Name: Arah S.

Morales

Birth day: December 24, 1988

Birth Place: Davao City

Address: # 11 Tangingue st., New Salmonan, Agdao, Davao City

Age: 22

Year/ Course: BSN 4

Cell #: 09398885996
What is GABA?

GABA, or gamma-aminobutyric acid, is the most abundant inhibitory neurotransmitter

in the brain. While GABA is an amino acid, it is classified as a neurotransmitter and
helps induce relaxation and sleep. It balances the brain by inhibiting over-excitation.
GABA contributes to motor control, vision, and many other cortical functions. Anxiety
is also regulated by GABA. Some drugs that increase the level of GABA in the brain
are used to treat epilepsy and to calm the trembling of people suffering from
Huntington’s disease.

Gamma-aminobutyric acid also stimulates the anterior pituitary, leading to higher

levels of Human Growth Hormone (HGH). Human Growth Hormone contributes
significantly to muscle growth and also prevents the creation of fat cells. Moreover,
HGH depletion is prevalent in adults over the age of 40 may be responsible for sleep
disturbances or interupted sleeping patterns.

Natural alternative medicines have been shown to act directly on the GABAnergic
system, allowing for greater availability of this neurotransmitter. This effect is
believed to be partially responsible for improvement in those individuals taking natural
alternative GABA antagonists like Valerian root.
Open Reduction Internal Fixation

An open reduction internal fixation (ORIF) refers to a surgical procedure to fix a severe bone
fracture, or break. "Open reduction" means surgery is needed to realign the bone fracture into the
normal position. "Internal fixation" refers to the steel rods, screws, or plates used to keep the
bone fracture stable in order to heal the right way and to help prevent infection. Open reduction
internal fixation can also refer to the surgical repair of a joint, such as a hip or knee replacement.

The surgical procedure is performed by a doctor who specializes in orthopedics, which is a

branch of medicine concerning the musculoskeletal structure of the body. Under general
anesthesia, an incision is made at the site of the break or injury, and the fracture is carefully re-
aligned or the joint replaced. The hardware is installed, and the incision is closed with staples or
stitches. The steel rods, screws, or plates can be permanent, or temporary and removed when
healing takes place.

Once the open reduction internal fixation is performed, a cast is usually applied. In the case of an
ankle fracture, for instance, the first cast is a non-weight bearing cast, and crutches can be used
to help keep weight off the healing bones. Later, when the healing has progressed, this cast will
be replaced with one that can bear weight. Eventually, after a period of some weeks, the cast will
be removed entirely.

Recovery from a bone fracture after an open reduction internal fixation can be quite painful, and
pain management becomes a concern. Commonly, acetaminophen with codeine is prescribed, as
research has shown ibuprofen or other non-steroid anti-inflammatory drugs (NSAIDs) may slow
down or inhibit the rate of healing. It is important to take the drugs as prescribed to help manage
the pain cycle.

Physical therapy is also an important part of the recovery process after an open reduction internal
fixation. Since the part of the body that has been injured is usually held still or immobilized for a
long period of time, the muscles, tendons, and ligaments can become weak. Physical therapy
helps to restore the strength, range of motion, and endurance of the affected area. It can also help
with pain management. Physical therapy can consist of exercises, hot or cold packs, ultrasound,
and nerve stimulation, or a combination of treatments

Collaborative

 Since broken bones are caused by trauma or an accident, an ORIF surgery is typically an
emergency procedure. Before your surgery, you may have:
 Physical exam—to check your blood circulation and nerves affected by the
broken bone
 X-ray , CT scan , or MRI scan —tests that take a picture of your broken bone and
surrounding areas
  Blood tests

 Tetanus shot —depending on the type of fracture and if your immunization is

current
 Questions your doctor may ask include: How did you break your bone? How
much pain do you feel? Do you take any blood-thinning medicines?
 Questions you should ask include: Will I need rehabilitation after surgery? What
will I need to assist in my recovery (eg, wheelchair , crutches )?
 An anesthesiologist will talk to you about anesthesia for your surgery.

 Arrange for a ride home from surgery.

 If your surgery is urgent, you may not have time to fast beforehand; make sure to tell
your doctor and the anesthesiologist when you last ate and drank.
 If your surgery is scheduled, you may be asked to stop taking medicines that thin the
blood, like warfarin (Coumadin), clopidogrel (Plavix), or aspirin . If surgery is urgent, make
sure to let your doctor know if you take any blood-thinners or other medicines.

Anesthesia  

General anesthesia may be used. It will block any pain and keep you asleep during the surgery. It
is given through an IV (needle in your vein) in your hand or arm. In some instances, a spinal
anesthetic, or more rarely a local block, may be used to numb only the area where the surgery
will be done. This will depend on where the fracture is located and the time it will take to
perform the procedure.

Expected Patient outcome

 Client will report relief of pain after analgesics and comfort measure
administered.

 Client will regain or maintain maximum mobility and optimal function position.

 Client will have increased strength and function in the affected limb.

 Client will maintain maximum self-care.

Definition of Terms

Avulsion fracture- a bone fracture which occurs when a fragment of bone tears away from the
main mass of bone as a result of physical trauma.

Acetaminophen- is used to relieve mild to moderate pain from headaches, muscle aches,
menstrual periods, colds and sore throats, toothaches, backaches, and reactions to vaccinations
(shots), and to reduce fever.

Epiphyseal fracture- The end of a long bone that is originally separated from the main bone by
a layer of cartilage but later becomes united to the main bone through ossification.

Fracture- A break, rupture, or crack, especially in bone or cartilage.

Informed Consent- is a phrase often used in law to indicate that the consent a person gives
meets certain minimum standards.

Nasogastric Suction- the process of removing solids, liquids, or gasses from the stomach or
small intestine by inserting a tube through the nose and suctioning the material through the tube.

Trauma- an often serious and body-altering physical injury, such as the removal of a limb

Indications for ORIF of fractures

Absolute

1. Unable to obtain an adequate reduction

2. Displaced intra-articular fractures
3. Certain types of displaced epiphyseal fractures
4. Major avulsion fractures where there is loss of function of a joint or muscle group
5. Non-unions
6. Re- implantations of limbs or extremities

Relative
 1. Delayed unions
2. Multiple fractures to assist in care and general management
3. Unable to maintain a reduction
4. Pathological fractures
5. To assist in nursing care
6. To reduce morbidity due to prolonged immobilisation
7. For fractures in which closed methods are known to be ineffective

Questionable

1. Fractures accompanying nerve of vessel injury

2. Open fractures
3. Cosmetic considerations
4. Economic considerations

Nursing Intervention ( Pre-op, Intra-op, Post-op)

SCRUB NURSE

Pre-operative Responsibilities

1. Assist with the preparation of the room for the designated surgical procedure, including
gathering supplies for the procedure.

2. Scrub, dry hands, gown, and glove.

3. Assist person scrubbed in first position with:
a. Setting up back table, mayo, and basins
b. Arrangement of instruments
c. Preparation of suture and needles
d. Preparation and counting sponges
e. Arrangement and preparation of other necessary items
f. Gowning and gloving surgeon and assistants
g. Assist with draping
h. Arrangement of sterile field

Intra-operative Responsibilities

1. During the procedure, progress from double-scrubbed position. Train self to keep eyes on
field, and learn steps of procedure.
2. Begin developing methods of anticipating needs of surgeon and assistant.
 3. After closing the skin:
a. Assist with care of instruments and counts if necessary
b. Care of specimen
c. Assist with dressing of wound

Post-operative Responsibilities

1. After the completion of the Procedure:

a. Assist with the gathering of all materials used during the procedure
b. Discard items as necessary being careful to discard sharp items in designated places
c. Return all items to respective area
d. Assist with cleaning of room
e. Clean the materials used properly and arrange them after drying
2. Perform any duties which will speed up the surgical procedure to follow in that room.

CIRCULATING NURSE
Pre-operative Responsibilities

1. Care for the patient before surgery by:

a. Greeting patient and assist nurse with identification
b. Checking patient's chart, preparation, etc.
2. Prepare the room by:
a. Obtaining instruments, supplies, and equipment for the designated operative procedure
b. Opening unsterile supplies
c. Assisting in gowning
d. Observing breaks in sterile technique
e. Assisting anesthesiologist as necesssary
f. Assisting with skin preparation and positioning
g. Assisting with forming of the sterile field
3. Count the instruments, sharps and sponges before the procedure and confirm with scrub nurse.

Intra-operative Responsibilities
1. During the Procedure:
a. Remain in room and dispense materials as necessary
b. Observe procedure as closely as possible
c. Begin establishing method of anticipating needs of surgical team
d. Care of specimen as indicated
e. Care of operative records as indicated
2. Before the closing of the organ or peritoneum, count all instruments, sharps and sponges and
confirm with scrub nurse.
3. Inform the surgeon and assistant surgeon of a report of the instruments.

Post-operative Responsibilities

1. Properly document all the necessary information on the patients chart.

2. Assist in the cleaning of the Operation Room as necessary.

Prior to operation:
 A careful history and physical examination are performed to exclude the possibility of
other gastrointestinal diseases that may mimic biliary colic, such as peptic ulcer disease
or reflux esophagitis.
 When the diagnosis of acute cholecystitis is suspected the patient should receive nothing
by mouth; however, nasogastric suction usually can be reserved for patients who are
vomiting or have ileus and abdominal distention.
 Intravenous fluids are given to correct volume depletion and any electrolyte imbalances
are measured and corrected. Monitor and regulate IVFs.
 The nurse instructs the patient about the need to avoid smoking to enhance pulmonary
recovery postoperatively and avoid respiratory complications. It is also important to
instruct the patient to avoid the use of aspirin and other agents that can alter coagulation
and other biochemical process.
 On of the most important responsibility of the nurse is to let the patient sign an informed
consent regarding the surgery.
 The patient is given anaesthesia prior to surgery and the patient is under NPO.

During the operation

  Monitoring the vital signs of the patient is one of the responsibilities of the nurse during
the surgery.
 Assisting the anesthesia care provider during induction of general anesthesia.
 Ensuring adequate oxygenation and hydration.

After the operation

 After recovery, the nurse places the patient in the low fowler’s position. IV fluids may be
given and nasogastric suction may be given to relieve abdominal distention. Water and
other fluids are given in about 24hours, and soft diet is started when bowel sounds
returned.

 Placing warm blankets on the patient to enhance comfort and preserve the patient's body
temperature
 Assessing the patient's vital signs, oxygen saturation level, level of consciousness,
circulation, pain, IV site, fluid rate, and hydration status, as well as the status of the
surgical site and dressing and all related monitoring equipment
 The nurse helps in relieving the pain by instructing the patient regarding proper
positioning.

 The nurse helps in improving the respiratory status by instructing the patient regarding
deep breathing exercises.

 The nurse also provides skin care like cleaning the incision part and providing clean
dressing following a strict aseptic technique

 The nurse instructs the patient about the medications that are prescribed by the physician

 Discussing recommended follow-up management with the physician and the surgeon

Patient Teaching

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.
Precautions (Special Considerations)

 Signs of infection, including fever and chills

 Redness, swelling, increasing pain in the affected limb

 A lot of bleeding or any discharge from the incision site

 Loss of feeling in the affected limb

 Swelling or pain in the muscles around the broken bone

 Pain cannot be controlled with the medicines you've been given

 Always feeling the need to urinate

 Pain or burning when urinating

 Blood in the urine

 Cough , shortness of breath, or chest pain

 Joint pain, fatigue, stiffness, rash, or other new symptoms

References:

Introductory Medical-Surgical Nursing, Barbara K. Timby & Nancy E. Smith

http://www.wisegeek.com/what-is-open-reduction-internal-fixation.htm

http://wiki.answers.com/Q/Indication_for_open_reduction_with_internal_fixation#ixzz1AjrAjE
Cc

http://www.med.nyu.edu/content?ChunkIID=539804

http://www.scribd.com/doc/33260801/Perioperative-of-ORIF

Nasogastric Suction, Information about Nasogastric Suction

http://www.faqs.org/health/topics/94/Nasogastric-Suction.html#ixzz1AkAjTGRz
© 2009 Nucleus Medical Media, Inc.