FRACTURE AT RIGHT FEMUR ORIF

[CASE STUDY]


I. INTRODUCTION

We as a student nurses, wellness of the patient is the primary objective. And the
best way to promote these is by means of actualization.

Fracture is any break in the continuity of bone. In some cases, a bone may fracture
without visibly breaking. Fractures occur when the bone is subjected to stress
greater than it can absorb. It can be caused by a direct blow, crushing force, sudden
twisting motion, or even 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. And according to the physician the kind of
fracture that Mr. M.C experience is comminuted fracture that the bone splinters at
the site of impact, and smaller bone fragments lie between the two main fragments.
Femur is the largest and strongest bone and has a good blood supply. Because of
this and its protective surrounding muscle, the shaft requires a large amount of force
to fracture. Once a fracture does occur, this same protective musculature usually is
the cause of displacement, which commonly occurs with femoral shaft fractures.
Orthopedic surgeons often encounter femur fractures because these fractures most
often result from high-energy trauma, one must have a high index of suspension for
complications or other injuries like vehicular accident that experience by Mr. M.C
.
While a variety of treatment options exist for a fracture that is associated to injury.
We have chosen Mrs. M.C with the case of fracture, comminuted at the distal third
right femur because the patient showed willingness and interest to learn and
understand about her condition. We also want to know, and understand more about
his case.
General Objectives:

At the end of the study or learning, the level 3 nursing students will be able to rectify,
expound, and relate all ideas or perception to the nursing approach in doing valid
and outmost care with the patient experiencing Fracture in the right Femur and
undergone ORIF procedure.

Specific Objectives:
The level 3 student nurses will be capable of:
1. Proposing the overall assessment findings with the patient experiencing Fracture
in the right Femur.
2. Expounding thoroughly and articulately the anatomy and physiology of the
systems involved in Fracture.
3. Providing illustration and explanation of the pathophysiology of the Fracture in the
right Femur with regards to the patient.
4. Devising a well planned, with the principle of SMART a comprehensive nursing
care plan that is applicable to the patient with Fracture in the right Femur.
5. Inculcating health teachings for the patient to follow and be in great help for his
condition.
6. Elucidating and discuss the rationale of the different nursing interventions to the
patient and to the family as well.
7. Evaluate the effectiveness and accuracy of the outcome of the nursing
interventions.
8. Providing the needed information or knowledge to attain a healthy living







II. PERSONAL DATA
Name: Mr. MGC
Address: # 334 Hugo Perez Trece Martires Cavite Birthday: August 18, 1979
Age: 29
Birthplace: Cavite
Nationality: Filipino
Case #:012744
Room #: 303-C
Hosp. #: 3322Attending
Physician: Dr. B, Dr. A, Dr. Barr, and Dr. G
How admitted: Via Stretcher
Admission Date & hour: November 13, 2008 04:30 AM
In case of emergency, please notify: MRS. MC
Relation: Wife
Contact #: 09164295484








B. Physical Assessment
Patient has posterior bandage of the right Femur, has pale pink nail beds on the
right foot, and complained of pain in the operative site but unfortunately, we failed to
ask for the pain scale and we did not have enough time to further assess and handle
the patient.

C. Medical History
For his past medication, we also failed to get information from the patient because
we did not have enough time and to handle the patient.

IV. History of Present Illness
2 days prior to surgery, Mr. M was on his way home at night from work via motor
vehicle. There was a road construction in the highway. He assumed that the
construction truck was way far from the excavated hole so he regulated his speed to
find out that the hole was directly after the truck. He couldnt swerve to the other lane
because there were fast cars so he fell under the hole.















V. Anatomy and Physiology



The femur or thighbone is the only bone in the thigh. It is the heaviest and strongest
bone in the body. Its proximal end has a ball-like head, a neck and greater and
lesser trochanters. The head of the femur articulates with the acetabulum of the
hipbone in a deep secure socket. Skeletal muscles are formed when the muscles
are attached to the skeleton or bone, which move the limbs and other parts of the
body.
The muscle that is attached to the femur is known to be the
Quadriceps group, which is consisted of the rectus femoris and three vastus
muscles. All four muscles insert into tibial tuberosity via patellar ligament.
VI. Pathophysiology



VII. MEDICAL MANAGEMENT


A.X-RAY
Patient was diagnosed of Fracture at the distal 3
rd
right Femur

B.PRE-OP MEDICATIONS
1) Ketorolac tromethamine
Action: Inhibit prostaglandin synthesis, to produce anti-inflammatory, analgesic,
antipyretic effects.
Indication: short-term management of moderately severe, acute pain (for single-dose
treatment or multiple-dose treatment)

2) Cefuroxime
Action: Second-generation cephalosporin that inhibits cell-wall synthesis, promoting
osmotic instability; usually bactericidal.
Indication: For bone or joint infection; Perioperative prevention

3) Ranitidine
Action: Competitively inhibits action of histamine on the H2 at receptor sites of
parietal cells, decreasing gastric acid secretion.
Indications: For active duodenal and gastric ulcer, maintenance therapy for duodenal
or gastric ulcer, pathologic hyper secretory conditions, GERD, erosive esophagitis
and heartburn.

4) Metoclopramide hydrochloride
Action: Stimulates motility of upper GI tract, increases lower esophageal sphincter
tone and blocks dopamine receptors at the chemoreceptor trigger zone.
Indication: To prevent or reduce postoperative nausea and vomiting.



5) Paracetamol
Action: Thought to produce analgesia by blocking pain impulses by inhibiting
synthesis of prostaglandin in the CNS or of other substances that sensitize pain
receptors to stimulation. The drug may relieve fever through central action in the
hypothalamic heat-regulating center.

C.HEMATOLOGY
Lab Results
HEMOGLOBIN Date: 11/12/08 10:16 pm
Release: 11/12/08 10:37 pm

Hemoglobin
NV: 140-175g/L RESULT: 139g/L

Hematocrit
NV: 0.41-0.50 RESULT: 0.41

HEMATOLOGY DATE: 11/13/08 4:50am
Release: 11/13/08 5:22 am

Hemoglobin Mass Concentration
NV: 12-17 gms% RESULT: 13gms%

Erythrocyte, Volume Fraction (Hct)
NV: 40-45 % RESULT: 39%






VIII. Surgical Procedure
An incision is made in the right thigh, exposing the fractured part of the bone. The
right femur (fractured bone) is then holed, so that the orthopedic surgeon would be
able to put the reconstruction nail into the medullary canal. Then nail were attached
to secure the femoral fracture. The screws were attached to fixate the rod.



























X. HEALTH EDUCATION

1. Explain basis for fracture treatment and need for patient participation in
therapeutic regimen.
2. Promote adjustment of usual lifestyle and responsibilities to accommodate
limitations imposed by fracture.
3. Instruct the patient to actively exercise joints above and below the immobilized
fracture at frequent intervals.
4. After removal of immobilizing device, have the patient start active exercises and
continue with isometric exercises.
5. Instruct the patient on exercises to strengthen upper extremity muscles if crutch,
walking is planned.
6. Instruct the patients in methods of safe ambulation-walker, crutches, and cane.
7. Emphasize instruction concerning amount of weight bearing that will be permitted
on fractures extremity.
8. Discuss prevention of recurrent fracture; review safety consideration, avoidance of
fatigue, proper foot wear.
9. Encourage follow-up medical supervision to monitor for bone union problems.
10. Teach the patient to recognize and report symptoms needing attention, such as
numbness, decrease function, increase pain, or elevated temperature.
11. Encourage the patient to follow an adequate balance diet to promote bone and
soft tissue healing.









XI. CONCLUSION

Towards the end of the case study or learning, the level 3 nursing students were
able to, propose the overall assessment findings with the patient experiencing a
Fracture, comminuted at the distal third right femur and expounded thoroughly and
articulately the anatomy and physiology of the systems involved. They were able to
illustrate and explain the pathophysiology of the Fracture, comminuted at the distal
third right femur with regards to the patient, devised a well planned, with the principle
of SMART a comprehensive nursing care plan that is applicable to the patient with
Fracture, comminuted at the distal third right femur, inculcated health teachings and
elucidated and discuss the rationale of the different nursing interventions to the
patient and to the family as well. After proving the interventions, they evaluated the
effectiveness and accuracy of the outcome.