San Pablo Colleges College of Nursing San Pablo City

CLINICAL CASE ANALYSIS

Fracture Open Complete Comminuted Left Distal Radius, Supracon Intercon Left Distal Humerus
Submitted to: PROF. PLASIDO Clinical Instructor Philippine Orthopedic Center

Submitted by: Arlene M. Dawang BSN III-Group 1

INTRODUCTION

Fracture is a medical condition in which there is a break in the continuity of the bone. A bone fracture can be the result of high force impact or stress, or trivial injury as a result of certain medical conditions that weaken the bones. Distal radius fractures are some of the most common fractures (the medical term for "broken .The radius is the forearm bone on the thumb side .Distal radius fractures are generally caused by a fall on an outstretched hand. The fracture is almost always within an inch of the wrist joint, and may extend into the joint. The nature of the fracture relates to the current alignment of your bones (what position they are in) and whether or not that alignment is acceptable. If it is acceptable, then you will probably get a cast. If it is not acceptable, the doctor needs to reduce the fracture (put the bones in a better position). Sometimes the fracture is of the sort that can be pushed into place without surgery (called a "closed reduction"), and sometimes the fracture needs surgery to push the bones into place (called an "open reduction", because the skin needs to be "opened" for surgery). Usually, if the broken bones need surgery (in medical terms, the fracture needs open reduction), some kind of metal implant will be needed to hold the bones in the proper place while they heal. Most of the time, the metal implant (often called a "plate"). In the case of this patient with Fracture Open Complete Comminuted Left Distal Radius, Supracondylar Intercon Left Distal Humerus , the surgery applied is open reduction where the fracture needs surgery to push the bones into place because the skin needs to be opened for surgery and they implanted the metal plate to hold the bones in the proper place while they heal. While the bone is healing, it also x-ray. The purpose of the x-ray is not to check the degree of healing, which is what most patients think. It is to check the position of the bone while it is healing. The x-ray is a great test, but it has its limits, it is great for checking bone, because a bone has a lot of calcium in it, and the calcium is what shows up in the x-ray. The new bone that is forming has little or no calcium in it, and it does not show up at all on x-ray. It only shows up after it gets calcified, which is about a month after it is formed, but this degree of calcification is slight. The fracture may be completely healed but only show up slightly on the x-ray. However, the x-ray is very good at examining the alignment of the bones, and that when it finally heals, it will be in the correct alignment.

CLINICAL CASE ANALYSIS

Patient's Demographic Profile

Name Address Date Admitted : Age Gender Religion Nationality Civil Status Occupation Chief Complaint(s) :

: : : : : : : : : :

Rogelio Pascual #325 San Mateo No Sagaray , Bulacan May 5, 2012 67 years old Male Roman Catholic Filipino Married Carpenter Left Forearm Pain Dr. Victor Illescas Fracture Open Complete Comminuted Left Distal Radius, Supracon Intercon Left Distal Humerus

Attending Physician : Diagnosis :

NURSING HISTORY

A: History of Present Illness/Injury NOI: POI: DOI: TOI: Fall Bulacan, Manila 5/4/12 03:00pm

Patient while at work designing a terrace of a house when he slipped and fell around 15 20 feet high landing on outstretched Left hand.

B. Past Medical History (-) Hypertension (-) Diabetes Mellitus (-) asthma (-) Previous Hospitalization

C. Family Health History (-) Hypertension (-) Diabetes Mellitus

D. Personal and Social History (+) smoker/alcohol drinker

LABORATORY AND DIAGNOSTIC TESTS

HEMATOLOGY ( Latest test )

Test Hematocrit Leukocyte Count Segmenters Lymphocytes Monocytes

Result 0.38 10.00 0.70 0.18 0.07

Interpretation Normal Normal Normal Normal Normal

Test Glucose Urea Creatinine Cholesterol Triglycerides HDL-Cholesterol LDL VLDL SGOT SGPT Sodium Potassium Chloride

Result 6.39 mmol/L 7.50 mmol/L 88.05 mol/L 4.75 mmol/L 0.54 mmol/L 1.38 mmol/L 3.12 mmol/L 0.25 mmol/L 27.00 U/L 18.05 U/L 147.00 mmol/L 4.30 mmol/L 104.00 mmol/L

Interpretation Normal Normal Normal Normal Normal Normal Normal Normal Normal Normal Normal Normal Normal

URINALYSIS Physical Characteristics Color Reaction Transparency Specific gravity Result Dark yellow 6.5 hazy 1.030 Normal Pale yellow to Amber 4.5 8 Hazy 1.030

DISCHARGED PLANNING
Bed rest is advised to allow time for inflammation to resolve. The physical therapist will perform and teach family members how to do passive range-of-motion (motion performed by others) for the entire arm. Movement is very important to prevent other joint problems from developing.

Prepare for discharge and home management Compliance with the appropriate pharmacological regimen Adequate rest period advised Physical activity limitations Dietary restrictions discussed Treatment modalities discussed Possible complications discussed Follow-up care Health Teachings Deep breathing exercises ROM exercises