West Visayas State University COLLEGE OF NURSING La Paz, Iloilo City

A CASE STUDY IN PHILOSOPHY ON THE CONTEXT OF BEHAVIORAL NURSING CARE AND REHABILITATION

Presented by: Jandi M. Nietes

CASE TITLE:
INTRODUCTION Ronel, a 25 year- old motorcycle driver is married to his 5- month pregnant wife whom happens to conceive their first child. Working as a motorcycle driver, he transports people and products from one place to another. Though he works at least 6 hours a day, Ronel finds no physical difficulty aside from hand pain after a day of hectic driving. He has never been hospitalized nor had any life- threatening accidents and allergies to any known food and drug. He is neither hypertensive nor diabetic and had no remarkable ailment notable prior to hospitalization.

2 hours prior to hospitalization, Ronel was cruising the national highway at Sara, Iloilo going to his work place while riding his motorcycle. Out of nowhere, an 8wheeler truck was directly on a collision course with him. He attempted to avoid the direction but it was so fast that it managed to bump his motorcycle at its sides. With the force of the truck, his motorcycle was thrust towards the sidewalk. Immediately, he felt a jolt of pain throughout his extremities with greater intensity on his right upper leg. Bystanders rushed towards him and rushed him immediately to the West Visayas State University Medical Center at La Paz Iloilo City. X- ray studies revealed a fractured femur on his right thigh.

PROBLEM DIAGNOSIS/DESCRIPTION

Fractures are breaks or discontinuations of a normal bone from its original structure caused by excessive force or stress on the bone which vary from type of bone fragmentation. Ronels case reveals a medical diagnosis of close, complete, transverse, thigh fracture on the 3rd right femur. Closed bone fracture results from nonperforated skin. Complete bone fracture is the complete detachment or separation of bone structures from one another. Transverse fractures are caused by fracture forming a right angle from the long axis of a bone. (Seeley, et al. 2007).

Fractures cause a varying degree of pain: (a) due to the nerve endings that surround bones containing pain fiber become irritated when the bone is broken or bruised, (b) broken bones bleed and the blood and associated swelling causes pain and (c) muscles that surround the injured area may go into spasm when they try to hold the broken bone fragments in place, and these spasms may cause further pain

Priority nursing diagnoses reveals impaired walking related to loss of bone integrity. The assessment criteria include Ronels inability to walk upright independently, difficulty in maintaining a standing position, pain radiating on the right thigh of the injured leg and use of crutches.
Diagnosis further reveals self- care deficit: bathing, dressing and toileting related to skeletal injury. Assessment criteria include inability to bathe, eliminate and dress independently or without assistance of significant others, and as well as pain felt on injured leg while bathing, eliminating, and dressing self. Another priority nursing diagnosis includes disturbed sleep pattern related to post- operative pains. Assessment criteria includes disturbed night time sleep from pain felt on site of operated leg, numbness of leg felt upon long periods without changing body position and difficulty in moving leg independently while lying on bed.

NURSING INTERVENTIONS Independent nursing interventions for impaired walking includes the following:

(1) demonstration of the proper use of crutches and as well as the different manner of gait or walking to provide a safe and efficient means of travelling, (2) scheduling of walking exercises as tolerated by Ronel with resting periods to reduce fatigue and promote condition, (3) encouraging active and passive exercises with an incrementing level of difficulty daily to increase stamina and endurance to develop muscle tone and prevent unwanted or further worsening of condition, (4) providing safety measures in walking and sleeping in order to avoid accidents and damages which may further injure the patient, (5) daily monitoring of condition and development of walking in order to establish level of improvement.

Independent nursing interventions for self- care deficit: bathing, toileting and dressing includes the following:
(1) promoting participation in bathing, toileting and dressing to develop patients confidence in doing assisted tasks until he is able to perform them independently, (2) scheduling of activities accordingly in order to prepare the patients mind set and psychologically allow the patient to adjust, (3) promoting good communication while assisting the patient in doing dependent tasks to build rapport and assess clients psychosocial well- being, (4) providing privacy preserves the clients self- worth and dignity from others, (5) providing client sufficient time to finish task performed, (6) daily monitoring of self- development until client is fully capable of performing bathing, toileting and clothing independently.

Nursing interventions for disturbed sleeping pattern includes the following:

(1) managing environmental factors such as room lighting, temperature and other nuisances, (2) allowing the patient to change position every after 4 hours to prevent numbness and promote healthy blood circulation, (3) warm compressing the site of pain before bedtime to relieve pain and discomfort, (4) providing a back massage to promote client comfort and prepare him for sleep, (5) educate client for the normal physiologic reasons for the occurrence of pain, numbness and slight redness on the site of operation (6) administer medications for pain management as ordered by physician.

Patients who are under recovery for fractures require a special diet rich in specific nutrients for the process of bone remodelling to commence. Protein is needed by the body for the formation of new tissues necessary for the process. Elements such as iron is important for the formation of blood cells which aid by increasing red blood cells that supply oxygen to the tissues where the bone is repairing itself. Calcium, being the main component for the structural integrity of bones is also essential by having it absorbed into the bone cells known as osteoblasts (Seeley, et al. 2007).

Prior to discharge, Ronel is given the option of attending therapies for walking. His leg was casted with plaster and screwed with 2 metal bolts to aid in the faster recovery and to prevent the dislodgement of the fractured femur. He was arranged to use crutches for at least 6 months to prevent excessive pressure to be exerted into the area of injury. Ronel was prescribed to take the antibacterial drug cephalexin to prevent staphylococcal bone infections and mefenamic acid to reduce pain felt due to the bodys adjusting physiologic process to the new material holding his femur together. Patients condition has been better and was given the order may go home.