epiphyseal separation

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PHILIPPINE ORTHOPEDIC CENTER

NURSING AFFILIATION 2011

COLEGIO de DAGUPAN

College of Nursing

S.Y. 2010-2011

EPIPHYSEAL SEPARATION

OF THIRD DISTAL TIBIA

Submitted by:

DEMATAWARAN, Charmaine B

Submitted to:

Mrs. Edita M. Placido


2/21

I N T R O D U C T I O N


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P A T I E N T S P R O F I L E

y Name:

QGYUINNE TRYSTANNE AMONGOy Age:

9 years old

y Birth Date:

August 5, 2001

y Sex:

Male

y Civil Status:

Single

y Nationality:

Filipino

y Religion:

Roman Catholic

y Address:

y 42 A Batis St. Bayanihan Drive St., Maligaya

Project 8 Quezon City

y Date of Admission:

y April 9, 2011

y 12 Midnight

y Chief Complaint:

Pain on right ankle

y Diagnosis:

y Epiphyseal Separation D/3 Tibia Salter Harris II

y Intervention:

Closed Reduction Planning

y Case No. :

y 641277


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y Course in the Ward:

y Patient was admitted and underwent application

of cast with pins

y Condition on Arrival:

y Good

y Doctor-in-charge:

Dr. Moreno


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BRIEF CLINICAL HISTORY AND PERTINENT

Physical Examination

Patients foot was caught in the spike of the bicycle wheel.

Brief History

Seven (7) days prior to consultation the patients right foot got

stucked inside the bicycle wheel.

Time of Incident

3:00 P.M.

Place of Incident

Road (Batangas)

HISTORY OF PRESENT ILLNESS

Eight (8) days prior to consult, patient foot was caught in a bicycle wheel.

Patient sought consent in nearby hospital and was advised daily wound care.

Persistence of pain prompted consult.

PAST MEDICAL HISTORY

Completed vaccination(+) previous hospitalization for Dengue

FAMILY HISTORY

(+) Diabetes Mellitus mother side

(+) Hypertension (HPN) mother side

(+) Asthma mother side

PERSONAL & SOCIAL HISTORY

Primary care given by his grandmother.


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PHYSICAL EXAMINATION

General-Survey

Patient is conscious, coherent not in distressed.

Laboratory Findings

Laboratory exam was unremarkable

Examination of Systems

Pink palpable conjunctival anicteric sclera

(-) Refraction

AP normal heart breath

(-) Murmur

Abdomen soft, non-tender

Other Physical Examination Findings

(-) Abrassion medial aspect right ankle

Discharge:

y April 13, 2011

y 4:00 P.M.


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L A B O R A T O R Y R E S U L T

Component

Hemoglobin Mass 124

Hematocrit 0.41Leucocyte Count 7.90

Differential Count

Segmenters 0.72

Lymphocytes 0.22

Monocytes 0.03

Eosinophils 0.03

Platelet Count: 459

Coagulation Studies

PTT 12.1

% Activity 107

INR 0.88

Activated PTT: 24.3

Blood Type: A

RH Typing: (+)

Indices

MCV 81

MCH 25

MCHC 31

RBC Morphology:

ESR Westerngren Method

Children:


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Clotting Time

(Lee & White) 6 00

Bleeding Time

(Ivys Method) 2 30

________________________________________________________________

U R I N A L Y S I S

Physical Characteristics

Color Yellow

Transparency Hazy

Reaction 6.0

SpecificGravity 1.030

Cells

RBC 0-2/hpf

Renal Cells Few

Epithelial Cells Few

Pus Cells 4-6/hpf

Bacteria Few

Crystal

Amorphous Few

Calcium Oxalate Few

Chemistry Test

Sugar NegativeProtein Trace


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ANATOMY & PHYSIOLOGY


10/21

D R U G S T U D Y

Drug Name Route/Dosage TherapeuticAction

AdverseReaction

Contraindication

Brand Name:

Amikin

GenericName:

AmikacinSulfate

Serious infections

caused by sensitive

strains of

Pseudomonas

aeruginosa,

Escherichia coli,

Proteus, Klebsialla,

or Staphylococcus.

Adults and

children:

15mg/kg/day

I.M. or I.V.

infusion, in

divided doses q

8 to 12 hours.

Neonates:

Initially, loading

dose of10mg/kg I.V.;

then 7.5 mg/kg

q 12 hours.

Inhibits protein

synthesis by

binding directly

into the 30S

ribosomal

subunit;

bactericidal.

CNS:

neuromuscular

blockade

EENT: ototoxicity

GU: azotemia,

nephrotoxicity,

possible increase

in urinary

excretion of casts.

Musculoskeletal:

arthralgia

Respiratory:

apnea

y Contraindicated

patients

hypersensitive t

drug or other

aminoglycoside

y Use cautiously

patients with

impaired renal

function or

neuromuscular

disorders, in

neonates and

infants, and in

elderly patients


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12/21


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AdverseReaction

Contraindication

Brand Name:

NalbuphineHydrochloride

GenericName:

Nubain

Moderate to

severe pain

Adults:

For a pts. of

about 70kg

{154lb}, 10 to

20 mg S.C.,

I.M., or I.V. q 3

to 6 hours,

p.r.n.

maximum, 160

mg daily.

Unknown. Binds

with opiate

receptors in the

CNS, altering

perception of and

emotional

response to pain.

CNS: H/A,

sedation,

dizziness, vertigo,

nervousness,

depression,

restlessness,

crying, euphoria,

hostility,

confusion,

unusual dreams,

hallucinations,

speech d/o.,delusions.

CV: HPN,

hypotension,

tachycardia,

bradycardia.

EENT: blurred

vision, dry mouth.

GI: cramps,

dyspepsia, bitter

taste, N/V,

constipation,

biliary tract

y Contraindicated in

pts. hypersensitive

to drugs.

y Use cautiously in

pts. with history of

drug abuse and in

those with emotional

instability, head

injury, increased

intracranial

pressure, impaired

ventilation, MIaccompanied by

N/V, upcoming

biliary surgery, and

hepatic or renal dse.

Alert: Certain

commercial

preparations contain

Na metabisulfate.

w

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spasms.

GU: urinary

urgency.

Respiratory:

respiratory

depression,dyspnea, asthma,

pulmonary

edema.

Skin: pruritus,

burning, urticaria,

clamminess,

diaphoresis.

w


15/21


Adverse Reaction Contraindication

Brand Name:

Ancef

GenericName:

CefazolinSodium

Perioperative

prevention in

contaminated

surgery

Adults:

1 g I.M. or

I.V. 30 to 60

minutes

before

surgery; then

0.5 to 1 g

I.M. or I.V. q6 to 8 hours

for 24 hours.

In operations

lasting

longer than 2

hours, give

another 0.5-

1g dose I.M.

or I.V.

intraoperativ

ely. Continue

treatment for

First-generation

cephalosporin

that inhibits cell-

wall synthesis,

promoting

osmotic

instability;

usually

bactericidal.

CNS: headache,

confusion, seizure.

CV: phlebitis,

thrombophlebitis with

I.V. injection.

GI:

pseudomembranous

colitis, nausea,

anorexia, vomiting,

diarrhea, glossitis,

dyspepsia,

abdominal cramps,anal pruritus, oral

candidiasis.

GU: genital pruritus,

candidiasis, vaginitis.

Hematologic:

nuetropenia,

leucopenia,

eosinophilia,

thrombocytopenia.

Skin: maculopapular

and erythematous

rashes, urticaria,

y Contarindicated

in patients

hypersensitive

to drug to other

cephalosporins.

y Use cautiously

in patients

hypersensitive

to penicillin

because of the

possibility of

cross-sensitivitywith other beta-

lactam

antibiotics.

y Use cautiously

in breast-

feeding women

and in patients

with a history of

colitis or renal

insufficiency.


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3 to 5 days if

life

threatening

infections is

likely.

pruritus, pain,

induration, sterile

abscesss, tissue

sloughing at injection

site, Stevens-

Johnson syndrome.


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NURSING CARE PLAN

Assessment Explanation of theProblem

Planning/Objectives Intervention

Nursing Dx:

Risk for

infection

Individuals normally

have defenses that

protect the body from

infection. These

defenses can be

categorized as

nonspecific and specific.

Nonspecific defenses

protect the person

against allmicroorganisms,

regardless of prior

exposure. Specific

(immune) defenses, by

contrast, are directed

against identifiable

bacteria, viruses, fungi,

or other infectious

agents. Persons at risk

for infection are those

whose natural defense

mechanisms are

After 2 hours of

nursing

intervention the

patient will gain

knowledge in

infection control

as evidenced by

discussing the

wound care.

yPatient will attain timely

healing of wounds or

lesions.

yPatient will exhibit

methods, lifestyle

changes to uphold safe

environment.

yPatient will keep a safe

aseptic environment.yPatient will recognized

Infection promptly to

allow for early

management.

yPatient will remain free

Independent:

1. Establish rappoirt

2. Teach patient to wash

hands often,especially

before toileting,

before meals and before

and after administering

self-care.

3. Talk about

necessitate for sufficient

nutritional intake.

4.Discuss to patients the

following signs of

infection - redness,

swelling, increased pain,

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inadequate to protect

them from the inevitable

injuries and exposures

that occur throughout

the course of living. An

infection happens whenthere is an invasion of

body tissue by

microorganisms and

when they grow there.

Such microorganism is

called an infectious

agent. If the

microorganism produces

no clinical evidence of

disease, the infection is

called asymptomatic or

subclinical.exogenos

sources.

of infection, as

manifested by normal

vital signs and

nonexistence of

purulent drainage from

wounds, incisions, andtubes.

yPatient will take part in

behaviors to decrease

risk of infection.

yPatient will verbalize

awareness of individual

causative or risk factors.

or purulent drainage on

the site and fever.

5. Demonstrate and

allow return

demonstration of woundcare.

6. Monitor visitors or

staff for signs of

infection. Manage visitor

adherence to protocol as

necessary.

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Dependent:

1. Give

antimicrobial/antib

iotic drugs as

ordered.

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in

mm

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2. Grant for infection

precautions or

isolation as

necessary.

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H E A L T H T E A C H I N G

epiphyseal separation

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