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Case number 3| Inday

Group 2|4nu01 Emergency room

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Case background|

18 year old client admitted to E.R. With right tibial and femoral fracture Has Allergies to Chicken and shrimp

Sexually active Ta k e s C o n t r a c e p t i v e P i l l s

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List down nursing, medical and pharmacological interventions performed during acute phase and give the rationale.
Nursing Management| C h e c k y o u r A B C D s !

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Nursing Management|
If there are any signs of bleeding Apply pressure with sterile Dressing

Expect physician to order IV fluids. - prepare IV set - Insert Foley Catheter

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Nursing Management|
If there are open fractures Irrigate with normal saline

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Nursing Management|
For pain and anxiety Pain medications as ordered s h o u l d b e a d m i n i s t e r e d S TAT Encourage Diversional activites

Others F r e q u e n t l y a s s e s s f o r 5 P s !

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Medical management|
Open Reduction/Closed Reduction Immobilization

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Pharmacological Management|
Analgesics Te t a n u s To x o i d Prophylactic Antibotics

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Correlate patient history with current condition of the patient.

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Use of contraceptives
Studies found that Decreased Estradiol secretion leads to poor b o n e m a i n t e n a n c e ( Strokosch, 2006)

Depot medroxyprogesterone a c e t a t e ( D M PA ) i s o n e o f t h e contraceptives found to have effect on estradiol production

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Chicken and shrimp allergy

Useful information to prevent Reactions before contrast medium Administration on diagnostic exams

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Rationalize the immediate diagnostic procedures performed on the patient and list possible diagnostic procedures that can be used for this case

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Radiographs (X-rays) Most common and widely available Cheap

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CT scan
further characterize fractures of the tibial plateau

Assess the depression of the tibia and the degree of diastasis

It demonstrates fracture displacement, impaction of the articular surface,

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MRI

- clear assessment of the fracture pattern and to find out injuries to the ligaments

- excellent for depicting ligamentous and meniscal injuries

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Arteriogram/ arteriography - useful if vascular compromise is suspected - may be used if popliteal artery injury is suspected

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Nursing Diagnosis: Assessment RR:28 cpm PS 8/10 Facial grimace

Acute pain r/t fracture

Planning
After 30 minutes of nursing intervention, reported pain will be minimized.

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Independent Encourage use of relaxation techniques Render quiet environment and calm activities Review procedures and tell patient when treatment will cause pain Encourage adequate rest period

Dependent Administer analgesics as indicated to maximum dosage as

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Nursing Diagnosis: Assessment

Impaired physical mobility related to injury of the right femur and tibia.

Fracture of the right femur and tibia Pain and discomfort Limited range of motion Swelling

Planning After 1 hour of nursing intervention, the patient will be able to demonstrate techniques and behaviors that enable resumption of activities.

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Independent

Increase independence in simple ADLs.

Obtain any assistive devices needed for activity.

Support affected part by using pillows.

Encourage participation in self care.

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Encourage adequate intake of fluids/ nutritious foods.

Ensure patients safety.

Before activity, treat pain with analgesics, as ordered.

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THANK YOU FOR LISTENING Q U E S T I O N S A R E H I G H LY U N A C C E P TA B L E B U T W I L L B E E N T E R N TA I N E D NONETHELESS

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