25336117 Case Pres Fracture

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FRACTURE

BSN III-BGROUP 1

Mariano Marcos StateUniversity

College of HealthSciencesDEPARTMENT OF

NURSINGBatac 2906, Ilocos Norte


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I. PERSONAL DATA


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Name: Ino Dulloog

Address: Baay, Batac, Ilocos Norte

Age: 56Hospital number: 579012

Date and place of birth:July 27, 1953

Civil status: Married

Religion: Roman CatholicEducational attainment: Highshool graduate

Occupation: Farmer

Date of admission: December 26, 2009

Admitting diagnosis: Fracture Close Tibia- fibulaproximal 3RD

Admitting physician: Dr. Rasos and Dr. Agustin

Final diagnosis: close tibia-fibula fracture-proximal 3rd


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Physiologically, the musculoskeletal system enableschanges in movement and position. The bony skeletonprovides support, protection and movable parts whilemuscles facilitate movement.

Structures of the Muscular System

MusclesThey make up 40-50% of body weight.

Skeletal Muscles They are considered as the living motor which

provides active movement of the skeleton. These attaches to bones of the skeleton. Exert force on bones or skin and moves them. They are attached to the bones of the skeleton by very

thin extensions of fascia or by tendons. Fascia are thinsheets of fibrous connective tissue. Tendons makestrong connections to bones.

Thousands of their fibers are bundled together by


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Function:

Produces movement- mobility of thebody as a whole reflects the activityof skeletal muscles, which areresponsible for all locomotion and

manipulation.

Maintaining posture

Stabilizing jointsGenerating heat- Generation of

body heat is a byproduct of muscle

activity. As ATP is used to power


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The skeletal system consists of two types oconnective tissue: cartilage and bone. Each of thisconnective types consist of living cells, nonlivingintercellular protein fibers, and an amorphous (shapeless0

ground substance. The tissue cells are responsible forsecreting and maintaining the intercellular substances inwhich they are housed. These substances provide thestructural characteristics of the tissue.

Two main types of intercellular fibers are found inskeletal tissue: collagenous and elastic. Collagen is aninelastic and insoluble fibrous protein. Because of itsmolecular configuration, collagen has great tensilestrength; the breaking point of collagenous fibers found in

human tendons is reached with a force of several hundredkilograms per square centimeters. Fresh collagen iscolorless, and tissues that contain large numbers ofcollagenous fibers generally appeared white. The collagenfibers in tendons and ligaments give these structure their

white color. Elastin is the major component of elastic fiber


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Bone

The bone is a rigid connective tissue consisting of bonecells, calcified intracellular substances, bone marrow, and itschief organic constituents in collagen which is in CHON. It has

a strength of cast iron. 2/3 of the adult bone is inorganiccalcium salts(Ca-phosphate and Ca-carbonate). Ca Phosphateis the primary ingredient for proper bone density. It has its ownblood vessel, lymphatic vessel and when fully developed has20% water, organic material (CHON) of 30%-40%, Ca

salts(inorganic substance)Ca phosphate and Ca carbonate of40%-50%.

Cartilage

Cartilage is a firm but flexible type of connective tissue

consisting of cells and intercellular fibers embedded in anamorphous, gel like material. It has a smooth and resilientsurface and a weight-bearing capacity exceeded only by thatof bone. It is a type of dense connective tissue that canwithstand considerable tension. It is a semi opaque and has no

nerve for blood supply of its own. Because cartilage has noblood vessels, this tissue fluid allows the diffusion of gases,


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Types of Bones

According to Distribution of Spaces Between Cells

Compact bone- dense and with closely spaced lamellae-

concentric layers of mineral deposits. Spongy/ Cancellous bone- with wide space lamellae. Arrange

in irregular network of thin plates of bones called trabeculae.

According to Shape

Long bones- length is greater than with. Found inextremities; in femur wich is the longest bone of the body.

Short bones- equal in with and thickness but irregular inshape. (e.g. carpal and tarsal)

Flat bones- thin and flat composed of thin layers of compactbones and spongy bone. (e.g. cranial bone, ribs, scapula andsternum)

Irregular bones- bones not classified in others.(e.g.vertebrae, hip bone,mandible)

-


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Anatomy of Bones

Gross Anatomy of Long Bones

1. Diaphysis/Shaft- main portion of long bones; body of bones.Hollow cylinder of compact canal, which is field with bone,contains medullary yellow bone marrow in adult located bet.Epiphysis.

2. Epiphysis- the end of the diaphysis composed of spongy bonecovered by thin layer of compact bone, contains red marrow ,

where some RBCs are manufactures during childhood andadolescence; erythropoietin activity in the adult mainly occurs inflat bones and vertebrae.

3. Metaphysis- it is made up of epiphyseal plate(growth plate) andthe adjacent bony trabeculae.

4. Growth plate- a thick flat plate of hyaline cartilage that providesthe framework for construction of the cancellous bone tissuewithin the metaphysic.

5. Articular cartilage- covers the epiphysis. Thin layer of cartilagecovering epiphysis and forms articulation with another bones.

6. Endosteum- membrane that line in the inner cavities of bones. It


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Types of Bone Cells

Osteogenic cells- found mostly in the deeplayer of periosteum and in bone marrow.Only bone cell that undergone mitosis anddevelop to an osteoblast during stress andhealing. Unspecialized cells derived from

mesenchymeOsteoblast- cell responsible in bone

formation; bone forming, repairing andbuilding. Usually found in the growingportion s of bones, including theperiosteum. Secretes matrix mineralizedground substance called osteoids.

Osteocytes mature osteoblasts. The


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FUNCTIONS OF BONE AND THE SKELETALSYSTEM

Support- serves as the structural framework forthe body by supporting soft tissues andproviding attachment point for the tendons ofmost skeletal muscle

Protection- protects many internal organs frominjury

Assistance in movement- because skeletalmuscles attach to bones, when muscles

contract, the pull on bones. Together, bones andmuscles produce movement

Mineral homeostasis- bone tissue stores severalminerals, especially calcium and phosphorus. Ondemand, bone releases minerals into the blood


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Blood cell production- within certain bones, aconnective tissue called red bone marrow producesred blood cells, white blood cells, and platelets, aprocess called hemopoiesis. Red bone marrowconsists of developing blood cells, adipocytes,fibroblasts, and macrophages within a network of

reticular fibers. It is present in developing bones ofthe fetus and in some adult bones, such as pelvis,ribs, breastbones, backbones, skull, and ends of thearm bones and thighbones

Triglyceride storage- triglycerides stored in the

adipose cells of yellow bone marrow are animportant chemical energy reserve. Yellow bonemarrow consists mainly of adipose cells, which storetriglycerides, and a few blood cells. In the newborn,

all the bone marrow is red and is involved inhemo oiesis. With increasin a e, much of the bone


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FRACTURES

Fracture, or discontinuity of the bone, is themost common type of bone lesion. Normal bone

can withstand considerable compression andshearing forces and, to a lesser extent, tensionforces. A fracture occurs when more stress isplaced on the bone than it is able to absorb.

A fracture of the tibia or fibula is a fracture ofone of the two bones of the lower leg. Thisfracture can occur anywhere between the kneeand ankle. The tibia is the most commonly

fractured long bone. Only the tibia bears weight,but fracture of the tibia is often associated withfracture of the fibula because force istransmitted via the interosseous membrane that

connects the two bones. Isolated fracture of theroximal or mid-shaft ortions of the fibula is
http://www.mdguidelines.com/fracturehttp://www.mdguidelines.com/fracturehttp://www.mdguidelines.com/fracturehttp://www.mdguidelines.com/fracture


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The tibia is the major bone of the lowerleg, commonly referred to as the shinbone. Tibia fractures can occur from manytypes of injuries. Tibia fractures come indifferent shapes and sizes, and eachfracture must be treated with individual

factors taken into account. Whendetermining treatment of a tibia fracture,the following factors must be considered:

Location of the fracture,

Displacement of the fracture, Alignment of the fracture, Associated injuries, Soft-tissue condition around the

fracture, and

C


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Causes

Sudden Injury- most common fractures;the force causing the fracture may bedirect, such as a fall or blow, or indirect,such as a massive muscle contraction ortrauma transmitted along the bone.

Fatigue or stress fractures- fatiguefracture results from repeated wear on abone; stress fractures in the tibia may beconfused with shin splints, a nonespecific term for pain in the lower leg fromoveruse in walking and running. Stressfractures result from repetitive force (eg,

from overuse); they occur most often in

Cl ifi ti


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ClassificationFractures are classified accdg. to location(proximal, midshaft, distal), the direction or

fracture line (transverse, oblique, spiral),and type (comminuted, segmental,butterfly, or impacted).Location

A long bone is divided into three parts:proximal, midshaft, and distal. A fracture ofthe long bone is described in relation to its

position in the bone.Types The type of fracture is determined by itscommunication with the external

environment, the degree of break in

Cl ifi ti f f t b


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Classification of fracture bycommunication with theenvironment

Open or compound fracture- whenthe bone fragments have brokenthrough the skin.

Closed fracture- no communicationwith the outside skin.

It can be further divided into: Grade 1-wound smaller than 1 cm with minimalcontamination. Grade 2- wound largerthan 1 cm with moderate

contamination. Grade 3- wound larger

Cl ifi ti b tt


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Classification by pattern

oblique-occurs at an oblique angle to the shaft.

Linear- a fracture that is parallel to the bone's

long axis.

Transverse- a fracture that is at a right angle tothe bone's long axis.

Spiral- a fracture that seems to spiral around thebone like a stripe on a candy cane.

Classification by appearance

Compression- common on the vertebrae.Comminuted- produced by high energy forces

(motor vehicle acccidennts) wherein bonefragments are crushed.

Greenstick- one side of the bone is broken and


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Cli i l M if t ti


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Clinical Manifestations

Deformity- strong muscle spasm maycause bone fragments to override;

therefore alignment and contour changesoccur. The deformity varies accdg. to thetype of force applied, the area of the bone

involved, the type of fracture produced,and the strength and balance of thesurrounding muscles.

Swelling- due to localization of serousfluids at the fracture site andextravagation of blood in to adjacenttissue.

Muscle spasm- involuntary muscle

HEALING


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HEALING

Five stages of the healing process

hematoma formation- occurs during the first 48 to 72

hours after fracture. It develops as blood from torn vesselsin the bone fragments and surrounding soft tissue leaksbetween and around the fragments of the fractured bone.

cellular proliferation- the bone-forming cells, multiplyand differentiate into a fibrocartilaginous callus. Cellular

proliferation begins distal to the fracture, where there isgreater supply of blood.

callus formation- fracture becomes sticky asosteoblasts continue to move in and through the fibrin

bridge to help keep it firm. This stage usu. occurs duringthe third to fourth week of fracture healing.

ossification- the final laying down of bone; safe toremove the cast

remodeling- resorption of the excess bony callus that

DIAGNOSIS AND TREATMENT


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DIAGNOSIS AND TREATMENT

Diagnosis is the first step in the care offractures and is based on history andphysical manifestations.

A splintis a device for immobilizing themovable fragments of a fracture. Furthertreatment depends on the generalcondition of the patient, the presence ofassociated injuries, the location of the

fracture and its displacement, andwhether the fracture is open or closed.

Three ob ectives for treatment of

Immobilization immobilization prevents


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Immobilization- immobilization preventsmovement of injured parts and is the single mostimportant element in obtaining union of the fracturefragments. Immobilization can be accomplished

through the use of:o External devices:

Splints- metal splints or air splints may be usedduring transport to a health care facility as atemporary measure until the fracture has beenreduced and another form of immobilizationinstituted

Casts- commonly used to immobilize fractures ofthe extremities; they often are applied with a

joint in partial flexion to prevent rotation of thefracture fragments.

External fixation devices - pins or screws areinserted directly into the bone above and below

Traction pulling force is applied to an


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Traction- pulling force is applied to anextremity or part of the body while acounterforce, pulls in the opposite direction;used to maintain alignment of the fracture

fragments and reduce muscle spasm. Manual traction- steady, firm pull that is

exerted by the hands Skin traction- pulling force applied to the

skin and soft tissues Skeletal traction- pulling force applied

directly to the boneo Internal fixation devices inserted during

surgical reduction of the fracture.

Preservation and Restoration ofFunction- exercises designed to preservefunction, maintain muscle strength, and reduce

joint stiffness should be started early. After the

fracture has healed, a program of physical

The goal of rehabilitation is t


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The goal of rehabilitation is tdecrease pain and restore full function tothe lower limb. Modalities such as heat

and cold can be used to control pain andedema. Rehabilitation emphasizesrestoring full range of motion, strength,

proprioception and endurance of alladjacent joints while maintainingindependence in all activities of dailyliving, if not contraindicated by thefracture stability. Gait training usingappropriate assistive devices is indicatedto promote independent ambulation. The

individual may progress from walker to

PREDISPOSING FACTORS


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PREDISPOSING FACTORS

1.Presence of underlying diseases- those with lowbone density( osteoporosis), bone tumors, bonecancers or a brittle bone disease called osteogenesisimperferta results to bone fragility.

2.Age- highest injury rate occurs in persons betweenages 15-24 because they are extremely active andparticipates in contact sports. In elderly, as a result ofdegenerative process, bones become fragile leading toeasier breaking of bones.

3.Sex- Injury rates are high for 15 - 24 years old males.The risk in males is 2.5 times greater than females, dueto the involvement of males in hazardous activities.However, during the menopausal stage, females havean increased risk to fracture because during this stage,ovaries stop producing estrogen, which normally

protects against bone loss.

5 Diet low in Ca Phosphorous and Vit D


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5.Diet low in Ca, Phosphorous, and Vit. D-Calcium and phosphorous are necessary forstrengthening the bones as well as

maintenance of density. Vitamin D on the otherhand hastens the reabsorption of Calcium. Ifthe bones are insufficient of Ca, Phosphorous,and Vit. D, bones will become less dense and

weaker, causing it to break easily.6.Lifestyle- A sedentary lifestyle contributesto the moving of calcium out from the bones tothe blood causing a decrease in the bone

composition and strength. The bones will bedepleted with calcium and demineralizationprocess will occur making the bones to becomespongy and may gradually deform and fractureeasily. Vehicular accident, fall, and even

RISK FACTORS


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RISK FACTORS

1.People who work with heights.These people are athigh risk for fracture because of the nature of their job.

2. People who engages in high risk sports. Thesepeople are at high risk because the sports they playthemselves is already risky and that it endangers their lifetoo.

OMPLICATIONS

1. Arterial damage- may consist of contused, thrombus,lacerated, severed or spastic arteries.

arteries may also be constricted by casts that are tootight.

Indications:

- absent pulse -continuing blood loss

- swelling - pain

- pallor - poor capillary feturns

2 Shock- laceration of large vessels and can cause bleeding


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2. Shock laceration of large vessels and can cause bleeding3.Compartment syndrome- fascia lining each compartment(compartments are made of muscles, bones, nerves andblood vessels) can not expand. Therefore any increase inthe compartment size due to bleeding or swelling will placepressure on pliable structures within the compartment, suchas muscles, nerves and blood vessels. Compartmentsyndrome can also develop if external pressure is applied,such as from a cast or tight dressing.

S/S:-uncontrollable pain - coolness-weak active movement - pallor-paresthesia earliest sign - absent peripheral pulses-

latest sign

4. Volkmans Ischemic Contracturecrippling condition of the hand or forearm arises from acomplication of a fracture around the elbow joint or forearmbonesif not relieved, pressure causes ischemia and results in a

permanent, stiff, claw-like deformity of the arm and handS/S:

5 Fat Embolism occurs 24 48 hours after


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5. Fat Embolism- occurs 24- 48 hours afterthe injury

develops when broken bones liberate fat

from the marrow cavity that embolizes tothe lungs and blood vessels which thencauses occlusion.

S/S:

-altered mental status

- tachypnea

- tachycardia

- hypoxemia

6. Infection


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FACTORS THAT AFFECT BONEHEALING

1. Age- older people heal slower thanyounger people

2. Diabetics- decrease rate of healingbecause of blood viscosity therefore

there is sluggish circulationwhich decreases the blood supply intothe area

3. Infection


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III. FAMILY BACKGROUND


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Ino Dulloog

The family is a group of persons united by


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The family is a group of persons united byties of marriage, blood or adoption,constituting single household, interacting

and communicating with each other in theirrespective social roles and creating andmaintaining a common culture. It iscomposed of people who are emotionally

involved with each other and live in closegeographical proximity.

The client is an extended family since the

mother of Ino is with them. They are 9 in thefamily: Mang Ino(56) and his wife MangAda(54). They have 4 sons namely Aldo(32),Emy(31), Enie(29), and Nickanor(21), 2daau hters Eve(29) and Ev (24), and the

Responsibilities at home are divided amongt the family


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espo s b es a o e a e d ded a o g e a ymembers. During the visit, there were no conflicts observedbetween the family. However, like any other family,misunderstandings between them do arise sometimes. Theysolve it by open and peaceful conversations. In addition, Lola

Maria also gives pieces advice to them so that they can avoidthe same problem will not occur again. The family helps eachother in doing household chores for the familys welfare. Interms of rearing practices, both parents admitted that theyseldom hit their child since they think that the child would just

aggravate his tantrums. As much as possible they talk anddeal with the child in a well-mannered way.

The family owns a 200 sq. meter of land which they usefor farming. The crops they harvest here are not sold butprimarily for family consumption. They also have a vegetablegarden at their backyard wherein they harvest tomato andchili which is also for their own benefit. They also own a deepwell situated about 5 meters which they use for bathing,cooking and drinking purposes. To ensure its potability, thebarangay health workers place chlorine at the deep well and

they cover it during rainy seasons.


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In relation to the family income,they earn about Php 6,000/month. Inoworks a a farmer and stressed that,they have two cropping seasons with

each season they are able to get 20sacks of palay and each sack of palayis worth about Php 1800. Therefore,the family earns Php72,000 annually,making up Php 6000/ month. Thefamily also receives foreign aid fromtheir daughter in law amounting to Php

2000. Evy, Inos daughter, who works

Monthly Allocation of Family


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Monthly Allocation of FamilyExpenses

All in all the family allocates Php 9000


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All in all, the family allocates Php 9000for their monthly budget.

The breakdown of their monthly expenses

is as follows. The family allocates Php 2000for food which includes meat, poultryproducts and groceries like soy, cooking oil,

fish paste, fish sauce and etc. They usuallybuy their foods and groceries at the publicmarket Batac. Php 1000 is allotted for theirelectricity and Php 800 is for the gasoline of

their kuliglig while Php of 50 is apportionedfor their fertilizer and Php 300 is for theshellane they are using. They also allocatePp 300 for miscellaneous that includestoiletries and medicines. A fixed amount of


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IV. HEALTH HISTORY

Family Health History


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y yBased from the genogram, the hereditary disease that runs

in the family is hypertension. According to Ino, his motherJuana has a hypertension which was diagnosed when she was50 y/o during her check up in the RHU. Eve and Nickanor alsohave hypertension which was both diagnosed during theconsultation in a medical mission. Medicines were prescribedto them during the check-up however, due to financialrestrictions at that time, they were not able to avail the saidmedicines and they eventually lost the prescriptions. Thefamily manages their hypertension by increasing their intakeof green leafy vegetables and chewing garlic and reducingintake of high-cholesterol foods.

Gregorio, Inos father, had arthritis and died at the age of

80 because of a heart attack. According to Juana, Gregoriowas not diagnosed to have a heart problem because theynever went to a doctor for any consultation although he hadexperienced recurring chest pains before he died. She alsoclaimed that Gregorio engages himself to cigarette smoking,

consuming 5-10 sticks per day. He also drinks 2-3 bottles ofliquor for 1 week for relax and fatiguerelieve fatigue. Juana, 96


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Marciano and Venabentura, Inos siblings, died at the agesof 62 and 57 respectively. Marciano had cataract and diedbecause of a heart attack. He consumes 1 pack ofcigarette/day. Venabentura died because he was stabbed bytheir neighbor due to a misunderstanding during a drinkingsession in their neighborhood. Nicholasa, 60 y/o and Ino is 56,y/o, have never experienced symptoms of hypertension. OnlyNickanor and Eve inherited hypertension.

The family is experiencing common illnesses such as cough,colds, fever and headache. These illnesses were managedthrough over-the-counter drugsSolmux, 1 cap every 4 hoursfor adults and Ambroxol, 1 tsp every 4 hours for the children forcough, Neozep for colds, 1 tab every 4 hours both for children

and adults. For fever, the children take Paracetamol 1 tsp every4 hours and 1 tab every 4 hours for adultsboth until the feveris gone. The family also considers the use of herbal medicinessuch as the use of oregano decoction and drinking of calamansi

juice for cough. But when the condition of a family member is

not relieved by the management aforementioned, they go to ahealth center for consultation. The famil oes to the RHU

The family members also suffered from chicken pox and


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The family members also suffered from chicken pox andmanaged it by avoiding the intake of poultry products dueto their belief that eating such foods would only contributeto the itchiness of the skin. They also practice wearing

black clothes to lessen the itchiness as claimed by Juana. They also suffered from measles and mumps. Theymanaged their mumps by applying anil until it heals.

With regards to the familys immunization, Ada claimedthat she was able to submit her children for immunizations

and vaccinations. But when asked about the yellow cards,she said that she cannot remember where she kept it andshe is not sure if all their children had a completeimmunization.

As with their vices, Gregorio used to smoke everyday

and could consume 5-10 sticks of cigarette. They firmlybelieved that his cigarette smoking caused him to sufferfrom a heart disease that eventually led to his death. All ofInos children are fond of carbonated beverages and theyusually consume 2 liters in a day. Their usual activities are

doing household chores and farming. Ino admits that he


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C. Present Health History

It was the 26th of December at around 1:00 pm, thepatient and his youngest son went to plow their landwith their kuliglig. Suddenly the patient felt thekuliglig was moving wrongly to the left but still he

kept on going so that they could finish earlier andthen the kuliglig turned and dropped down on his leftlower leg. His son came running to his side andhelped him push away the kuliglig. When they finally

pulled his leg out, his leg just bent downwards and hefelt much pain. His son carried him home and rushedhim to the hospital. He was admitted at the MMMHand MC with an admitting diagnosis of fractured tibia-fibula proximal 3rd.

V DEVELOPMENTAL DATA


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V. DEVELOPMENTAL DATAErik Eriksons Developmental Theory

Erik Erickson, a German Psychoanalyst, proposed thepsychosocial theory of development. This theory states that

life is composed of sequence of levels of achievement andeach stage indicates a certain task to be achieved. Hebelieves that maturation of bodily functions is linked withexpectations of society and culture in which the person lives.A successful resolution would indicate a support to the

persons ego while a failure to resolve the crises is damagingto the ego. When needs are met, a healthy or positivepersonality is developed and the individual moves to thefuture stages with particular strength; but if not, anunhealthy outcome occurs which will influence future

relationships.According to Ericksons developmental theory, the

primary developmental task of the adulthood is to achieveGenerativity. It is the willingness to care for and guideothers. Generativity is being creative and productive and it

can be achieved with their children and the others through

A negative resolution would be evident by the person who islfi h d lf d h i bl h hi


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selfish and self-centered. The person is unable to share hispotential to others which can serve as their guidance. This coulddevelop due to a failure in the earlier tasks which resulted to thedifficulty in achieving a higher developmental task.

In the case of our client, Ino is able to achieve thedevelopmental task completely. Positive indications of achievingthe task include productivity and concern for others. Ino isproductive in the sense that he can raise his 6 children well andthat they have enough food to eat for their everyday living. Healways see to it that all of them could eat their meals thrice a dayand that he could support and sustain all his childrens needs andoffer some help to his daughter who is already married but has ahard time raising her own family financially. Ino is also concernedto what is happening to his friends and neighbors as well as hisrelatives. He sees to it that he is able to talk to his friends and

relatives even just once every two weeks to know how they aredoing. He also attends wake and burials as a way of sympathizingto the bereaved family. He would also show his love and concernto his family by always talking to them and asking how the dayhas been and by telling that he loves them.

Analysis: Based on the cues presented, Ino was able to


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Robert Havighurts theoryRobert S. Havighurst theorized that there are

developmental task one must accomplish all throughout life.He believes that learning is basic to life and that peoplecontinue to learn throughout life. According to him,developmental task is a task which arises at or about a certainperiod in the life of an individual, successful achievement ofwhich leads to his happiness and to success with later tasks,while failure leads to unhappiness in the individual,disapproval by the society and difficulty with later task.Ino is 56 y/o and is under the middle age period. The followingare his tasks:

Achieving adult civic and social responsibility Establishing and maintaining an economic standard

of living Assisting teenage children to become responsible &

happy adults

Developing adult leisure-time activities Relating oneself to ones spouse as a person

Ino loves to mingle or interact with other people and


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Ino loves to mingle or interact with other people andhe is always attentive and conversant to what the otherperson is saying. With regards to his socialresponsibilities, he always participate programs in their

barangay like Clean & Green, and Fiestas. When itcomes to economic standard of living, Ino together withhis wife is involved in decision making. Ino sees to itthat he could provide for the basic needs of his family

although there are 7 of them living together in thesame roof. He raised his children properly andresponsibly. Inos leisure time is to go and have sometalks with his friends and neighbors after his work.Whenever he faces any problem, he always talks to his

wife and asks for pieces of advice on how to solve hisproblems. At his age, he already accepted thephysiologic changes that he undergoes right now likehis declining strength and he had already adjusted to

the aging of his mother.

VI. LEVELS OF

COMPETENCIES


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COMPETENCIES


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Analysis: There was a significant change in thepatients physical competency due to the

immobility and weakness brought about by hiscondition. He was not able to perform the activitiesof daily living since his health requires ample rest.


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Analysis: There is a significant change in our patientsemotional level of competency during his hospitalizationas brought about by the fear and anxiety of the result ofhis condition. His condition also affects his way of

communicating to others which makes him difficult to


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Analysis: There is a significant change in Inos social levelof competency because he cannot attend the barangaygatherings before as he used to as brought about by his

condition because he easily gets tired and this hinders him


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Analysis: There is no change in the mental competencyof the client. Although he was a bit disturbed about hiscondition, it did not alter his mental competency sincehe remained to be oriented and mentally competent by

answering appropriately all the questions asked to him.


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Analysis: There was no alteration with regards tospiritual aspect of Ino except for not being able toattended the Sunday mass during the

hospitalization. His faith in God got strongerdes ite of his illness because he sees it as a


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VII. PATTERNS OF

FUNCTIONING


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Analysis: There is no change in the amountof food intake of the patient before theillness and during the hospitalization

(before surgery) because the patient wasordered for a full diet. However, there is adecrease in the amount of food intake onthe night before the surgery until the

evening of the day of the surgery becausethe patient was ordered NPO post-midnight.This is indicated for the purpose ofdecreasing the workload of the stomachtherefore preventing the stimulation of the

vagal nerve which increases thehydrochloric secretion, thus neutralizing orbuffering hydrochloric acid, inhibiting acidsecretion, decreasing the activity of pepsin,and to eradicate helicobacter pylori. Thenthe atient was ordered soft diet because

Before the accident thepatient drinks 6 8

Before Surgery:


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11/26/10

patient drinks 6-8

glasses of water a day

approximately 1380-

1840cc and drinks 1

bottle of Gin shared

with his sons thrice

every week.

During hospitalization

before surgery the

patient drinks 4-6

glasses of water a dayapproximately 1000-

1200cc.

After Surgery:

During hospitalization

after surgery the

patient was on NPO

then 4-6 glasses a day

after the surgery.Analysis: there is a change in the amount of fluid intake ofthe patient before the illness and during the hospitalizationbecause the patient was ordered for NPO before the surgery.Then he resumed his usual drinking pattern a day after thesurgery for he is already in full diet.


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Before Surgery:


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11/26/10

During

hospitalization

before surgery he

did not eliminate.

After Surgery:

During

hospitalization aftesurgery he

eliminated once.

The color w

brown and it was

hard and dry in

consistencyAnalysis:There is a decrease in the frequencyof bowel elimination due to a decrease in

activity and a change in the environment.

Before Surgery:

D i h i li i b f


63/64

11/26/10

During hospitalization before

surgery the patient slept at 10

pm with a length of 3-6 hours. At

night before he slept he prayed.He took naps every afternoon.

After Surgery:

During hospitalization after

surgery the patient slept at10pm with a length of 3-6 hours.

At night before he slept he

prayed. He took naps every

afternoon.

Analysis: There is a change in thesleeping pattern of the patient in termsof duration because of the change in

environment (noisiness), pain and

Before illnessthe patient

Before Surgery:


64/64

the patient

takes a bath 2

times a day at

6:30-7:30 in themorning and

dusk using

shampoo and

soap thus

having a

complete bath.

During hospitalization before

surgery the patient takes a bath

once a day at 8:00-9:00 in the

morning using sponge and

soap, classified as partial bed

bath.

After Surgery:During hospitalization afte

surgery the patient takes a bath

once a day a 9:00-10:00 in the

morning using sponge and

soap, classified as partial bed

bath.Analysis: There is a change in thefrequency and type of bathing pattern of

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25336117 Case Pres Fracture