This case study analyzes a 16-year-old male patient admitted to the Philippine Orthopedic Center with a fractured left foot from a vehicular accident. The patient underwent surgery to repair fractures of the 5th, 1st, 2nd, and 3rd metatarsals and 2nd metatarsal head. Diagnostic tests revealed the fractures and ruled out infection or inflammation. The patient is being treated medically with antibiotics, analgesics, and ulcer medications and is recovering from surgery with a slipper mold. The case study aims to evaluate the patient's condition and formulate an appropriate nursing care plan.
This document outlines the objectives of a study on Hepatitis C Virus Disease (HCVD), Cirrhosis of the Liver Secondary to Hepatitis C (CASHD), and Nursing Intervention Formulation (NIF). The objectives are to gain knowledge about these conditions, increase awareness, and teach proper patient care. Specific objectives include determining the patient's health history, functional health patterns, review of systems, physical assessment, affected anatomy/physiology, disease process, lab/test results, medical management, medications, and developing a discharge/care plan.
The document describes a family case study conducted by nursing students in Malaccabibi, Solana, Cagayan. The family lives in an inadequate home with poor sanitation. They have 10 members but the mother is the sole breadwinner since the father passed away 8 years ago. Their main source of income is farming but they only earn 500-700 pesos per week. The nursing students identified the family's main health problems as poor sanitation, accident hazards, and inadequate living space due to limited financial resources. They created a nursing care plan to educate the family on improving sanitation, preventing accidents, and considering options to maintain sustainable family size.
This case study summarizes the medical details of 75-year-old male patient Sergio Abbago who was admitted to the hospital due to difficulty breathing and leg swelling. He was diagnosed with atrial septal defect, hospital-acquired pneumonia, and acute urinary retention. The case study provides background on the patient's medical history, presents results from diagnostic testing, discusses the conditions diagnosed and their pathophysiology, outlines the medical and nursing management of the patient, and establishes goals for his care and discharge plan. The objectives are to comprehensively present the case and develop knowledge and skills for delivering quality healthcare to patients.
This document presents a case study on Dengue Fever conducted by a nursing student. It includes an introduction to Dengue Fever, objectives, theoretical foundation, nursing history of the patient, physical assessment findings, and a proposed nursing care plan. The case study follows the standard format for an individual case study report and provides details to analyze the patient's condition, nursing diagnosis, and appropriate nursing interventions.
The document describes a patient's activities of daily living before and during hospitalization. It discusses the patient's health perceptions, nutritional patterns, elimination patterns, activity levels, sleep patterns, cognitive functioning, self-concept, family roles, stress coping mechanisms, sexual history, and religious beliefs. The patient viewed himself as healthy but able to work, but now in the hospital feels less healthy. His routines have changed in the hospital, including following the hospital diet and engaging in limited physical activity. He is oriented but experiences confusion during seizure attacks. He views hospitalization positively and is well-supported by his family.
The document contains multiple sections from nursing notes on different patients. It includes assessments of patients' symptoms and concerns, nursing diagnoses, objectives for interventions, details of interventions provided and their rationales, and evaluations of outcomes. Key information includes patients presenting with anxiety about their health, pain, knowledge deficits, and weight gain related to changes in diet. Nurses addressed these issues through monitoring, education, and lifestyle counseling aimed at reducing anxiety and pain levels, increasing knowledge, and identifying unhealthy eating habits within 8 hours of interventions.
Here is a prioritized list of the patient's problems:
1. Constipation r/t obstruction
2. Acute Pain r/t obstruction
3. Acute pain r/t surgical incision
4. Altered comfort secondary to pain
5. Fatigue r/t post-operative experience
6. Impaired Skin Integrity r/t surgery
7. Altered Health Maintenance r/t choice of health practices
8. Health-Seeking Behavior r/t concern for health status
9. High Risk for Injury r/t developmental age
10. Readiness for enhanced ability to eliminate waste products r/t post-operative experience
The document provides a nursing history for a 64-year-old male patient who was admitted to the hospital for left-sided body weakness. It details his personal history, medical history, family history, and assessments of his functional health patterns. The patient lives with his daughter and has a history of smoking and hypertension. Since his admission, he requires assistance with activities of daily living and has prolonged sleep periods. His relationship with his daughter remains strong and supportive.
This document outlines the objectives of a study on Hepatitis C Virus Disease (HCVD), Cirrhosis of the Liver Secondary to Hepatitis C (CASHD), and Nursing Intervention Formulation (NIF). The objectives are to gain knowledge about these conditions, increase awareness, and teach proper patient care. Specific objectives include determining the patient's health history, functional health patterns, review of systems, physical assessment, affected anatomy/physiology, disease process, lab/test results, medical management, medications, and developing a discharge/care plan.
The document describes a family case study conducted by nursing students in Malaccabibi, Solana, Cagayan. The family lives in an inadequate home with poor sanitation. They have 10 members but the mother is the sole breadwinner since the father passed away 8 years ago. Their main source of income is farming but they only earn 500-700 pesos per week. The nursing students identified the family's main health problems as poor sanitation, accident hazards, and inadequate living space due to limited financial resources. They created a nursing care plan to educate the family on improving sanitation, preventing accidents, and considering options to maintain sustainable family size.
This case study summarizes the medical details of 75-year-old male patient Sergio Abbago who was admitted to the hospital due to difficulty breathing and leg swelling. He was diagnosed with atrial septal defect, hospital-acquired pneumonia, and acute urinary retention. The case study provides background on the patient's medical history, presents results from diagnostic testing, discusses the conditions diagnosed and their pathophysiology, outlines the medical and nursing management of the patient, and establishes goals for his care and discharge plan. The objectives are to comprehensively present the case and develop knowledge and skills for delivering quality healthcare to patients.
This document presents a case study on Dengue Fever conducted by a nursing student. It includes an introduction to Dengue Fever, objectives, theoretical foundation, nursing history of the patient, physical assessment findings, and a proposed nursing care plan. The case study follows the standard format for an individual case study report and provides details to analyze the patient's condition, nursing diagnosis, and appropriate nursing interventions.
The document describes a patient's activities of daily living before and during hospitalization. It discusses the patient's health perceptions, nutritional patterns, elimination patterns, activity levels, sleep patterns, cognitive functioning, self-concept, family roles, stress coping mechanisms, sexual history, and religious beliefs. The patient viewed himself as healthy but able to work, but now in the hospital feels less healthy. His routines have changed in the hospital, including following the hospital diet and engaging in limited physical activity. He is oriented but experiences confusion during seizure attacks. He views hospitalization positively and is well-supported by his family.
The document contains multiple sections from nursing notes on different patients. It includes assessments of patients' symptoms and concerns, nursing diagnoses, objectives for interventions, details of interventions provided and their rationales, and evaluations of outcomes. Key information includes patients presenting with anxiety about their health, pain, knowledge deficits, and weight gain related to changes in diet. Nurses addressed these issues through monitoring, education, and lifestyle counseling aimed at reducing anxiety and pain levels, increasing knowledge, and identifying unhealthy eating habits within 8 hours of interventions.
Here is a prioritized list of the patient's problems:
1. Constipation r/t obstruction
2. Acute Pain r/t obstruction
3. Acute pain r/t surgical incision
4. Altered comfort secondary to pain
5. Fatigue r/t post-operative experience
6. Impaired Skin Integrity r/t surgery
7. Altered Health Maintenance r/t choice of health practices
8. Health-Seeking Behavior r/t concern for health status
9. High Risk for Injury r/t developmental age
10. Readiness for enhanced ability to eliminate waste products r/t post-operative experience
The document provides a nursing history for a 64-year-old male patient who was admitted to the hospital for left-sided body weakness. It details his personal history, medical history, family history, and assessments of his functional health patterns. The patient lives with his daughter and has a history of smoking and hypertension. Since his admission, he requires assistance with activities of daily living and has prolonged sleep periods. His relationship with his daughter remains strong and supportive.
The document provides a course syllabus for Competency Appraisal II at Eastern Samar State University College of Nursing. The course aims to apply the nursing process and core competencies in caring for individuals, families, and communities. Over 90 hours, students will learn through lectures, discussions, and nursing simulations. Simulations will integrate nursing process, levels of care, and prevention for individuals with cellular abnormalities, behavioral issues, emergencies, and more. Students will also develop competencies in leadership, resource management, documentation, collaboration, quality improvement, ethics, and research through various clinical setting scenarios. Upon completion, students will be able to provide holistic nursing care and demonstrate competencies across all areas of responsibility.
The document discusses a nursing assessment and plan of care for a patient experiencing disturbed sleep patterns due to environmental factors. The nursing diagnosis is disturbed sleep pattern related to environmental noise and light. Short term goals are for the patient to understand their sleep disturbance and verbalize their usual sleep pattern. Interventions include observing the patient's sleep habits, addressing misconceptions, and advising limiting caffeine and taking naps. The objective is to evaluate sleep quality measures and the long term goal is improved sleep and well-being.
The document defines focus charting as a systematic method for organizing health information using nursing terminology to describe a patient's health status and care. It involves focusing on key concerns from the care plan like skin integrity or activity tolerance. A focus note includes subjective and objective data supporting the focus, nursing interventions, and the patient's response. An example focus note addresses a patient's pain by documenting their complaint, administering medication, repositioning the patient, and noting their improved pain level in response.
1) The document is a learning feedback diary from a nursing student named Edmar Erick R. Guitto during their clinical rotation at Holy Infant Hospital.
2) The student's objectives were to familiarize themselves with the hospital setting, establish rapport with clients, maintain good relationships with staff and instructors, and provide total client care while developing their nursing skills.
3) The student found their clinical instructor engaging and learned some important nursing concepts. They were challenged by their preliminary grades but aim to improve during their rotation.
1) The document discusses the author's three rotational community duties as a nursing student in rural health units and municipalities in Baguio City and Benguet, Philippines.
2) During their community duties, the students conducted home visits, health teachings, and simple medical interventions. They provided care like blood pressure monitoring and gained experience applying their nursing knowledge.
3) The author learned valuable skills like managing their time efficiently, communicating with patients and staff, and computing important health metrics for pregnant women. They found the duties a crucial learning experience.
Drug study- Paracetamol and Cefuroxime NaMj Hernandez
Paracetamol is used for mild pain or fever. It works by blocking pain impulses and inhibiting prostaglandin synthesis. The dosage is 250/5ml every 4 hours for children, with a maximum of 5 doses in 24 hours. Nurses should advise not using it for marked or prolonged fever without a prescriber's direction.
Cefuroxime is a second-generation cephalosporin used for respiratory, urinary, and skin infections. It works by inhibiting cell wall synthesis. The dosage is 500mg every 8 hours. It is contraindicated in those with hypersensitivity to it or other cephalosporins, and should be used cautiously in those with penicillin aller
This document provides information about pediatric community-acquired pneumonia (PCAP) in a young female patient. It includes the patient's profile, physical assessment findings, relevant anatomy and physiology of the respiratory system, and signs and symptoms of pneumonia. Crackles were auscultated in the lower lung fields, indicating inflammation. The document also outlines the patient's nursing care plan.
This document contains 10 multiple choice questions related to nursing care in emergency situations. The questions cover topics like priority interventions for a client with chest pain, appropriate treatment for anaphylaxis, identifying fracture types, appropriate work for a float nurse, purpose of glucagon, correct placement of defibrillator pads, assessing bowel sounds, priority care for a chemical eye splash, concerning findings after hip replacement, and appropriate seizure precautions.
This document contains sample focus charting from a nurse's notes. It includes 3 entries with the date, focus, and progress notes in the DAR (Data, Action, Response) format. The focuses included pain, hyperthermia, and fatigue. The summaries provided nursing assessments, interventions, and the patient's response for each focus area in 3 sentences or less.
This document contains nursing care plans for various conditions including fever, infiltration of an IV site, ineffective breathing patterns, laboratory/diagnostic workup, pain, and discharge teaching. For each condition, it lists assessment findings, nursing interventions, and evaluation of the patient's response to those interventions. The nursing interventions focus on monitoring vital signs, providing comfort measures, administering medications, ensuring proper positioning and oxygen therapy, teaching the patient and family, and following up on diagnostic test results.
This document provides a community diagnosis of Sitio Asana 1 in Barangay Santisima Cruz, Laguna, Philippines. It includes a community profile with information on the population, family structure, socioeconomic factors, homes and environment, health care practices, community development issues and recommendations. A total of 332 households were surveyed out of 520 households in the community. The population is made up of slightly more males than females. Most families are nuclear in structure and the main occupations include fishing and construction.
Focus charting describes documenting from the patient's perspective about their current status, progress towards goals, and response to interventions. It uses a focus column that incorporates the patient's concerns, therapies, responses, and functional health. The focus charting includes data about observations, actions describing nursing interventions, and response describing the patient outcome. The purpose is to bring focus back to the patient and their priorities in a holistic way.
1. The document provides background information on pneumonia including its causes, risk factors, signs and symptoms, and treatment. It discusses pneumonia as a leading cause of death from infectious disease.
2. It then outlines the general and specific objectives of studying the case of a 47-year-old female patient admitted for difficulty breathing later diagnosed with pneumonia.
3. The theoretical framework draws upon Florence Nightingale's environmental theory, noting how the patient's living conditions relating to air, water, sanitation and space likely contributed to her illness.
The document summarizes a case presentation by BSN level III nursing students. It describes the objectives of demonstrating knowledge of a patient's diagnosis, disease process, complications, treatment plan, and nursing interventions. It then outlines the specific program, which involved students presenting thorough assessments and understanding pathophysiology, drug therapy, contributing factors, and formulating appropriate nursing care plans. The summary describes the student groups presenting cases involving various conditions like CVA, hyperthyroidism, heart failure, and gallstones. The panelists provided feedback and advice to help students improve their analysis and presentations.
The document provides information about various eye, throat, and immune system problems, as well as musculoskeletal problems. For each system, specific disorders are enumerated and described. One problem from each system is then selected and a nursing care plan is provided using the nursing diagnosis, objectives of care, nursing interventions, and rationale format. The care plan example provided is for a patient with glaucoma involving the eyes, pharyngitis involving the throat, lupus erythematosus involving the immune system, and a herniated disk involving the musculoskeletal system.
The document outlines several potential nursing diagnoses and interventions for patients with chronic illnesses or cancer diagnoses. It discusses interventions to address risks of infection, ineffective coping, acute pain, ineffective sexual patterns, powerlessness, and hopelessness. The interventions focus on hygiene, monitoring for infection signs, encouraging fluid intake and coping skills, managing pain, providing education and support for sexuality issues, enhancing patient autonomy, and addressing fears and isolation.
The document describes Focus-Data-Action-Response (F-DAR) charting, which organizes health information in a patient's record with three columns: Date/Hour, Focus, and Progress Notes. The Progress Notes column contains three sections - Data (assessment findings), Action (nursing care provided), and Response (patient outcomes). Several examples of completed F-DAR charts are provided addressing issues like pain, fever, risk of infection, nausea, and more. F-DAR charting aims to make the patient and their concerns the focus of care through systematic documentation of assessments, interventions, and responses.
The document discusses preeclampsia, including its signs, symptoms, risk factors, diagnostic tests, pathophysiology, and treatment. Preeclampsia is a pregnancy complication characterized by high blood pressure and signs of damage to other organ systems. It is caused by abnormal development of the placenta leading to reduced blood flow and endothelial cell dysfunction systemically. Proper management involves monitoring blood pressure, delivering the baby to resolve symptoms, and potentially using antihypertensive medications.
Joshua Ninichuck has over 20 years of experience in healthcare, including 6 years as a paramedic, 3 years as an orthopedic spine surgery PA, and 3 years in pediatric/family practice. He has extensive experience in emergency medicine, surgery, orthopedics, pediatrics, and family medicine. He is certified by the NCCPA and is a member of the AAPA.
This document provides an introduction to posterior hip dislocation, including definitions, causes, symptoms, and treatment. It then presents a case study of an 8-year-old male patient from Masbate, Philippines who suffered a posterior dislocation of the right hip after falling from a tree two weeks prior. He was unable to walk since the incident. Upon examination at the hospital, he displayed limited range of motion and tenderness in the right hip. He was diagnosed with posterior hip dislocation of the right hip and prescribed balance skeletal traction to aid in reduction.
The document provides a course syllabus for Competency Appraisal II at Eastern Samar State University College of Nursing. The course aims to apply the nursing process and core competencies in caring for individuals, families, and communities. Over 90 hours, students will learn through lectures, discussions, and nursing simulations. Simulations will integrate nursing process, levels of care, and prevention for individuals with cellular abnormalities, behavioral issues, emergencies, and more. Students will also develop competencies in leadership, resource management, documentation, collaboration, quality improvement, ethics, and research through various clinical setting scenarios. Upon completion, students will be able to provide holistic nursing care and demonstrate competencies across all areas of responsibility.
The document discusses a nursing assessment and plan of care for a patient experiencing disturbed sleep patterns due to environmental factors. The nursing diagnosis is disturbed sleep pattern related to environmental noise and light. Short term goals are for the patient to understand their sleep disturbance and verbalize their usual sleep pattern. Interventions include observing the patient's sleep habits, addressing misconceptions, and advising limiting caffeine and taking naps. The objective is to evaluate sleep quality measures and the long term goal is improved sleep and well-being.
The document defines focus charting as a systematic method for organizing health information using nursing terminology to describe a patient's health status and care. It involves focusing on key concerns from the care plan like skin integrity or activity tolerance. A focus note includes subjective and objective data supporting the focus, nursing interventions, and the patient's response. An example focus note addresses a patient's pain by documenting their complaint, administering medication, repositioning the patient, and noting their improved pain level in response.
1) The document is a learning feedback diary from a nursing student named Edmar Erick R. Guitto during their clinical rotation at Holy Infant Hospital.
2) The student's objectives were to familiarize themselves with the hospital setting, establish rapport with clients, maintain good relationships with staff and instructors, and provide total client care while developing their nursing skills.
3) The student found their clinical instructor engaging and learned some important nursing concepts. They were challenged by their preliminary grades but aim to improve during their rotation.
1) The document discusses the author's three rotational community duties as a nursing student in rural health units and municipalities in Baguio City and Benguet, Philippines.
2) During their community duties, the students conducted home visits, health teachings, and simple medical interventions. They provided care like blood pressure monitoring and gained experience applying their nursing knowledge.
3) The author learned valuable skills like managing their time efficiently, communicating with patients and staff, and computing important health metrics for pregnant women. They found the duties a crucial learning experience.
Drug study- Paracetamol and Cefuroxime NaMj Hernandez
Paracetamol is used for mild pain or fever. It works by blocking pain impulses and inhibiting prostaglandin synthesis. The dosage is 250/5ml every 4 hours for children, with a maximum of 5 doses in 24 hours. Nurses should advise not using it for marked or prolonged fever without a prescriber's direction.
Cefuroxime is a second-generation cephalosporin used for respiratory, urinary, and skin infections. It works by inhibiting cell wall synthesis. The dosage is 500mg every 8 hours. It is contraindicated in those with hypersensitivity to it or other cephalosporins, and should be used cautiously in those with penicillin aller
This document provides information about pediatric community-acquired pneumonia (PCAP) in a young female patient. It includes the patient's profile, physical assessment findings, relevant anatomy and physiology of the respiratory system, and signs and symptoms of pneumonia. Crackles were auscultated in the lower lung fields, indicating inflammation. The document also outlines the patient's nursing care plan.
This document contains 10 multiple choice questions related to nursing care in emergency situations. The questions cover topics like priority interventions for a client with chest pain, appropriate treatment for anaphylaxis, identifying fracture types, appropriate work for a float nurse, purpose of glucagon, correct placement of defibrillator pads, assessing bowel sounds, priority care for a chemical eye splash, concerning findings after hip replacement, and appropriate seizure precautions.
This document contains sample focus charting from a nurse's notes. It includes 3 entries with the date, focus, and progress notes in the DAR (Data, Action, Response) format. The focuses included pain, hyperthermia, and fatigue. The summaries provided nursing assessments, interventions, and the patient's response for each focus area in 3 sentences or less.
This document contains nursing care plans for various conditions including fever, infiltration of an IV site, ineffective breathing patterns, laboratory/diagnostic workup, pain, and discharge teaching. For each condition, it lists assessment findings, nursing interventions, and evaluation of the patient's response to those interventions. The nursing interventions focus on monitoring vital signs, providing comfort measures, administering medications, ensuring proper positioning and oxygen therapy, teaching the patient and family, and following up on diagnostic test results.
This document provides a community diagnosis of Sitio Asana 1 in Barangay Santisima Cruz, Laguna, Philippines. It includes a community profile with information on the population, family structure, socioeconomic factors, homes and environment, health care practices, community development issues and recommendations. A total of 332 households were surveyed out of 520 households in the community. The population is made up of slightly more males than females. Most families are nuclear in structure and the main occupations include fishing and construction.
Focus charting describes documenting from the patient's perspective about their current status, progress towards goals, and response to interventions. It uses a focus column that incorporates the patient's concerns, therapies, responses, and functional health. The focus charting includes data about observations, actions describing nursing interventions, and response describing the patient outcome. The purpose is to bring focus back to the patient and their priorities in a holistic way.
1. The document provides background information on pneumonia including its causes, risk factors, signs and symptoms, and treatment. It discusses pneumonia as a leading cause of death from infectious disease.
2. It then outlines the general and specific objectives of studying the case of a 47-year-old female patient admitted for difficulty breathing later diagnosed with pneumonia.
3. The theoretical framework draws upon Florence Nightingale's environmental theory, noting how the patient's living conditions relating to air, water, sanitation and space likely contributed to her illness.
The document summarizes a case presentation by BSN level III nursing students. It describes the objectives of demonstrating knowledge of a patient's diagnosis, disease process, complications, treatment plan, and nursing interventions. It then outlines the specific program, which involved students presenting thorough assessments and understanding pathophysiology, drug therapy, contributing factors, and formulating appropriate nursing care plans. The summary describes the student groups presenting cases involving various conditions like CVA, hyperthyroidism, heart failure, and gallstones. The panelists provided feedback and advice to help students improve their analysis and presentations.
The document provides information about various eye, throat, and immune system problems, as well as musculoskeletal problems. For each system, specific disorders are enumerated and described. One problem from each system is then selected and a nursing care plan is provided using the nursing diagnosis, objectives of care, nursing interventions, and rationale format. The care plan example provided is for a patient with glaucoma involving the eyes, pharyngitis involving the throat, lupus erythematosus involving the immune system, and a herniated disk involving the musculoskeletal system.
The document outlines several potential nursing diagnoses and interventions for patients with chronic illnesses or cancer diagnoses. It discusses interventions to address risks of infection, ineffective coping, acute pain, ineffective sexual patterns, powerlessness, and hopelessness. The interventions focus on hygiene, monitoring for infection signs, encouraging fluid intake and coping skills, managing pain, providing education and support for sexuality issues, enhancing patient autonomy, and addressing fears and isolation.
The document describes Focus-Data-Action-Response (F-DAR) charting, which organizes health information in a patient's record with three columns: Date/Hour, Focus, and Progress Notes. The Progress Notes column contains three sections - Data (assessment findings), Action (nursing care provided), and Response (patient outcomes). Several examples of completed F-DAR charts are provided addressing issues like pain, fever, risk of infection, nausea, and more. F-DAR charting aims to make the patient and their concerns the focus of care through systematic documentation of assessments, interventions, and responses.
The document discusses preeclampsia, including its signs, symptoms, risk factors, diagnostic tests, pathophysiology, and treatment. Preeclampsia is a pregnancy complication characterized by high blood pressure and signs of damage to other organ systems. It is caused by abnormal development of the placenta leading to reduced blood flow and endothelial cell dysfunction systemically. Proper management involves monitoring blood pressure, delivering the baby to resolve symptoms, and potentially using antihypertensive medications.
Joshua Ninichuck has over 20 years of experience in healthcare, including 6 years as a paramedic, 3 years as an orthopedic spine surgery PA, and 3 years in pediatric/family practice. He has extensive experience in emergency medicine, surgery, orthopedics, pediatrics, and family medicine. He is certified by the NCCPA and is a member of the AAPA.
This document provides an introduction to posterior hip dislocation, including definitions, causes, symptoms, and treatment. It then presents a case study of an 8-year-old male patient from Masbate, Philippines who suffered a posterior dislocation of the right hip after falling from a tree two weeks prior. He was unable to walk since the incident. Upon examination at the hospital, he displayed limited range of motion and tenderness in the right hip. He was diagnosed with posterior hip dislocation of the right hip and prescribed balance skeletal traction to aid in reduction.
None
Allergies: None known
Marital Status: Single
Occupation: Housewife
Educational Attainment: High School Graduate
Financial Status: Low income
Family History: Non-consanguineous parents, no family history of hereditary diseases
Social History: Lives with parents and siblings in a small house made of light materials at Purok 2 Salvacion, Panabo City.
Developmental History: Within normal limits for age
Previous Hospitalization: None
Previous Surgeries: None
Menstrual History: N/A
Sexual History: N/A
Substance Abuse: None
Review of Systems:
Pejman Ferdowsian is a medical doctor seeking a new position. He has over 10 years of experience in various medical specialties including family medicine, internal medicine, surgery, obstetrics/gynecology, pathology, pediatrics, psychiatry, and interventional radiology. He has worked in clinical settings in the US and Canada. Pejman has strong communication, research, and analysis skills. He is currently involved in ongoing medical research and professional development.
Dr. Jagarlamudi Kalyan Chakravarthy is a hospitalist at Banner Del Ebb Medical Center in Phoenix, AZ. He received his medical degree from Deccan College of Medical Sciences in India in 2007. He completed his residency in internal medicine at St. Vincent Mercy Medical Center in Toledo, OH from 2011-2014. He is licensed to practice medicine in Arizona and has passed all steps of the USMLE.
This document is a resume for Amber Schroeder, who is pursuing a Master of Science in Physician Assistant Studies at the University of New England. It outlines her education, which includes a Bachelor of Science in Microbiology from Idaho State University. It also details her clinical experience, which includes over 1200 patient care hours and 1400 patient encounters in specialties such as family medicine, pediatrics, emergency medicine, and surgery. Her clinical rotation summary provides further details on her rotations at various hospitals and clinics.
Orthodontic Diagnosis
For general practitioners
Prepared by Dr. M Alruby
Orthodontic diagnosis deals with recognition of the various characteristics of the malocclusion. It involves collection of data in a systematic manner to help in identifying the nature and cause of the problem. Comprehensive orthodontic diagnosis is established by use of certain clinical implements called diagnostic aids.
Consideration of general health, appearance and attitude:
The first step in any orthodontic examination is to form a general idea of patient's health status, physical appearance and attitude toward orthodontics.
Case history:
Case history involves eliciting and recording of relevant information from the patient and parents to aid in the overall diagnosis of the case. The information is gathered from the patient and parents.
Personal details:
Name: the patient's name should be recorded for the purpose of communication and identification. Most patients like being called by their name. Addressing the patient by his or her name has a beneficial psychological effect as well. In case of children it is wise to record their pet names.
Age: the patient's chronological age should be recorded. Age consideration helps in diagnosis as well as treatment planning. There are certain modalities that are best carried out during the growing age. Growth modification procedures using functional and orthopedic appliances are carried out during the growth period. Surgical respective procedure is best carried out after the cessation of growth.
** Dental age determination: can be determined by two different methods:
- Stage of eruption of teeth.
- Stage of tooth mineralization on radiograph.
Determination of the dental age from observation has been the only method available for long time. In certain cases however, the accuracy of the method is limited.
When determining the dental age radiographically according to the stage of germination, the degree of development of individual teeth is compared to a fixed scale.
** Skeletal age evaluation: assessment of the skeletal age is often made with the help of a hand radiograph which can be considered the biologic clock. For the analysis of skeletal maturity the stage of mineralization of the carpal bones must be determined thereafter the development of the metacarpal bones and phalanges should be evaluated. For the evaluation of the hand radiograph various indicators regarding the development and maturity are established which occur regularly in a definite sequence during skeletal development.
Sex: the patient sex should be recorded in the case history. This is important in planning treatment, as the timing of growth events such as growth spurts is different in males and females. Females usually precede males in onset of growth spurts, puberty and termination of growth.
Address and occupation: this help in evaluation of socio-economic status of the patients and parents. Some countries
Simone Assaad has extensive experience working in a variety of medical settings through her physician assistant program and subsequent clinical rotations. These include pediatric, behavioral medicine, geriatrics, emergency medicine, women's health, internal medicine, surgery, family medicine, orthopedics, and nursing home care. She has performed duties such as patient exams, testing, treatment, education, and assisting in medical procedures. Simone also has experience providing wellness education and basic first aid as a peer educator and certified nursing assistant. She is expected to graduate with a Master of Medical Science degree and physician assistant certification in August 2014.
Gregory J. Merth has over 20 years of experience in healthcare, including as an ophthalmic technician, health science specialist, and doctor of chiropractic. He has strong clinical skills in eye exams, vision testing, and ophthalmic equipment. Currently he works at the Minneapolis VA Medical Center running longitudinal studies involving eye exams, memory assessments, and balance testing.
Botulinum toxin injections were found to be a useful and safe treatment for reducing self-biting behavior in six patients with Lesch-Nyhan disease. Patients received an average of 20 botulinum toxin injections over 1.5 to 7.1 years, with injections targeting the masticatory muscles, biceps brachii, and other muscles. Of the 119 total injections, 113 (95%) were partially or completely effective in reducing self-biting. Only 3 injections (2.5%) produced adverse effects such as difficulty swallowing or general weakness. Botulinum toxin injections provided an effective treatment option for managing self-injurious behavior in patients with Lesch-Nyhan disease.
This document provides a summary of the education, experience, and areas of expertise of naturopathic doctor Todd Adam Born. It outlines his extensive training and experience in integrative medicine with a focus on chronic disease, gastrointestinal issues, neurological disorders, endocrinology, cardiovascular disease, autoimmune disease, behavioral issues, HIV/AIDS, and geriatrics. It also lists his professional activities including owning his own practice, editing newsletters, reviewing journals, and presenting on various health topics.
Brigham Elliott is a highly motivated registered nurse licensed in Wisconsin seeking a position in emergency or critical care nursing. He has over 12 years of experience as a licensed practical nurse and 1 year of experience as a neuroscience registered nurse. His experience includes providing direct patient care, wound care, intravenous therapy, and responding to emergency situations in both hospital and military clinical settings. He holds BSN and LPN degrees and is certified in ACLS, BLS, and stroke assessment.
This document describes a model of orthopaedic dysfunction that can be used as a clinical decision-making framework in physical therapy. The model outlines how various stimuli can lead to internal tissue responses, impairments, functional disabilities, and handicaps. It presents the internal tissue response section in detail to help therapists analyze patients' impairments in relation to the pathophysiology. The model is intended to help therapists formulate hypotheses about dysfunction, explain examination and treatment choices, and identify appropriate treatment goals. A case study is used to demonstrate how the model can be applied in clinical practice. The document also discusses implications for using the model in education and research.
The document discusses the examination of musculoskeletal dysfunction. It explains that the examination involves both subjective and objective components. The subjective examination includes a thorough patient history, with details on types of histories to collect and pain scales to assess pain levels. The objective examination involves observing movement, performing special tests, assessing reflexes and sensation, and examining joint play and palpation. Both subjective and objective parts of the examination are needed to fully understand the patient's problem and make an accurate diagnosis.
This Volume of Progress in Clinical Neurosciences brings to you a synthesized overview of clinically relevant topics in an easy-to-read format. It would enable both the practicing Clinician and the student in training to update their knowledge and apply it in day-to-day practice. The most significant advances in traumatic brain injury, pituitary adenomas, myasthenia gravis, epilepsy source localization, and poststroke rehabilitation have been addressed. The controversies regarding the management of low grade gliomas, solitary brain metastasis and optimal surgical approach to colloid cysts are discussed cogently. A systematic diagnostic approach to myelopathy and encephalopathy is illustrated. The future of neurosurgical education is simulation and there is a detailed explanation of this strategy. The importance and relevance of clinical examination in today's era of highly advanced diagnostic imaging cannot be understated and this has been put forth emphatically.
NURS 4435 TUTA Critically Read and Critique Nursing Research Articles.docxstirlingvwriters
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1. Republic of the Philippines
UNIVERSITY OF NORTHERN PHILIPPINES
Tamag, Vigan City
College of Nursing
A CASE ANALYSIS
On
Fracture closedcomplete displaced proximal phalanges
In Partial Fulfillment
of the Requirements of the Course,
NCM103
(Philippine Orthopedic Center Duty)
Presented to:
MRS. VIRGINIA R. RUBIO, RN,MAN, Ed.D
Clinical Instructor
Presented by:
CHEZKA MARIE PALOLA
BSN – III BROMELIADS
ANGELICA MARIE RAFANAN
BSN-III GAZANIA
2. CASE STUDY GRADING SHEET FOR NCM
PARAMETERS PERCENTAGE
%
ACTUAL
GRADE
I. Introduction & Objectives 5
II. Personal Data
III. Nursing History of Past and Present
Illness
5
IV. PEARSON Assessment 15
V. Diagnostic Procedures
a. Ideal
b. Actual
5
VI. Anatomy & Physiology 5
VII. Pathophysiology
Algorithm
Explanation
15
VIII. Management
a. Medical
b. Surgical
c. NCP with Evaluation
d. Promotive and Preventive Management
5
20
5
IX. Drug Study 5
X. Discharge Planning 5
XI. Updates 5
XII. ORGANIZATION 2.5
XIII. BIBLIOGRAPHY 2.5
TOTAL 100
REMARKS:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Mrs. Virginia R. Rubio, RN, MAN, Ed. D
Clinical Instructor
3. Table of Contents
Introduction & Objectives ……………………………………………………………………………………………….. 1 - 2
History of Past and Present Illness ……………………………………………………………………………………
PEARSON Assessment ……………………………………………………………………………………………………………..
Diagnostic Procedure:
a. Ideal …………………………………………………………………………………………………………….
b. Actual …………………………………………………………………………………………………………….
Anatomy & Physiology …………………………………………………………………………………………………………….
Pathophysiology:
a. Algorithm …………………………………………………………………………………………………………….
b. Explanation…………………………………………………………………………………………………………….
Management:
a. Medical
Ideal …………………………………………………………………………………………………
Actual …………………………………………………………………………………………………
b. Surgical ……………………………………………………………………………………………………………..
c. Nursing Care Plan …………………………………………………………………………………………………
d. Promotive & Preventive Management …………………………………………………………..
Drug Study …………………………………………………………………………………………………………………………..
Discharge Planning ………………………………………………………………………………………………………………
Update ………………………………………………………………………………………………………………………………………..
Bibliography ……………………………………………………………………………………………………………………………
4. I. INTRODUCTION:
The World Health Organization defines health as the state of complete physical, mental
and social well being and not merely the absence of a disease. This implies that to be healthy,
an individual must be free from any factors that bring disequilibrium or imbalance within his
body, his thought processes and the way he relates with the people around him and to his
environment.
Likewise, a disease is a departure from the state of health caused by an interruption or
modification of any of the vital functions of the different systems of the body. It is
characterized by a definite manifestation called sign or symptom.
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 extreme muscle
contractions. When the bone is broken, adjacent structures are also affected, 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.
There are different types of fractures and these include, complete fracture, incomplete
fracture, closed fracture, open fracture and there are also types of fractures that may also be
described according to the anatomic placement of fragments, 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.
Patient X is a 16 year old male from 265 Sauyo, Cabuyao, Novaliches, Quezon City who
was admitted for the first time to Philippine Orthopedic Center with a chief complaints of pain
at the left foot secondary to vehicular accident. Further assessment reveals fracture closed
complete displaced proximal phalanges 5th, 1st, 2nd, 3rd metatarsals head of 2nd metatarsals left
fracture closed medial malleolus left.
As the student-nurse assigned to care for Pt. X for 2 duty days, I have observed his
condition and identified some of his health needs. Although my contribution to the patient’s
recovery may be insignificant, witnessing my patient’s condition improving is a very fulfilling
5. experience. But more than the feeling of fulfillment, I felt that I was an instrument of God in
trying to bring back wholeness in X’s life no matter how insignificant it may be.
OBJECTIVES
After completing this case study, the student-nurse will be able to obtain appropriate
knowledge, skills and attitude in caring for a patient with bone injury particularly to a patient with
metatarsal closed frature. This is manifested by the student’s ability:
1. To present accurately the patient’s profile.
2. To obtain a comprehensive past, present and family history of patient’s illness.
3. To assessthe healthstatusof the patientusingthe cephalocaudalmethodandorganize cuesfor
Nursing Care Plan.
4. To know the different diagnostic examinations (ideal and actual) related to the patient’s case
and understand the purpose and limitation of each examination.
5. To study the results/outcome of the diagnostic procedures that the patient has undergone and
explain how these are related to the case of the patient.
6. To discuss the anatomy and physiology of the organ involved in the case.
7. To illustrate throughaschematicdiagramthe pathophysiologyof the patient’s case and explain
the mechanism that is involved.
8. To present the medical and surgical management done to the patient.
9. To formulate a practical and realistic plan of care for the patient through:
a. systematic organization of the subjective and the objective cues related to the case.
b. identifyingand prioritizing nursing diagnoses using the PES format (Problem-Etiology-
Signs/Symptoms) and according to NANDA.
c. analysisof the pathophysiologyof the identifieddiagnosisbasedon the presentation of
the patient
d. formulating appropriate nursing objectives following the SMART criteria.
e. planningforindependent,dependentandcollaborativeinterventionsandexplainingthe
rationale for every intervention done.
f. evaluatingthe degreeof achievement for all the objectives set at the beginning of the
intervention.
10. To make a list of the different drugs taken and is presently taking by the patient with their
correspondingdosages,mechanismsof action,side/adverseeffectsandnursingresponsibilities.
11. To formulate a Discharge Plan covering the following areas: METHOD (Medications, Exercises,
Treatments, Health Teachings, Out-Patient Department and Diet).
6. PATIENT’S PROFILE
Personal data
Name: Michael Caguindagan Salac
Address: 265 Sauyo Cabuyao, Novaliches, Quezon City
Age: 16y/o
Sex: Male
Birthday: April 24, 1996
Birthplace: Arayat, Pampanga
Civil Status: Single
Religion: Roman Catholic
Nationality: Filipino
Clinical data
Date and time of Admission: April 10, 2012 @ 1:00 pm
Physician-in-Charge: Dr. Melvin Valera
Chief Complaints: Pain at the left foot secondary to vehicular accident
Medical Diagnosis: Fracture closed complete displaced proximal
phalanges 5th, 1st, 2nd, 3rd metatarsals head of 2nd
metatarsals left fracture closed medial malleolus
left.
NURSING HISTORY OF PAST AND PRESENT ILLNESS
I.PAST ILLNESS
Patient X claimed that he has no major hospitalizations yet.
When he was 3 months old, he had bronchial asthma and lasted for 8 years. He had his
last attack when he was 10 years old. According to the patient, he completed his immunizations
(BCG, OPV, DPT, etc.). Like every children, he also experienced fever, cough and colds, bruises,
scratches and minor wounds. In these cases, he takes paracetamol for fever, applies betadine
for wound and neozep for cough and colds. he has no drug allergies.
7. II.PRESENT ILLNESS
Patient X, a 16 year old male from 265 Sauyo Cabuyao, Novaliches, Quezon City was
admitted to Philippine Orthopedic Center with a Chief Complaints of pain at the left foot
secondary to vehicular accident. Further assessment reveals fracture closed complete displaced
proximal phalanges fifth, first, second, third metatarsals, head of second metatarsal left
fracture closed medial malleolus left. It was about 2:00 pm on April 9, 2012 when the incident
happened. According to Patient X, he was on his way home when unfortunately, he was hit by
SUV and his left foot was crushed.
In POC, further tests were done to the patient as he was not responding to regular
treatment regimen. X-ray revealed the exact area of fracture and hematologic exams for any
occurrence of microorganisms and inflammation and site of fracture.
The patient is under the observation of Dr. Valera. She underwent fastecotomy with
slipper mold. While recovering, Pt X is taking the following medications:
Cefuroxime 750mg, IV q8 for infection.
Paracetamol 150mg 1tab IV q4 for temperature >38. 8 degree Celsius for fever
Celecoxib 200mg q12 for pain.
Ketorolac 15mg IV q6 for mild pain
Tramadol 50mg q6 for pain
Ranitidine 25mg q8 for duodenal ulcer
Ferrous sulfate tab OD for anemia
He underwent different diagnostic procedures such as Complete Blood Count and X-ray.
He is about 4 days confined at the hospital already and he had an improved condition. He
claimed that the pain decreased compared to his first confinement, swelling also decreased and
mobility of fractured area improved.
8. IV. PEARSON ASSESSMENT
DATES April 12, 2012 April 13, 2012
PSYCHOSOCIAL
Identity vs Role Confusion
16 year old , male
Single, a student
Lives at
Roman Catholic, Filipino
Basic needs are met such as
providing health teachings and
morning care.
Kept comortable and rested.
c swelling at the left ankle and
metatarsals.
c tolerable pain at the swollen
left ankle and metatarsals.
c elastic bandage applied at the
left ankle and metatarsals.
c open wound at the anterior
aspect of the metatarsal area as
claimed by the patient’s mother.
Weak in appearance
Conscious and coherent
Basic needs are met such as
providing health teachings and
morning care.
Kept comortable and rested.
c swelling at the left ankle and
metatarsals.
c tolerable pain at the swollen
left ankle and metatarsals.
c elastic bandage applied at the
left ankle and metatarsals.
c open wound at the anterior
aspect of the metatarsal area as
claimed by the patient’s
mother.
Conscious and conversant.
ELIMINATION
Urinates frequently
Urinates with assistance.
(-) BM
Urine output:
(-) vomiting
Urinates frequently
Urinates with assistance.
(-) BM
Urine output:
(-) vomiting
ACTIVITY &
There is dizziness upon doing
some ADL’s as claimed by the
patient.
Able to have enough sleep for 7-8
hours.
c limited movements due to the
condition of the patient.
Able to sleep for 8 hours.
Still c limited movements due
to the condition of the patient.
Conversant
Active
Changed positions frequently.
9. REST
Weak in appearance
Changed positions frequently
SAFETY
s allergies
c elastic bandage applied at the
let ankle and metatarsals.
c open wound at the anterior
aspect of the metatarsal area as
claimed by the patient’s mother.
Wound dressed at times.
Clean and ventilated room
No side rails
s allergies
c soiled elastic bandage applied
at the left ankle and
metatarsals.
c open wound at the anterior
aspect of the metatarsal area as
claimed by the patient’s
mother.
Wound dressed at times.
Clean and ventilated room
No side rails
OXYGENATION
RR: 30 cpm
PR: 99 bpm
(-) DOB
c an IV of D5LRS 1L x 12 hours
inserted at right cephalic vein
regulated to 20-21 gtts/min.
RR: 29 cpm
PR: 97 bpm
(-) DOB
c an IVF of D5LRS 1L x 12 hours
inserted at the right cephalic
vein regulated to 20-21
gtts/min.
NUTRITION
on DAT diet
c fair appetite
c an IVF of D5LRS 1L x 12 hours
inserted at the right cephalic
vein regulated to 20-21
gtts/min.
There is enough fluid intake.
Ate meals at the right time.
Needs assistance when eating
still on DAT diet
c good appetite
c an IVF of D5LRS 1L x 12 hours
inserted at the right cephalic
vein regulated to 20-21
gtts/min.
Increased fluid intake.
Increased intake of fruits rich in
Vit. C.
Ate meals at the right time.
Still needs assistance when
eating.
10. VI. ANATOMY AND PHYSIOLOGY
Any of the five long bones of thefoot (hind feet in quadrupeds), which collectively make up the
metatarsus. They are analogous to the metacarpals of the hand. The metarsals articulate at one
end with the tarsals (ankle bones) and at the other with thephalanges (toe bones). The
metatarsals are numbered from the medial side (ossa metatarsalia I.-V.); each presents for
examination a body and two extremities.
Common characteristics of the metatarsal bones
The body is prismoid in form, tapers gradually from the tarsal to the phalangeal extremity, and
is curved longitudinally, so as to be concave below, slightly convex above. The base or posterior
extremity is wedge-shaped, articulating proximally with the tarsal bones, and by its sides with
the contiguous metatarsal bones: its dorsal and plantar surfaces are rough for the attachment
of ligaments. The head or anterior extremity presents a convex articular surface, oblong from
above downward, and extending farther backward below than above. Its sides are flattened,
and on each is a depression, surmounted by a tubercle, for ligamentous attachment. Its plantar
surface is grooved antero-posteriorly for the passage of the flexor tendons, and marked on
either side by an articular eminence continuous with the terminal articular surface.
Characteristics of the individual metatarsal bones
The first metatarsal bone is remarkable for its great thickness, and
is the shortest of the metatarsal bones. The body is strong, and of
well-marked prismoid form. The base presents, as a rule, no
articular facets on its sides, but occasionally on the lateral side
there is an oval facet, by which it articulates with the second
metatarsal. Its proximal articular surface is of large size and
11. kidney-shaped; its circumference is grooved, for the tarsometatarsal ligaments, and medially
gives insertion to part of the tendon of the Tibialis anterior; its plantar angle presents a rough
oval prominence for the insertion of the tendon of the Peronæus longus. The head is large; on
its plantar surface are two grooved facets, on which glide sesamoid bones; the facets are
separated by a smooth elevation.
The second metatarsal bone is the longest of the metatarsal bones, being prolonged backward
into the recess formed by the three cuneiform bones. Its base
is broad above, narrow and rough below. It presents four
articular surfaces: one behind, of a triangular form, for
articulation with the second cuneiform; one at the upper part
of its medial surface, for articulation with the first cuneiform;
and two on its lateral surface, an upper and lower, separated
by a rough non-articular interval. Each of these lateral
articular surfaces is divided into two by a vertical ridge; the
two anterior facets articulate with the third metatarsal; the
two posterior (sometimes continuous) with the third
cuneiform. A fifth facet is occasionally present for articulation
with the first metatarsal; it is oval in shape, and is situated on the medial side of the body near
the base.
The third metatarsal bone articulates proximally, by means of a
triangular smooth surface, with the third cuneiform; medially, by
two facets, with the second metatarsal; and laterally, by a single
facet, with the fourth metatarsal. This last facet is situated at the
dorsal angle of the base
The fourth metatarsal bone is smaller in size than the preceding; its
base presentsanoblique quadrilateral surface forarticulationwith the
cuboid; a smooth facet on the medial side, divided by a ridge into an
anterior portion for articulation with the third metatarsal, and a
posterior portion for articulation with the third cuneiform; on the
lateral side a single facet, for articulation with the fifth metatarsal.
The fifth metatarsal bone is recognized by a rough eminence, the
tuberosity, on the lateral side of its base. The base articulates
behind, by a triangular surface cut obliquely in a transverse
direction, with the cuboid; and medially, with the fourth
metatarsal.Onthe medial part of its dorsal surface is inserted the
tendon of the Peronæus tertius and on the dorsal surface of the
tuberosity that of the Peronæus brevis. A strong band of the
plantaraponeurosis connectsthe projectingpart of the tuberosity
with the lateral process of the tuberosity of the calcaneus. The
plantar surface of the base is grooved for the tendon of the
Abductor digiti quinti, and gives origin to the Flexor digiti quinti
brevis.
12. VII. Pathophysiology
A. Algorithm
Vehicular accident
Patient was hit by SUV
X-ray
Bleeding occurs
Swellingand
Inflammation
Pain,lossof function,deformity,crepitus,swellinganddiscoloration
Interventions
Fasciotomywithslipper
mold
Left metatarsal received direct violent trauma
Break on the proximal 5th phalanges and 1st, 2nd,3rd metatarsals without communication on the
outside.
Bone splintered into several fragments
Muscles are destroyed and undergo muscle spasm which pulls the fragments in different
positions
Blood vessel and marrow of the bone re disrupted
Tissues are damaged
13. B. Explanation:
Trauma is the most common cause of fracture. The trauma is caused by vehicular
accident. The amount and direction of the force will vary from accident to accident resulting
from violent direct trauma, either comminuted or multiple muscles are attached to the bones.
Ones the bones are destroyed, muscles tend to go through spasmwhich is the reason why the
splintered fragment of the bones move away or will be scattered. In this case, the 5th proximal
phalanges of the metatarsal and so with the 1st, 2nd, rd metatarsal are damaged. The proximal
bone is displaced due to muscle spasm. Blood vessels and the bone marrows are also destroyed
due to the trauma. Tissue damage causes bleeding. Aside from bleeding, inflammation occurs
followed by pain, deformity, loss of function, crepitus, swelling and discoloration.
Fasciotomy with slipper mold was done to the patient to reduce pressure and
facilitate circulation on the left foot.
VIII. MANAGEMENT
MEDICAL MANAGEMENT
IDEAL ACTUAL
For immediate treatment, you have to
elevate the injured foot and put an ice pack
over it. If the person can go to the nearest
hospital he must use crutches and not try to
walk unsupported. For non-operative
treatment, the doctor may recommend stiff
soled shoe or casting the foot to make it
more secured and make the healing faster.
For medium to severe foot fractures, the
doctor will advise the patient to use non-
weight bearing cast for more than a month.
This is the healing time. The most important
treatment is to rest your foot. This means
avoiding any exercise or activity that may
have caused your stress fracture. Elevating
your foot can help to relieve pain. Your
doctor may also suggest that you take
simple painkillers such as paracetamol or
non-steroidal anti-inflammatory painkillers
such as ibuprofen. Special shoes are
available to help to immobilise the fracture
and support your foot so that you are able
to walk. If pain is severe, your doctor may
suggest that you have a below-the-knee
plaster cast until the fracture is healed.
A posterior mold was applied last April 9, 2012
on his left ankle to immobilize the affected
part and to reduce further fracture or damage.
This also helps in healing of the fracture if
surgery is not needed.
Intravenous therapy is used to replace fluids,
electrolytes and nutrient loses, anti-infectives,
blood products and dyes. Hypertonic fluids are
solutions having an osmotic pressure greater
than that of the solution with which it is
compared.
An IVF of D5LRS has been inserted at his left
metacarpal vein that runs for 12 hours at 20-
21 gtts/min. It aids in hydrating the patient
and maintain balance in his fluids and
electrolytes in his body.
Analgesics are medications used to relieve
pain. The two basic categories o analgesics are
opioids and the non-opioids. Opioids are a
natural or synthetic morphine-like substance
14. Fracture Reduction
Fracture reduction refers to restoration of
the fracture fragments to anatomic
alignment and positioning. Either closed
reduction or open reduction may be used to
reduce fracture. The specific method
selected depends on the nature of the
fracture; however, the underlying principles
are the same. Usually, the physician reduces
a fracture as soon as possible to prevent loss
of elasticity from the tissues through
infiltration by edema or hemorrhage. in
most cases, fracture reduction becomes
more difficult as the injury begins to heal.
Before fracture reduction and
immobilization, the patient is prepared for
the procedure; consent for the procedure is
obtained, and an analgesic is administered
as prescribed. Anesthesia may be
administered. The injured extremity must be
handled gently to avoid additional damage.
Closed reduction
In most instances, closed reduction is
accomplished by bringing the bone
fragments into snstomic alignment through
manipulation and manual traction. The
extremity is held in the aligned position
while the physician applies a cast, splint, or
other device. Reduction under anesthesia
with percutaneous pinning may also be
used. The immobilizing device maintains the
reduction and stabilizes the extremity for
bone healing. X-rays are obtained to verify
that the bone fragments are correctly
aligned.
Traction (skin or skeletal) may be used until
the patient is physiologically stable to
undergo surgical fixation.
responsible for reducing severe pain. While
non-opioids act at the peripheral nervous
system.
Ketorolac is an NSAID that interferes with
prostaglandin biosynthesis by inhibiting
cyclooxygenase pathway or arachidonic acid
metabolism; also acts as potent inhibitor or
platelet aggregation. It is for moderately
severe acute joint pain. It is administered
intravenously every 6 hours with a dosage of
750mg.
Tramadol is an opioid analgesic that inhibits
reuptake of serotonin and norepinephrine in
CNS. It is for moderate to moderately severe
pain. It is administered orally ever 6 hours with
a dosage of 50mg.
Celecoxib is a COX-2 inhibitor that exhibits
anti-inflammatory, analgesic, and antipyretic
action due to inhibition of COX-2 enzyme. It is
administered orally every 12 hours or for pain
with a dosage of 200mg.
Paracetamol is an analgesic and antipyretic, its
action is unclear but pain relief may result
from inhibition of prostaglandin synthesis in
CNS, with subsequent blockage of pain
impulses. Fever reduction may result from
vasodilation and increased peripheral blood
flow in hypothalamus, which dissipates heat
and lowers body temperature. It is
administered intravenously every 4 hours for
temp. ≥ 38.80c with a dosage of 250mg.
The antibiotics’ primary goal of antimicrobial
therapy is to assist the body’s deenses in
eliminating the pathogens. Medications that
accomplish this goal by killing bacteria are
15. called bactericidal.
Cefuroxime is a second-generation
cephalosphorin that interferes with bacterial
cell-wall synthesis and division by binding to
cell wall, causing cell to die. Active against
gram-negative and gram-positive bacteria,
with expanded activity against gram-negative
bacteria. It is administered intravenously every
8 hours with a dosage of 750mg.
Histamine2-Receptor Antagonist block the
stimulation of gastric acid secretion and are
use to treat peptic ulcer.
Ranitidine is a histamine2-receptor antagonist
that reduces gastric acid secretion and
increases gastric mucus and bicarbonate
production, creating a protective coating on
gastric mucosa. It is administered orally every
8 hours with a dosage of 25mg.
Mineral supplements are used to maintain and
replenish loss of minerals in the body.
Ferrous sulfate is a mineral supplement that
facilitates O2 transport via haemoglobin. It is
used as iron source as it replaces iron found in
haemoglobin, myoglobin and other enzymes. It
is administered orally 1 tablet, once a day.
SURGICAL MANAGEMENT
IDEAL ACTUAL
Surgery for metatarsal fractures is usually
done as an outpatient. You will require
a general anesthetic or spinal anesthetic. The
surgery is called open reduction and internal
Fasciotomy or fasciectomy is a surgical
procedure where the fascia is cut to relieve
tension or pressure (and treat the resulting
loss ofcirculation to an area
of tissue or muscle). Fasciotomy is a limb-
16. fixation, or ORIF.
During the surgery one or more incisions will
be made over the area of the fracture, usually
2 - 3 inches in length. The fractured bone ends
are exposed, and then put back together, or
“reduced”. The bones are then held together
with some combination of screws, wires or
plates.
The reason to do surgery is to put the bones
and joints back together as close as possible
to how they were before the injury.
Day of Surgery
At the end of the surgical procedure the
wound is stitched-up, and covered. A short leg
plaster splint is applied. That dressing gives
support to the foot, holding it securely. That
should be left in place until I change it at the
first post-operative office visit.
You will be given crutches at the surgery
center, and I want you to not put any weight
on that leg during the first 6 weeks. Do not
walk on the splint.
Post-operative Course
Dealing with post-operative pain will be your
major concern for the first few days.
Most people find that for the first few days
after surgery their foot will feel better if it is
elevated. Generally, if you let it hang down for
any period of time it will throb and you may
have more swelling. You can put it into
whatever position feels best, but usually that
will be elevated with a pillow under the foot.
Most patients have swelling about the surgical
area that lasts for about 4 months after
surgery. You should not resume athletic
activities for about 4 months after surgery.
Final Results
The goal of the surgery is to leave you with a
painless foot that will allow normal activities.
You should be able to regain full strength and
power in the leg and ankle, and have no
restriction of motion. Some patients will have
saving procedure when used to treat
acute compartment syndrome. It is also
sometimes used to treat chronic compartment
stress syndrome. The procedure has a very
high rate of success, with the most common
problem being accidental damage to a nearby
nerve.
Process
Fasciotomyinthe limbsisusuallyperformedbya
surgeonundergeneral orregional anesthesia.An
incisionismade inthe skin,anda small area of
fasciais removedwhere itwill bestrelieve
pressure.
Plantarfasciotomyis anendoscopicprocedure.
The doctor makestwosmall incisionsoneither
side of the heel.Anendoscope isinsertedinone
incisiontoguide the doctor.A tinyknife isinserted
inthe other.A portionof the fascianearthe heel is
removed.The incisionsare thenclosed.
In addition to scar formation, there is a
possibility that the surgeon may need to use a
skin graft to close the wound. Sometimes
when closing the fascia again in another
surgical procedure, the muscle is still too large
to close it completely. A small bulge is visible,
but is not harmful.
17. some mild soreness still. Some will notice
discomfort when the weather changes. It will
usually take 6 – 9 months to reach maximum
improvement.
PROMOTIVE AND PREVENTIVE MANAGEMENT
Relieving Pain
Affected part should immobilize with a splint to decrease pain and muscle spasm.
Handle the affected area with great care and gentleness because wounds are frequently
very painful.
Elevation reduces swelling and associated discomfort.
Pain is controlled with prescribed analgesics and other pain- reducing techniques.
Improving Physical Mobility
Immobilization devices and avoidance of stress on the bone.
Patient must understand the rationale for the activity restrictions.
Encourage full participation in ADLs within the physical limitations to promote general
well-being.
Controlling the Infectious Process
Monitor response to antibiotic therapy.
Observe for evidence of phlebitis, infection, and infiltration in the IV access.
Ensure adequate circulation.
Maintain needed immobility.
Comply with weight- bearing restrictions.
Change dressings using aseptic technique to promote healing and to prevent cross-
contamination.
A diet high in protein and Vitamin C promotes healing.
Encourage adequate hydration.
18. X. DISCHARGE PLAN
MEDICATIONS
Since patient MCS isn’t yet discharged from
the hospital, he can take his medications from
the hospital to their home. He is going to
maintain his mediations like his antibiotics,
pain relievers and multivitamins inorder or
him to boost his healing process.
ENVIRONMENT
Upon discharge of the patient, he should be in
a safe and sound environment. It’s significant
others is advised to lower the patient’s risk for
further fracture by assessing the home for fall
hazards. And he should be also in a clean
environment.
TREATMENT
The patient should take simple painkillers such
as paracetamol or non-steroidal anti-
inflammatory painkillers such as ibuprofen.
Another one is wound dressing. It is done to
prevent infection and to address the proper
treatment of the post-surgical wound of the
patient.
HEALTH TEACHINGS
The patient is adviced to have an adequate
calciumand Vit. D to avoid further bone
breakage. Another is by exercisig to
strengthen his bones and improve balance.
And he should have a balance diet to promote
wound healing.
OPD
The patient should attend his follow-up check
up inorder for the physician to see the
progress of the patient and to advise him what
to do.
DIET
The patient has no restrictions when it comes
to diet but he should increase his intake in
calciumand Vit. D specially when he had
undergone a surgery. He can have these two
19. by supplements or by the foods he eats
everyday. Vit. C should also be increased in his
diet for better wound repair and to boost his
immune system.
XI. UPDATES: Metatarsal Stress Fracture Treatment & Management
Acute Phase
Rehabilitation Program
Physical Therapy
The patient should rest from the offending activity. Immobilization is recommended for
comfort, with use of a postoperative (wooden-soled) shoe or short CAM Walker (Bird and
Cronin, Inc, Eagan, Minn). It is important to apply ice and elevate the foot to minimize pain and
swelling. If there is marked pain or minimal evidence of healing for stress fractures of the
second or third metatarsals, a short-leg walking cast can be used until there is radiographic
evidence of healing.
Recreational Therapy
During the respite period from the offending activity, the patient may maintain fitness by
cycling, aqua-running, or resistance training by using equipment that does not involve the
affected area.
Surgical Intervention
Stress fractures of the second or third metatarsals rarely require surgical intervention. Most of
these fractures heal uneventfully, and nonunion is rare. However, stress fractures of the fifth-
metatarsal base are more problematic. Displacement of these fractures tends to increase with
continued weight bearing. The treatment options are 2-fold as follows:
Less-active patients should be non-weight bearing in a short-leg cast for 6-8 weeks or until
there is radiographic evidence of healing. If an established nonunion develops, screw fixation
and/or bone grafting may be required.[16]
For active patients, early intramedullary screw fixation, with or without bone grafting, is often
recommended.
Consultations
Consult an orthopedic surgeon for fifth-metatarsal fractures or for second- or third-metatarsal
fractures that do not demonstrate radiographic healing after 6 weeks.
20. Recovery Phase
Rehabilitation Program
Physical Therapy
During the recovery phase, the patient may progress to weight bearing as tolerated, initially in a
wooden-soled shoe, and then in a comfortable shoe.
Recreational Therapy
Aqua-running, swimming, or bicycling may be continued to maintain physical fitness.
Other Treatment (Injection, manipulation, etc.)
Albisetti et al reported their experience with diagnosing and treating stress fractures at the
base of the second and third metatarsals in young ballet dancers from 2005-2007.[17] Of 150
trainee ballet dancers, 19 had stress fractures of the metatarsal bone bases. All of the dancers
were recommended to rest, but external shockwave therapy (ESWT) was also used in 18 and
electromagnetic fields (EMF) and low-intensity ultrasonography was used in 1, with good
results in each case.[17]
Albisetti advised the best approach to metatarsal stress fractures is early diagnosis with clinical
examination and radiologic studies such as x-ray and MRI. The investigators also noted ESWT
led to good results, with a relatively short time of rest from the patients' activities and a return
to dancing without pain.[17] However, further study is warranted given the small study size and
that all but one of the young dancers received ESWT.
Maintenance Phase
Rehabilitation Program
Physical Therapy
The patient may be allowed to gradually return to his or her sport with a slow build-up in
intensity and duration, with regular rest intervals. No more than a 10% increase in intensity or
duration should be allowed from week to week. Any pain recurrence should prompt a rest
period, followed by resuming the activity at a lower level.
Recreational Therapy
The patient may resume running with a slow increase in duration and intensity of the workouts
(ie, no more than a 10% increase in intensity or duration per week).
Surgical Intervention
Patients who continue to have painful nonunion fractures are candidates for surgical
intervention.[16] A fibrous nonunion that is not painful and does not limit the patient's
functional abilities may be left alone.
Consultations
21. An orthopedic surgeon should be consulted in cases in which there is radiographic evidence of
nonunion or prolonged pain.
XII. BIBLIOGRAPHY:
Website:
Metatarsal Stress Fracture Treatment & Management
Author: Andrew D Perron, MD; Chief Editor: Sherwin SW Ho, MD
http://emedicine.medscape.com/article/85746-treatment
Metatarsal fractures. http://www.patient.co.uk/health/Metatarsal-Fractures.htm,
http://bonesfracture.com/metatarsal-fracture-treatment-metatarsal-bone-fracture-
surgery-fractured-metatarsal-healing-time-recovery-types-symptoms-and-causes/,
http://www.physioroom.com/injuries/ankle_and_foot/metatarsal_fracture_full.php
http://www.daviddarling.info/encyclopedia/M/metatarsal.html
http://www.nlm.nih.gov/medlineplus/ency/article/001224.htm
Books:
Nursing Care Plan 8th Edition by Marilyn E. Doenges, Mary Frances Moorhouse & Alice
C. Murr
PDR Nurse’s Drug Handbook 2008 Edition by George R. Spratto and Adrienne L.
Woods
Fracture reduction. Textbook of Medical-Surgical Nursing Twelvth Edition by
Brunner and Suddadrth Vol. 2.
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