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Anatomy and Pathophysiology:

1. Anatomy

The Femur

FIG. a.j. – Upper extremity of right femur viewed from behind


and above.

The femur, the longest and strongest bone in the skeleton, is almost
perfectly cylindrical in the greater part of its extent. In the erect posture it is
not vertical, being separated above from its fellow by a considerable interval,
which corresponds to the breadth of the pelvis, but inclining gradually
downward and medialward, so as to approach its fellow toward its lower part,
for the purpose of bringing the knee-joint near the line of gravity of the body.
The degree of this inclination varies in different persons, and is greater in the
female than in the male,on account of the greater breadth of the pelvis. The
femur, like other long bones, is divisible into a body and two extremities.

The Upper Extremity (proximal extremity, Fig. a.j.).— The upper extremity
presents for examination a head, a neck, a greater and a lesser
trochanter.

The Head (caput femoris).—The head which is globular and forms rather
more than a hemisphere, is directed upward, medialward, and a little
forward, the greater part of its convexity being above and in front. Its surface
is smooth, coated with cartilage in the fresh state, except over an ovoid
depression, the fovea capitis femoris, which is situated a little below and
behind the center of the head, and gives attachment to the ligamentum
teres.

The Neck (collum femoris).—The neck is a flattened pyramidal process of


bone, connecting the head with the body, and forming with the latter a wide
angle opening medialward. The angle is widest in infancy, and becomes
lessened during growth, so that at puberty it forms a gentle curve from the
axis of the body of the bone. In the adult, the neck forms an angle of about
125° with the body, but this varies in inverse proportion to the development
of the pelvis and the stature. In the female, in consequence of the increased
width of the pelvis, the neck of the femur forms more nearly a right angle
with the body than it does in the male. The angle decreases during the period
of growth, but after full growth has been attained it does not usually undergo
any change, even in old age; it varies considerably in different persons of the
same age. It is smaller in short than in long bones, and when the pelvis is
wide. In addition to projecting upward and medialward from the body of the
femur, the neck also projects somewhat forward; the amount of this forward
projection is extremely variable, but on an average is from 12° to 14°.

The neck is flattened from before backward, contracted in the middle, and
broader laterally than medially. The vertical diameter of the lateral half is
increased by the obliquity of the lower edge, which slopes downward to join
the body at the level of the lesser trochanter, so that it measures one-third
more than the antero-posterior diameter. The medial half is smaller and of a
more circular shape. The anterior surface of the neck is perforated by
numerous vascular foramina. Along the upper part of the line of junction of
the anterior surface with the head is a shallow groove, best marked in elderly
subjects; thisgroove lodges the orbicular fibers of the capsule of the hip-joint.
The posterior surface is smooth, and is broader and more concave than the
anterior: the posterior part of the capsule of the hip-joint is attached to it
about 1 cm. above the intertrochanteric crest. The superior border is short
and thick, and ends laterally at the greater trochanter; its surface is
perforated by large foramina. The inferior border, long and narrow, curves a
little backward, to end at the lesser trochanter.

The Trochanters.—The trochanters are prominent processes which afford


leverage to the muscles that rotate the thigh on its axis. They are two in
number, the greater and the lesser.

The Greater Trochanter (trochanter major; great trochanter) is a large,


irregular, quadrilateral eminence, situated at the junction of the neck with the
upper part of the body. It is directed a little lateralward and backward, and, in
the adult, is about 1 cm. lower than the head. It has two surfaces and four
borders. The lateral surface, quadrilateral in form, is broad, rough, convex,
and marked by a diagonal impression, which extends from the postero-
superior to the antero-inferior angle, and serves for the insertion of the
tendon of the Glutæus medius. Above the impression is a triangular surface,
sometimes rough for part of the tendon of the same muscle, sometimes
smooth for the interposition of a bursa between the tendon and the bone.
Below and behind the diagonal impression is a smooth, triangular surface,
over which the tendon of the Glutæus maximus plays, a bursa being
interposed. The medial surface, of much less extent than the lateral, presents
at its base a deep depression, the trochanteric fossa (digital fossa), for the
insertion of the tendon of the Obturator externus, and above and in front of
this an impression for the insertion of the Obsturatorinternus and Gemelli.
The superior border is free; it is thick and irregular, and marked near the
center by an impression for the insertion of the Piriformis. The inferior border
corresponds to the line of junction of the base of the trochanter with the
lateral surface of the body; it is marked by a rough, prominent, slightly
curved ridge, which gives origin to the upper part of the Vastus lateralis. The
anterior border is prominent and somewhat irregular; it affords insertion at its
lateral part to the Glutæus minimus. The posterior border is very prominent
and appears as a free, rounded edge, which bounds the back part of the
trochanteric fossa.

The Lesser Trochanter (trochanter minor; small trochanter) is a conical


eminence, which varies in size in different subjects; it projects from the lower
and back part of the base of the neck. From its apex three well-marked
borders extend; two of these are above—a medial continuous with the lower
border of the neck, a lateral with the intertrochanteric crest; the inferior
border is continuous with the middle division of the linea aspera. The summit
of the trochanter is rough, and gives insertion to the tendon of the Psoas
major. A prominence, of variable size, occurs at the junction of the upper part
of the neck with the greater trochanter, and is called the tubercle of the
femur; it is the point of meeting of five muscles: the Glutæus minimus
laterally, the Vastus lateralis below, and the tendon of the Obturator internus
and two Gemelli above. Running obliquely downward and medialward from
the tubercle is the intertrochanteric line (spiral line of the femur); it winds
around the medial side of the body of the bone, below the lesser trochanter,
and ends about 5 cm. below this eminence in the linea aspera. Its upper half
is rough, and affords attachment to the iliofemoral ligament of the hip-joint;
its lower half is less prominent, and gives origin to the upper part of the
Vastus medialis. Running obliquely downward and medialward from the
summit of the greater trochanter on the posterior surface of the neck is a
prominent ridge, the intertrochanteric crest. Its upper half forms the posterior
border of the greater trochanter, and its lower half runs downward and
medialward to the lesser trochanter. A slight ridge is sometimes seen
commencing about the middle of the intertrochanteric’ crest, and reaching
vertically downward for about 5 cm. along the back part of the body: it is
called the linea quadrata, and gives attachment to the Quadratus femoris and
a few fibers of the Adductor magnus. Generally there is merely a slight
thickening about the middle of the intertrochanteric crest, marking the
attachment of the upper part of the Quadratus femoris.

2. Pathophysiolog ETIOLOGY
y
pseudomonas local spread of
aeruginosa infections

Infection may expand


through the bone cortex
and spread under the
periosteum

formation of
subcutaneous abscesses
(that may drain
spontaneously through
the skin)

Affected individual
may experience
weight loss, fatigue,
fever, and localized
warmth,
Sweeling,erythema and
tenderness

HOST
RISK FACTOR
V.N.C
Osteomyelitis occurs more
often in men than in women.
People of any age can
develop osteomyelitis,,
Certain situations allow
germs more opportunities to
access your body Examples
include people who illegally
inject drugs, people on
dialysis, people who use
urinary catheters,,
Osteomyelitis
Poor circulation,,
A recent injury,,
Orthopedic surgery.

Penetrates to the body

Occlude blood vessels

Bone necrosis and


3. Signs and Symptoms

Textbook- based Patient’s Manifestation Interpretation


1. Warmth, swelling and Swelling of patients hip. Due to the bacteria that
redness over the area of invaded
the infection
2. Pain or tenderness in Pain was felt in his hip. Due to the bacteria that
the affected area. invaded
3. Chronic fatigue none
4. Drainage from an Has yellowish discharge Due to bacteria in the
open wound near the from wound. wound
area of the infection
5. Fever, sometimes Had fever before Due to infection caused
hospitalization. by the bacteria.

Medical Management:

Medication and Treatment ordered:

1. Rifampicin 250/5ml OD 5ml


2. Isoniazid 250/5ml OD 2.5ml
3. Pyrazinamide 250/5ml OD 5ml

4. Pyrazinamide 250/5ml OD 5ml

The primary goal in medical management is to kill the bacteria through


specific antibiotics. And it is also important to maintain fluid and electrolyte
balance and to control symptoms.
3. Health Teaching Plan

➢ Teach patient good hand washing technique. Most especially after defecation
and before handling food
➢ Encourage cleanliness and sanitation as well as proper food handling,
preparation and storage techniques and not to allow food to sit at room
temperature for very long periods.
➢ Encourage patient to avoid scratching the affected area.
➢ Encourage patient to do simple range of motion exercise.
➢ Encourage patient to follow doctor’s orders to promote fast recovery.
➢ Encouraged patient to eat foods that are recommended for him, and avoid
fatty and too salty foods.
➢ Encouraged patient to say a Prayer, and thank GOD for everyday’s blessings.

4. Discharge plan

M- Advised patient to take medications at the right time and amount as


prescribed by the physician.

1. Rifampicin 250/5ml OD 5ml


2. Isoniazid 250/5ml OD 2.5ml
3. Pyrazinamide 250/5ml OD 5ml

4. Pyrazinamide 250/5ml OD 5ml

E- Instructed the S.O. of the patient to do environmental sanitation such


as cleaning the house and backyard.

T- Advised the S.O.to have the patient a regular check-up and visit the
doctor after a week of discharge.

H- Advised the patient to have a proper hygiene and if possible clean the
affected area more often and keep it dry always.
(Please refer to health teachings at the top)

O- Advised S.O. to consult a Doctor if symptoms occur such as severe


pain on affected area.

D- Encouraged S.O. to give clean foods to patients to prevent ingesting


bacteria and viruses that may harm her child.

S- Encouraged S.O. to bring her child to Church if possible to say a little


prayer.

BIBLIOGRAPHY:
Black, Joyce M. et. al. Medical-Surgical Nursing: Clinical Management for
Positive Outcomes, 6th Edition, Vol. 1. Philadelphia : WB Saunders
Company, 2001.
Daniels, Rick. Nursing Fundamentals: Caring & Clinical Decision Making.
Thomson Learning Asia , 2004.
Deglin, Judith Hopfer & April Hazard Vallerand. Davis's Drug Guide for Nurses,
9th Edition. Philadelphia : F.A. Davis Company, 2005.
Doenges, Marilynn E. et. al. Nursing Care Plans: Guidelines for Individualizing
Patient Care, 6th Edition. Philadelphia : F.A. Davis Company, 2002.
Marieb, Elaine N. Essentials of Human Anatomy & Physiology, 7th Edition.
California : Pearson Education Inc., 2004.
Nettina, Sandra M. The Lippincott Manual of Nursing Practice, 7th Edition, Vol.
1. Philadelphia : Lippincott Williams & Wilkins, 2001.

Prepared By: Checked By:

_________________ _____________________
Yap, Aileen Jane T. Mr. Elbert Jann
Roldan
(Student) (Clinical Instructor)