Close Right Arm

Fracture

OUR LADY OF FATIMA

UNIVERSITY
COLLEGE OF NURSING
JENNIFER CARULLA RN,MAN.
CLINICAL INSTRUCTOR
JOSE R. REYES MEMORIAL MEDICAL CENTERE.R DEPT.
JOHN TIMOTHY D.G CASTRO
BSN 4Y1-2B

LEARNING OBJECTIVES:
General:
This case study aims to identify and determine the general health
problems

and

needs of

a patient

suffering

from

fracture

secondary to vehicular accident. This also intends to help patient

promote health and understanding of such condition through the
application of nursing skills.

SPECIFIC OBJECTIVES:
To gain knowledge and acquire more information regarding
to the cause of the disorder, anatomy , pathophysiology.
To identify the different signs and symptoms and even
complications.
To identify appropriate nursing interventions by using of
nursing skills and knowledge.

INTRODUCTION:
This is a case of 35 year-old male from manila city. The patient
rushed to the hospital (emergency dept.) after hitted by a
motorcycle. He was diagnosed with a closed right arm fracture.
A fracture is a break in the continuity of bone and is defined
according to its type and extent. Fractures occur when the bone is
subjected to stress greater that it can absorb. Fractures are
caused by direct blows, crushing forces, sudden twisting motions,
and even ex t re m e m u s c l e co n t r a c t i o n s. W h e n t h e b o n e
i s b ro ke n , a d j a c e n t s t r u ct u re s a re a l s o aff ected,
resulting in soft tissue edema, hemorrhage into the muscles
and joints, joint dislocation,
ruptured tendons, severed nerves, and damaged blood
vessels. Body organs maybe injured by the force that cause the
fracture or by the fracture
fragments.T h e re a re d i f f e r e n t t y p e s o f f r a c tu re s a n d t h e
s e i n c l u d e , c o m p l e t e f r a c t u r e, incomplete fracture, closed
fracture, open fracture and there are also types of fractures

that may also be described according to the anato

m i c p l a c e m e n t o f f r a g m e n t s , particularly if they are
displaced or nondisplaced. Such as greenstick fracture, depressed
fracture, oblique fracture, avulsion, spinal fracture, impacted
fracture, transverse fracture and compression fracture. A
comminuted fracture is one that produces several bone fragments
and a closed fracture or simple fracture is one that not cause a
break in the skin.

Patients Profile:
Name: P.C
Age: 35y/o
Sex: Male
Civil Status: Married
Address. Manila City.
Religion: Catholic
Date of Admission: Sept. 22, 2015
Admitting Dx: Close Right Arm Fracture
Chief Complaint: Pain of the right Arm
Family Hx: (-)DM, (-)HPN
Personal Hx: (+) Smoker, (+) Alcoholic Drinker

Anatomy&Physiology:

The word skeleton comes from the Greek word meaning driedup body, our internal framework is so beautifully designed and
engineered and it puts any modern skyscraper to shame. Strong,
yet light, it is perfectly adapted for its functions of body protection
and motion. Shaped by an event that happened more than one
million years ago when a being first stood erect on hind legs
our skeleton is a tower of bones arranged so that we can stand
upright and balance ourselves. The skeleton is subdivided into
three divisions: the axial skeleton, the boned that form the
longitudinal axis of the body, and the appendicular skeleton, the
bones of the limbs and girdles. In addition to bones, the skeletal
system includes joints, cartilages, and ligaments (fibrous cords
that bind the bones together at joints). The joints give the body f

exibility and allow movement to occur. Besides contributing to

body shape and form, or bones perform several important body
functions such as support, protection, movement, storage
and blood cell formation. Classification of Bones The diaphysis, or
shaft, makes up most of the bones length and is composed
of compact bone. The diaphysis is covered and protected by a
fibrous connective tissue membrane, the periosteum. Hundreds of
connective tissue fibers, called Sharpeys fibers, secure the
periosteum to the underlying bone. The epiphyses are the ends of
the long bone. Each epiphyses consist of a thin layer of compact
bone enclosing the area filled with spongy bone. Articular
cartilage, instead of periosteum, covers its external surface.
Because the articular cartilage is glassy hyaline cartilage, it
provides a smooth, slippery surface that decreases friction at joint
surfaces. In adult bones, there is a thin line of bony tissue
spanning the epiphyses that looks a bit different from the rest of
the bone in that area. This is the epiphyseal line. The epiphyseal
line is a remnant of the epiphyseal plate (a fat plate of hyaline
cartilage) seen in young, growing bone. Epiphyseal plates cause
the lengthwise growth of the long bone. By the end of puberty,
when hormones stop long bone growth, epiphyseal plates
have been completely replaced by bone, leaving the epiphyseal
lines to mark their previous location. In adults, the cavity of the
shaft is primarily a storage area for adipose (fat) tissue. It is called
the yellow marrow, or medullary, in infants this areas forms
blood cells, and red marrow is found these. In adult bones, red
marrow is confined to the cavities of spongy bone of fat bones
and the epiphyses some long bones. Bone is one of the hardest
materials in the body, and although relatively light in weight, it
has a remarkable ability to resist tension and other forces acting
on it. Nature has given us an extremely strong and exceptionally
simple (almost crude) supporting system without up mobility. The
calcium salts deposited in the matrix bone its hardness, whereas
the organic parts (especially the collagen fibers) provide for
bones fexibility and great tensile strength.

Pathophysiology:
Predisposing Factors:

Precipitating:

Trauma

Falls

Vehicular Accident

Osteoporosis

Damage to the bld. Supply of entire bone

Circulatory Compromise

Avascular (ischemic) necrosis may lead to:

Pain

Loss of Function
Deformity
Swelling
Paresthesia

DRUG STUDY

Drug/Class

Action

Indicatio
n

Contraindicate
d

Adverse
Rxn

PARACETAMOL

Acts directly Reduction

Allergy to

Headache,

Antipyretic

on heat-

of fever,

acetaminophen

Dyspnea,

regulating

back and

u/c impaired

hepatotoxicit

center to

muscle

hepatic, chronic

y and liver

cause

aches

alcoholism

failure

vasodilation
& sweating

Intervention

- Perform skin
test
- Give drug
with food
- DC if hypersensitivity
occurs

NURSING CARE PLAN

Assessm
ent
Subjectiv
e:
Nilalagnat
ako kagabi
pa as
verbalized
by the Pt.
Objective
:
(+) weak
(+) fushed
skin
(+) warm
to touch
(+)
headache
T 38.4 C
P 97
R 18
BP 120/80

Diagnosis
Hyperther
mia r/t the
body
response
to
disorder
AEB:
Increased
body temp,
weakness,
skin fushed
and warm
to touch.

Plannin
g
After 4
hours of
nursing
care, the
patient
will
appear
more
relaxed
and
display
reduced
body
temp.

Intervention

Establish
rapport.
Monitor VS
carefully

Place patient
in low-back
rest, change
position
frequently

Rationale

Build trust
while
making
comparative
data

To maximize
breathing
effort

Provide Tepid
Sponge Bath

To promote
surface
cooling

Instruct to
increase oral
fuid intake

To replace
fuid loss

Monitor urine
output and
skin turgor

To identify
signs of
dehydration

Instruct to
avoid darkcolored foods

Encourage
high calorie
diet

To meet
metabolic
demands

To conserve
body energy

Encourage

To identify
signs of
bleeding

Evaluatio
n
After 4
hours of
nursing
care, the
patient
appeared
more
relaxed
and
displayed
reduced
body temp.
AEB:
Less
weakness,
skin less
warm to
touch
(+) cold
sweat
T 37.9
P 95
R 19
BP 120/80
Goal is
partially
met.

adequate
rest or sleep

Instruct to
wear loosefit clothing
Provide
bedside care
(side rails
up)

To limit
contributing
factors

For comfort
and bed
safety

DISCHARGE PLAN
Medication: Advise the client or significant other to take paracetamol as indicated.
Exercise and Activity: Instruct patient to take adequate rest breaks when tired, do not
over exert. Advice to perform ADLs as tolerated and do range of motion and repetitive
body movements for promotion of exercise.
Treatment: Instruct to client or significant others to follow treatment regimen.
Health Teaching: Instruct client or significant others to watch out for or report any sign
of 4Ps (Pain, Pallor, Pulselessness, Paresthesia,) also watch out for yellowish
discharge that may indicate infection and report any signs of compartment syndrome.
Out-patient: Instruct for a return checkup as advised by the physician
Diet: Advice Patient to Increase fluid intake.
Encourage patient to eat high calcium foods/drinks and nutritious foods for faster
and better bone healing.

Medical Management:
Temporary skin traction
Open or Closed of fracture or internal fixation
Cast
NSAID for Pain