ASSESSMENT

DIAGNOSIS

BACKGROUND KNOWLEDGE Bacterial contamination (direct inoculus, introperative contamination, haematogenous)

PLANNING

INTERVENTION

RATIONALE

EVALUATION

Subjective: sumasakit po ang kaliwang binti ko as verbalized by the patient. Objective: -yellowish purulent discharge on the surgical wound at the left femur. -Pain localized to their one or both legs. -Paresthesias, numbness, and or weakness of the lower extremities. -Intensity of pain 6 score out of 10.

Risk for infection related to post surgical Incision.

After 30mins. Of nursing intervention the patient will be able to prevent the spread of Bacterial adhesion to bone infections to or implant other part of the body. infection Intensity 6 out Chronicity of 10 to 5 out of 10 and will be able to improved physical mobility.

1. Encourage the patient to discuss problem that may contribute to pain. 2. Advise the patient to rest in bed in firm mattress.

- To assess infection site.

-To provide immobilization and relieve strain on back muscles, ligaments and other structures. -To relax muscles spasms and relieve discomfort. - To minimized strain on back muscles.

3. Apply heat or ice as prescribed.

The goal was met as evidence by the patient manifested good facial grimace and the reduce of yellow purulent discharge on the surgical wound at the left femur.

4. Keep pillow between flexed knees while inside lying position. 5. Administer medication as Dr.s prescribed. 7. Advice the client to avoid prolong sitting.

-To reduce pain.

-Prolonged sitting can lead to back or neck pain.

ASSESSMENT

Backgorund knowledge

DIAGNOSIS

PLANNING

INTERVENTION

RATIONALE

EVALUATION

Subjective: Hindi ko Maigalaw Ang Aking mgabinte as verbalize by the patient Objective: -Limited range of motion -Decreased muscle strength -Inability to move purposefully Vital Sign Taken and recorded T:36.8 c P:87 R:18 BP:100/70

-Trauma -fracture of the Left leg -Bleeding from damage ends of bone &sorrounding tissue -stimulates inflammatory response -increase capillary permeability -fluid & cellular exudation -pain -impaired physical mobility.

Impaired mobility related to loss of integrity of bone structures

After 2-3 days of nursing intervention the patient will regain or maintain mobility at the possible level.

-Determine the diagnosis that contribute immobility -Assist the client to reposition self on a regular schedule -Support affected body part using pillows

-To Identify contributing factors

-To promote optimum level of function and prevent complication -To maintain position and function and reduce risk of pressure ulcers -It promote wellbeing and maximize energy production

After 2-3 days of nursing intervention the patient was able to regain or to maintain mobility at the highest possible level

-Encourage adequate intake of fluids/restriction foods

Assessment Subjective: Hindi ko alam kung paano ko aalagaan yung anak ko pagkatapos ng aksidente, ganito pa kalagayan ko, as verbalized by the client. Objective: y Verbalization of perceived inadequacy y Helplessness y Anxiety/ uncertainty y Failure to assume role

Diagnosis Alteration in parenting related to vehicular accident as evidenced by verbalization of frustration of role

Planning After 8 hours of nursing interventions, the patient will begin to verbalize positive feelings towards her present condition, identify outside resources for support and develop realistic plans in initiating active role in childs care. y

Interventions Establish rapport and check vital signs Assess patients parenting skill level taking into account the clients physical strengths and weaknesses Encourage expression of feelings y

Rationale To gain patients trust and cooperation

Evaluation After 8 hours of nursing interventions, the patient had been able to verbalize positive feelings towards her present condition, identify outside resources for support and develop realistic plans in initiating active role in childs care.

To identify areas of need for skill training and information on which to base plan for enhancing parenting skills Identification of feeling promotes understanding of self and enhances connection between the nurse and the patient Enhance commitment to plan, optimizing outcomes and develop client independence in decision-making To serve as appropriate support system in child care

Assist client in developing plan of action and set goals to achieve desired outcomes

y y Assist patient in identifying and contacting appropriate outside resources

Name of Drug Brand Name: Penicillin G

Dosage , Frequency, Route

Indications

Contraindications

Mechanism of Action y LongActing (repository) form in aqueous or oily vehicle. Destroyed by penicillinas e. Because slow onset, a soluble penicillin is often administer ed concomita ntly for fulminating infections. y

Adverse Effect

Nursing responsibilities

Injection Percutaneous infiltration anaesthesia Adult: 350-600 mg Generic using 0.25 or 0.5% Name: solutions. Wycillin Injection Peripheral nerve block Classification: Adult: 500 mg procaine Antibiotic HCl as a 0.5%, 1% or Peniciilin 2% solution. Up to 1 g may be used.

Natural penicillins remain the drugs of choice for a variety of bacteria, including group A beta-hemolytic streptococci, many gram positive anaerobes, spirochetes, gram negative aerobic cocci, and some gram negative aerobic bacilli. Generally, if a bacteria is susceptible to a natural penicillin, either penicillin G or V is preferred for treating that infection as long as adequate penetration of the drug to the site of the infection occurs and the patient is not hypersensitive to penicillins.

Use in newborns due to possible sterile abscesses and procaine toxicity. Injection into or near an artery or nerve. IV use.

Hypersensitivity reactions, N&V, diarrhea, abdominal cramps, thrush/ yeast infection, sore mouth/ tongue.

Assessment y Note reasons for therapy, onset, characteristics of signs and symptoms, any drug allergies, other therapies trialed, culture results. Administration y Shake multiple-dose vial thoroughly to ensure uniform suspension before injection. y Use a 20-gauge needle and aspirate immediately after withdrawing medication from the vial. Aspirate to check that the needle is not in the vein. y Administer into two sites if dose is large or available in muscle mass is small. Do not massage the site. y Inspect visually for particulate matter and discoloration prior to administration. y Store from 2-8C. DO NOT FREEZE!

Name of Drug

Dosage, Frequency. Route Dosage: Adults, children, older infants : 15mg/kg/day in two to three aqually divided dose. Route: Intramascular (preffered) , IV Frequency: Every 8-12 hours for 7-10 days

Indications

Contraindications

Mechanism of Action

Adverse Effect

Nursing Responsibilities

Brand Name: Amikacin Sulafete

Generic Name: Amikin

Classificatio n: Antibiotic, Aminoglycos ide

Amikacin is indicated for the treatment of infections of: central nervous system, urogenital system, biliary and intestinal tracts, skin and subcutaneous tissues, intraabdominal infections, pneumonia, caused by Gramnegative microorganisms, secondary infections after combustion, bacterial septicemia, infections of the bones and joints (caused by sensitive to Amikacin microorganisms).

Hypersensitivity to aminothiol compounds or mannitol. Use in hypotensive or dehydrated clients, in those on antihypertensive therapy that cannot be terminated for 24hr and in clients receiving chemotherapy for malignancies that are potentially curable.

Its spectrum is somewhat broader that of other aminoglycosides, including Serratia and Acinetobacter species, as well as certain staphylococci and streptococci. Effective against both penicillinaseand nonpenicillinase producing organism.

Arthralgia, oliguria, hearing loss/ deafness, loss of balance, apnea, acute muscle paralysis.

ASSESSMENT y Note reasons for therapy; C&S results. Assess weight, hydration status, U/A, renal and LFTs. y Obtain audiometric assessment with high doses or prolonged use. y Note vestibular dysfunction; monitor for 8th CN impairment r/t elevated peak drug levels. ADMINISTRATION y add 500mg vial to 200 ml of sterile diluents (NSS or D5W). y administer over 30-60 min period for adults. y Administer to infants in prescribed fluid amount over 1-2hr. y Potency not affected if solution turns light yellow.

Name of Drug Brand Name: Acetaminoph en

Dosage, Frequency, Route Adult: 0.5-1 g 4-6 hrly as necessary. Max: 4 g daily. Child: Neonate 28-32 wk post menstrual age: 20 mg/kg as a single dose then 10-15 mg/kg 8-12 hrly (max 30 mg/kg daily in divided doses); neonate >32 wk post menstrual age: 20 mg/kg as a single dose then 10-15 mg/kg 6-8 hrly (max 60 mg/kg daily in divided doses); child 1-3 mth: 30 mg 8 hrly (max 60 mg/kg daily in divided doses); 3 mth-1 yr: 60-120 mg 4-6 hrly (max 4 doses in 24 hr); 1-5 yr: 120-250 mg 4-6 hrly (max 4 doses in 24 hr); 6-12 yr: 250-500 mg 4-6 hrly (max 4 doses in 24 hr).

Indications

Contraindications

Adverse Effect

Mechanism of Action

Nursing Responsibilities

Generic Name: Paracetamol

Classificatio n: Analgesic Antipyretic

The preparation is indicated in diseases manifesting with pain and fever: headache, toothache, mild and moderate postoperative and injury pain, high temperature, infectious diseases and chills (acute catarrhal inflammations of the upper respiratory tract, flu, small-pox, parotitis, etc.).

Paracetamol should not be used in hypersensitiv ity to the preparation and in severe liver diseases. Renal insufficiency, anemia. Clients with cardiac or pulmonary disease are more susceptible to acetaminoph en toxicity.

Nausea, allergic reactions, skin rashes, acute renal tubular necrosis. Potentially Fatal: Very rare, blood dyscrasias (e.g. thrombocytop enia, leucopenia, neutropenia, agranulocyto sis); liver damage.

Decrease fever by a hypothalamic effect leading to sweating and vasodilation and inhibits the effect of pyrogens on the hypothalamic heat-regulating centers. Does not cause any anticoagulants effect or ulceration of the GI tract. Antipyretic and analgesic effects are comparable to those of aspirin.

ASSESSMENT y Note reasons for therapy, prescribed dosage and expected outcomes. y With long term therapy, monitor CBC, liver and renal function studies. y Document presence of pain/fever. y Check urine for occult blood and albumin; assess for nephritis. ADMINISTRATION y Do not exceed 4 grams/24 hr in adults and 75mg/kg/day in children. y Do not take for >5days for pain in children, 10days for fever in adults or children without consulting provider. y Take ER product with water; do not crush, chew, or dissolve before swallowing. y Bubble gum flavored OTC pediatric products are available to treat fever or/and pain.