Philippine Orthopedic Center

CASE STUDY: P3 Femoral fracture 2

OSTEOGENESIS IMPERFECTA

Balintag, Angela D.C. Celestino, John Christopher S.

Wup sn 13

Prepared by:

Mrs. Phoebe caisip, rn, man

Clinical instructor

OBJECTIVES

The student nurses will be able to gain: Understanding about the disease process and treatment regimen. Ability to demonstrate different nursing implementations regarding the patients therapy overtime. To express positive attitude about nursing care and establishing patient trust including a therapeutic approach.

Patients profile
Name: Address: 918-Int. M. Naval, Navotas City Date Admitted: 09/05/11 @ 3:30pm Doctor In charge: Dr. Velasco Diagnosis: fracture close complete displacement proximal 3rd of right femur, secondary to Osteogenesis Imperfecta Nursing History: thigh. Patient was running and he fell on his right side, landing on his right

Patient was immediately non-ambulatory. He was brought to PGH where X-ray done showed a right femoral fracture. CR 1 Hip Spica Cast was done. Patient was advised for Steinmans Pin Insertion & application of 90-90 traction hence their admission. Past Medical History: - known case of Osteogenesis Imperfecta - right humeral fracture 2007, 2009 - regular follow up check-up @ PGH pedia genetics - no known allergy to food and drugs - no asthma Family History: - (+) HPN, mother - (--) asthma, DM Personal & Social History: - born to a 30y/o G2P2 (2-0-0-2) mother via NSD, breech.

Pathophysiology

Presence of inherited OI Improper collagen synthesis Bone rigidity/brittleness Crushing forces/factors for fracture Easier break in continuity of bone

Diagnostic procedures
X-ray - showed proximal 3rd of right femur fracture. Skin Biopsy for collagen structure, indicated for diagnosing OI.

Medical management
Application of 1 Hip Spica Cast. SURGICAL: Steinman Pins Insertion for 90-90 Traction. PHARMACOLOGIC: o Ibuprofen (Motrin) IV DRUG STUDY IND: for mild to moderate pain; osteo- rheumatoid arthritis; Antipyretic S/E: Pruritus, peripheral edema, hepatotoxicity, gastritis, dizziness, drowsiness, tinnitus, N/V, diarrhea. Nsg Resp: 1.) Assess pain (characteristic, onset, location) & effectiveness of drug therapy. Use a Wong Baker Pain Scale for pediatric patients. 2.) Advice that it may cause dizziness and altered consciousness. 3.) Monitor for I&O, liver & renal function test obtained from laboratory. o Co AmoxiClav (Augmentin) IV DRUG STUDY IND: combination of amoxicillin and clavulanate acid, enhances the spectrum effect of amoxicillin. Dental infections, Hyperlipidaemias, Lower respiratory tract infections, Overdosage with opioids, Soft tissue and skin infections, Surgical prophylaxis, Upper respiratory tract infections, Urinary tract infection. S/E: common; diarrhea, nausea & vomiting, oral thrush, vaginal itching, constipation, headache.

Nsg Resp: 1.) Ask patient for penicillin hypersensitivity. 2.) Patient teaching: purpose of antibiotic therapy. 3.) Tell for possible side effects.

Nurse patient interaction

Nurse: Patient: Rationale: Nurse: Patient: Rationale: Nurse: Patient: Rationale: Nurse: Patient: Rationale:

Nursing care plan

PAIN: Assessment: - Wong Baker Pain Scale rating of 7/10 - V/S: T: 36.9 P: 91 R: 26 Nursing Diagnosis: - Acute pain related to traction Planning: - Patient will experience relief of pain Implementation: - Independent: - Assess functional level of the patient pain perception - Apply cold/heat packs as tolerated. - Diversion activities, for pediatric psycho pain. - Maintain immobilization and proper counter traction - Collaborative: - Administer analgesics as prescribed. Evaluation: - The Wong Baker Pain Scale rating lessen to 2/10. IMPAIRED PHYSICAL MOBILITY: Assessment: - Patient inactivity

Nursing Diagnosis: - Impaired physical mobility related to traction Planning: - Patient will maintain body strength. Implementation: - Independent: - Allow patient to perform ROM exercises. - Turn patient every 2 hours, to avoid pressure ulcers. - Deep breathing exercises for proper lung expansion to prevent lung collapse or pneumonia. Evaluation: - The patient regained and maintained muscle strength. RISK FOR INFECTION: Assessment: Nursing Diagnosis: - Risk for infection related to traction pin insertion. Planning: - Control & eradication of infection. Implementation: - Independent: - Regular pin cleansing. - Change in wound dressing aseptically. - Collaborative: - Administer antibiotic as prescribed.