBC and pro-time if patient is onlong-term therapy.-Check I&O ratio;decreasing output may indicate renalfailure .-Assess for fever and pain--Assess hepatotoxicity:dark urine, clay-colored stools-Assess allergic reactions: rash,

63

reduce incidence of fever and pain

64

IV. SYNTHESES OF CLIENT’S CONDITION/STATUS FROM ADMISSION TO PRESENT

A. Conclusion

After a gradual evaluation of the patient’s condition from the first day of our duty

to the last, I came up with a conclusion that it is beyond doubt unpredictable as to what

happens in the whole period of my nursing care.

The overall condition of my patient was illustrated to have achieved a high level

of wellness with the teamwork of the entire member of the health care team.

B. Patient’s Prognosis

POOR FAIR GOOD JUSTIFICATION

DURATION

Patient has been admitted because of fall since

November 17, 2012 and has a diagnosis of closed

Supracondylar Fracture type III and still for OR

scheduling during our last day of duty. November

29,2012.

ONSET

The patient’s condition became better than he was

first admitted since the pain on his left arm didn’t

occur since the skin traction was maintained.

WILLINGNESS

The patient and his parents is willing to comply all

medication and activities conducive to faster

healing and recovery.

ENVIRONMENT

The nature of the environment is conducive for

faster recovery because there is proper ventilation

and the fan in the ward is near for him.

C. Recommendations

The following are the my suggestions for a faster therapeutic effect:

To the patient -I encourage him to follow medical regimen by

continuing medications as ordered by his attending

physician.

- Follow the health teachings rendered to him

by the health care team.

-Cooperate in everything that the health care

team advises.

To the family -I recommend to the patient’s immediate family

members tofulfill the medical regimen that is ordered

by the physician for faster recovery of their son.

.-provide adequate support, care, love and

understanding to the patient’s situation.

-Develop knowledge about the patient’s

recovery status to avoid further complications.

– follow the health teaching that was rendered

to act upon their son need.

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V. EVALUATION OF THE OBJECTIVES OF THE STUDY

After a step by step review on related topics on this case study, I hereby

presenting my evaluation with relation to my main objectives that I affirmed at the

start of this case study. Myself settled that I was able to meet the chosen case

with sensible data gathered. Further documented related information that are

important as I relate the nursing skills I have learned not only for this study but

also for future references, and that I gained information about the case chosen

and use them to function as student nurses in the community and I was able to

use the nursing process as a framework for the care of my patient and for goal

attainment and that is to prevent and manage potential complications.

With sufficient effort, I have come up with this comprehensive case

presentation that deals not only on the basic facts of the topic but also

mysuccess in every detail directed to have an abundant yield.

67

Bibliography

A. Textbooks.

1. Elaine N. Marieb, R.N., Ph.D. Essentials of Anatomy and Physiology 6th edition 2002.

2. Nurse’s Pocket Guide. Doenges Moorhouse Murr. 10th Edition. 2008.3. Suzanne C. Smeltzer, et al. Brunner and Suddarth’s Textbook of Medical

Surgical Nursing 11th edition. Vol. 1 and 2. 20104. Judith Hopfer Deglin and April Hazard Vallerand. Davis Drug Guide for

Nurses 10th edition. 20075. Suzanne C. Smeltzer, et al. Brunner and Suddarth’s Textbook of Medical

Surgical Nursing 10th edition. Vol. 1. 2004

B. Electronic Media1. Rebello GN, Albright MB. Broken Bones: Common Pediatric Upper Extremity Fractures – Part II. Orthopaedic Nursing. 2006;25(5):311-323.2. Marquis CP, Cheung G, Dwyer JSM, Emery DFG. Supracondylar fractures of the humerus. Current Orthopaedics. 2008;22(1):62-69.3. Jonathan Cluett, M.D., About.com Guide http://orthopedics.about.com/od/pediatricfractures/a/elbowfracture.htm

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closed supracondylar fracture type iii secondary to fall

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