GRAND CASE PRESENTATION

BERIOSO, MAY ANN

BSN-III
DE GUIA, JAMESON
DIMAIN, MITZI
DUMANGAS, AIZLE MAY
ECLARINAL, LYKA MAE
EMPENO, MANUEL
MARGATE, CHRISTINA
REYES, MARY ANN
TABILE, JOHAN ROSS
TORREGOZA, EDUARD JOHN
VELASCO, BRYAN LENNARD
VILLANUEVA, RHODORA
YAP, ESLYM
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A Case Analysis on
Radius and Femur
Fracture
2
Aizle May Dumangas
Student Nurse

3
General Objectives:
The student nurse will able to
gain adequate knowledge,
attitude and skills in caring
for a patient who has
fracture towards optimum
level of functioning.

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 d u c tio n
I ntro
Johan Ross Tabile
Student Nurse

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Anatomy and Physiology

May Ann Berioso

Student Nurse

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Anatomy and Physiology

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Cortical Bone

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Cancellous Bone

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Bone marrow

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Yellow bone marrow Red bone marrow

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Cells and Remodelling

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Extracellular

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Types

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Development

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Intra membranous ossification

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Endochondral ossification

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 Femur
- The femur,
femurs, or femora
or thighbone is
the only bone in
the thigh.

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Upper extremity

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body of the femur (or shaft)

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Lower extremity of femur

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 Radius (bone)
The radius or radial
bone is one of the
two large bones of
the forearm, the
other being the ulna.

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Body of the radius

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 Joint surfaces
The carpal articular surface The articular surface

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Bone healing

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Biographical Data

Manuel Empeno
Student Nurse

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Nursing History

Jameson De Guia
Student Nurse

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Cousin Brother Patient X

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Patterns of Functioning

Mitzi Dimain
Student Nurse

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Health Perception/ Health Management Pattern

Angkalusugan ay
importante at
mahalagasabuhay as
verbalized by the
client. He scaled his
health as 8/10.

37
 Nutritional-Metabolic Pattern
3 meals a day.

Vegetable

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 Food Allergy

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 Elimination Pattern

5-6 times a day 1,500ml water

normal urine color 40
Activity Exercise Pattern

Upon admission

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 During admission

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 Sexuality-Reproductive Pattern

Circumcised at the age of 9.

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Cognitive-Perceptual Patten
????

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 Role-Relationship Pattern

.Napakaimportante ng pamilya
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Self-Perception/ Self-Concept Pattern

Industrious Supportive
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Coping-Stress Pattern

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Values-Belief Pattern
Naniniwala ako
kay God kasi bigla
akong nabuhay
nung nadisgrasya
ako.Binigyan pa
Niya ako ng
pagkakataon.

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 Sleep-Rest Pattern
Upon Admission

During Admission

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Eslym Yap
Student Nurse

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Head

51
Hair

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Face

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Eye

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Ear

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Nose

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 Mouth
Lips

Tongue

Teeth
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 UPPER EXTREMETIES:
Arms

hands

fingernails
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 CHEST APPEARANCE
Breast Appearance

Heart

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ABDOMEN

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 Elimination
Intake

Output

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BACK AREA

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 LOWER EXTREMITIES
Legs

knees

feets
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 GENERAL APPEARANCE
Skin
Gait
Personal Hygiene
Pain Scale
Neuro-
Logy system

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Laboratory Procedures

Lyka Mae Eclarinal

Student Nurse

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Bryan Lennard Velsco
Student Nurse

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Drugs Study
Eduard John Torregoza
Student Nurse

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 Generic
name
Omeprazole

Brand
name

Prilosec, Omesec,
Zegerid

70
 dose

40 mg IV OD

Classificatio
n

Proton pump
inhibitors (PPI)

71
 Indication

stomach and esophagus

problems (such as acid
reflux, ulcers).

Mechanism
of action

works by inhibiting the

action of the proton pumps
and this reduces the
production of stomach acid.
72
 contraindicatio
n
Patients who is hypersensitive to
this drug.
Nursing
Responsibilit
y
It should be given before meals.
Report severe headache,
worsening of symptoms , fever,
chills , severe diarrhea.
73
 SIDE
EFFECTS

Headache
Nausea
Vomiting
Diarrhea
stomach pain
Constipation
Fever
or cold symptoms such as stuffy
nose
Sneezing
sore throat.
74
Generic
name

Ceftriaxone

Brand
name

Rocephin

75
 dose

1gm IV q 8 hrs. (ANST)

Classificatio
n

ANTIBIOTIC
(Third Generation /
Cephalosporin) Broad
Bacteriocidal
76
 Indication
Susceptible bacterial septicemia, acute
bacterial otitis media, lower respiratory tract,
UTIs, skin and skin structure, bone and joint,
pelvic inflammatory disease (PID), intra
abdominal infections, meningitis,
uncomplicated gonorrhea

Mechanism of
action
Agent that acts by inhibition of
bacterial cell wall synthesis
77
 contraindicatio
n
Contraindicated in patients
hypersensitive to drug or other
cephalosporin.
Nursing
Responsibilit
y
Before giving drug ask the patient if
he or she allergic to cephalosporin.
Obtain specimen for culture and
sensitivity test before giving first dose.

78
 SIDE
EFFECTS

Rash
Diarrhea
Nausea
Vomiting
upset stomach
blood clots
dizziness
Headache
pain or swelling in your tongue
alump where the medicine was
injected
sweating
79
Generic
name

Ketorolac

Brand
name

Toradol
Acular and
Sprix
80
 dose

30mg IV q 6 hrs

Classificatio
n

Nonsteroidal
anti-inflammatory
drug (NSAID)
81
 Indication

Short term treatment of

moderately severe pain.

Mechanism
of action

Inhibits prostaglandin
synthesis
82
 contraindicatio
n
Hypersensitivity
Asthma (why)
GI upset
Nursing
Responsibilit
y
Dont forget to assess first the patient before
administering this drug: know the history
Administer with food to minimize GI
adverse reaction
Report any signs of itching, swelling in the
ankles, sore throat, easy bruising
83
 SIDE
EFFECTS

upset stomach
mild nausea or
vomiting
diarrhea constipation
mild heartburn
stomach pain
dizziness headache
drowsiness
sweating
84
 Generic
name

Cefuroxime
Brand
name

Ceftin, Zinacef

85
 dose

500mg 1 cap TID

Classificatio
n

ANTIBIOTIC
(Second Generation / Cephalosporin)
Broad
Bacteriocidal
86
 Indication

Treating bacterial infections (sinus, skin,

lung, urinary tract, ear, and throat)

Mechanism of
action
Cephalosporin stop or slow the growth of
bacterial cells by preventing bacteria from
forming the cell wall that surrounds each
cell. The cell wall protects bacteria from
the external environment and keeps the
contents of the cell together. Without a
cell wall, bacteria are not able to survive.
87
 contraindicatio
n
Contraindicated in patients hypersensitive to
drug or other cephalosporin.

Nursing
Responsibility
Before giving drug ask the
patient if he or she allergic to
cephalosporin.
Obtain specimen for culture
and sensitivity test before
giving first dose.
88
 SIDE
EFFECTS

Dizziness
Headache
Drowsiness
itching/swelling,
Rash
Nausea
Vomiting
abdominal pain
stomach upset
gas,
headache,
itching or rash 89
 Generic
name

Mefenamic Acid

Brand
name

Ponstel
90
 dose

500mg 1 cap TID

Classificatio
n

Non-steroidal anti-
inflammatory
drug (NSAID) with anti-
inflammatory, antipyretic
and analgesic activities.
91
 Indication

Mild to moderate pain.

Mechanism
of action

Inhibits prostaglandin
synthesis
92
 contraindicati
on
Hypersensitivity
Peptic Ulcers
Kidney Disease (why
Nursing
Responsibilit
y
Assess the patient Before
administering drug
Administer with food to minimize
GI adverse reaction
Discontinue drug promptly if
diarrhea, dark stools, hematemesis,
or rash occur and do not use it again.
93
 SIDE
EFFECTS

stomach pain
nausea
vomiting
heartburn
constipation,
diarrhea,
rash,
dizziness 94
Generic
name

Ibuprofen

Brand
name

Advil Motrin
Nurofen
95
 dose

200mg q 8 hrs

Classificatio
n

Nonsteroidal anti-
inflammatory drug
(NSAID)
96
 Indication
Used in the management of mild to
moderate pain, inflammation and
fever. These symptoms arise when
the body releases chemicals called
prostaglandins.

Mechanism
of action

Inhibits prostaglandin
synthesis
97
 contraindicatio
n
Hypersensitivity to this drug
GI upset
Asthma
Nursing
Responsibilit
y
Assess the patient first before
administering drug.
Tell patient to take with meals
or milk to reduce adverse GI
reactions
Monitor for some side effects.
98
 SIDE
EFFECTS

upset stomach, mild

heartburn, nausea,
vomiting;
bloating, gas,
diarrhea, constipation;
dizziness, headache,
nervousness;
mild itching or rash;
99
 Generic
name

Metoclopramide
Brand
name

Reglan

100
 dose

10mg IV at 8am

Classificatio
n

ANTI EMETICS /
DOPAMINETIC BLOCKER

101
 Indication

Prevention and reduction of nausea and

vomiting.

Mechanism
of action

action of metoclopramide is due to its

antagonist activity at D2receptors in the
chemoreceptor trigger zone in the
central nervous system this
action prevents nausea and vomiting
triggered by most stimuli 102
 contraindicatio
n
Parkinsons Disease
patients with known sensitivity or
intolerance to the drug
Nursing
Responsibility
Evaluate for the medication
effectiveness.
Assess for allergy to this drug.
Have Phentolamine readily available
incase of hypertensive crisis. 103
 SIDE
EFFECTS

diarrhea,
dizziness,
drowsiness
headache
nausea,
vomiting,
restlessness,
malaise,
trouble sleeping
(insomnia) 104
 Generic
name

TRAMADOL

Brand
name

Ultram

105
 dose

50mg SIV q 6hrs

Classificatio
n

NARCOTIC ANALGESIC

106
 Indication

Moderate to severe
pain

Mechanism
of action

Inhibits reuptake of
serotonin and
norepinephrine in CNS.
107
 contraindicatio
n
Patients hypersensitive to this drug and other
opoid. Those with acute intoxication with
alcohol.
Nursing
Responsibilit
y
Assess type, location, and intensity of
pain before and 2-3 hr (peak)
after administration.
Assess BP & RR before andperiodically
duringadministration.
Respiratorydepression has not
occurredwith recommended doses.
Assess previous analgesic. 108
 SIDE
EFFECTS

Nausea,
constipation,
Dizziness
headache
drowsiness
vomiting

109
 Generic
name

Dextromethorphan
Brand
name

Robitussin DM

110
 dose

50mg IV q 8 hrs x 6 dose

Classificatio
n

NON NARCOTIC
ANTITUSIVE
111
 Indication
Indicated for the temporary
symptomatic relief of nonproductive
cough due to minor throat and
bronchial irritation occurring with
colds or inhaled irritants.

Mechanism
of action
Suppresses the cough reflex
by a direct action on the
cough center in the medulla
of the brain. 112
contraindicatio
n
Asthma
Mucus or phlegm with cough
Nursing
Responsibilit
y
Monitor for dizziness and
drowsiness, especially when
concurrent therapy with
CNS depressant is used.
113
 SIDE
EFFECTS

Vomiting.
Drowsiness.
Nausea.
Dizziness.
Diarrhea.
Constipation.
Nervousness.
Restlessness
114
 Generic
name

Diphenhydramine

Brand
name

Benadryl

115
 dose

50mg IV now

Classificatio
n

ANTIHISTAMINE
116
 Indication
Temporarily relieves these symptoms due to
hay fever or other upper respiratory
allergies: runny nose. sneezing. itchy, watery
eyes

Mechanism
of action

Is an inverse agonist of the histamine

H1receptor. It is a member of the
ethanolamine class of antihistaminergic
agents. By reversing the effects of
histamine on the capillaries, it can reduce
the intensity of allergic symptoms. 117
 contraindicatio
n
Hypersensitivity to
antihistamines
Nursing
Responsibilit
y
Drug causes drowsiness.
Avoid activities requiring
mental alertness
Inform the client that this
drug may cause dry mouth.
118
 SIDE
EFFECTS

Sedation
Tiredness
Sleepiness
Dizziness
disturbed coordination
constipation
dry mouth/nose/throat,
difficulty urinating
upset stomach
119
 Generic
name
Paracetamol
Brand
name

Tylenol
Calpol
Panadol
120
 dose

300 mg IV every 4
hours PRN

Classificatio
n

ANALGESIC /
ANTIPYRETIC
121
 Indication

treatment of pains of all kinds

(headaches, dental pain,
postoperative pain, pain in connection
with colds, post-traumatic muscle pain.

Mechanism
of action
Through the produce of analgesia by
blocking pain impulse by inhibiting
synthesis of prostaglandin in CNS
that synthesized pain receptor to
stimulation 122
 contraindicatio
n
Patients hypersensitive to this drug.
Patients with long term alcohol use
because it cause hepatotoxicity in these
patients.
Nursing
Responsibilit
y
Assess the patient pain and
temperature before the therapy.
It can be taken on an empty
stomach. Before or after meals.
123
 SIDE
EFFECTS

Rash
Ulticaria

124
Nursing Care
Plan
Rhodora Villanueva
Student Nurse

125
126
127
Christina Margate
Student Nurse

128
129
130
Mary Ann Reyes
Student Nurse

131
Medicines

132
Wound Care

133
Self-care

134
Physical therapy

135
Foods

136
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