LICEO DE CAGAYAN UNIVERSITY

COLLEGE OF NURSING

NCM104

In Partial Requirements of the course NCM104

SURGICAL WARD

Related Learning Experience

A CASE STUDY ON

Multiple physical injuries secondary to vehicular

accident

Submitted To:

Ma’am Glenda Demafeliz RN, MN

Clinical Instructor

Submitted by:

Xyrex D. Nicolas

BSN-NCM104

FEB 26, 2013

TABLE OF CONTENTS

PAGES

I. INTRODUCTION

A. OVERVIEW OF THE STUDY 2

B. SCOPE AND LIMITATIONS OF THE STUDY 3

C. OBJECTIVE OF THE STUDY 4

II. PROFILE OF THE PATIENT 5

III.DEVELOPMENTAL THEORY 6

IV. HEALTH HISTORY

a.Personal Health History 8

b.History of Present Illness 8

V. MEDICAL MANAGEMENT

a. Medical Orders with Rationale 9

b. Laboratory Results 14

c. Drug Study 16

VI. ANATOMY AND PHYSIOLOGY 22

VII. PATHOPHYSIOLOGY 27

VIII. NURSING ASSESSMENT

a. Nursing System Review Chart 28

IX. NURSING MANAGEMENT

b. Ideal Nursing Management 29

c. Actual Nursing Management 34

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X. EVALUATION AND IMPLICATION 37

XI. REFERRALS AND RECOMMENDATION(HEALTH TEACHINGS) 38

38

XII. PROGNOSIS 40

XIII.BIBLIOGRAPHY 41

I. INTRODUCTION

a. Overview of the Study

Motorcycles are becoming more popular as a means of transportation.

However, per vehicle-mile traveled, a motorcyclist is 37 times more likely to die in a

crash and 9 times more likely to be injured (NHTSA, 2008f). As the motorcycle

itselfoffers almost no protection, the occupant is subject to severe forces similar to

those experienced by an ejected automobile or truck occupant. Head injury is

common, especially in the absence of a helmet. There may be multiple fractures and

large, painful abrasions with imbedded debris (road rash).Before looking at injury

patterns, it is helpful to review some of the physics involved. Newton’s First Law of

Motion states that an object in motion will remain in motion until acted on by another

force. Thus, a vehicle in motion will keep moving until something—a tree, another

vehicle, the brakes, or some other force—causes it to slow down, stop, or change

direction. When such a force is applied, people in the vehicle will continue to move at

the original speed and direction until a force such as the seat belt, the steering wheel,

or the windshield causes them to slow down, stop, or change direction. Even then, the

organs of the body will continue in motion until slowed or stopped by the bones and

other supporting structures within the body.

The forces on the vehicle, the body, and the organs are applied in sequence.

This sequence is rapid if the vehicle strikes a fixed object and much less so during a

controlled stop. If this sequence were to be observed in slow motion, the body and the

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organs would seem to move toward the point of impact. This is important because it

provides clues as to where to look for injury.

Remember that it is not only the change in speed that causes the damage but how fast

the change occurs. Going from 60 mph to a full stop may do no damage if it happens

over a few seconds. But if the change occurs over a few milliseconds, a much greater

force is involved, and it can be deadly. Anything that increases the stopping time will

decrease the forces involved. This is the reason for such safety features as crush zones

in the vehicle’s front end, a collapsible steering column, and the stretch in seat belts.

b. Scope and Limitation of the Study

This study includes the collection of information specifically to the patient’s health

condition primarily to multiple physical injuries secondary to vehicular accident. The

study also includes the assessment of the physiological-emotional status, adequacy of

support systems, and care given by the family as well as other health care providers.

The scope of this study includes:

Data collected via assessment, interviews with the patient and the Wife.

Actual and Ideal problems and its appropriate nursing interventions that would be

applied throughout his stay in the hospital.

Developing a plan of care that will reduce identified predicaments and

complications

Coordinating and delegating interventions within the plan of care to assist patient

Mr. RED to reach maximum functional health.

Further evaluating the effectiveness of nursing interventions that have been

applied to patient Mr. RED entire course of therapy.

The study is limited by the following factors:

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The nursing interventions done to patient Mr. RED are only limited to our

assessment for 2 consecutive dates: January 30, 2013 @4:00p.m (assessment – 1st

visit) and February 6,2013 (2nd visit). Information gathered was limited only to the client

himself, and to his wife. The X – ray result is also not available on the chart. There were

also limitations on the interventions we were only permitted to perform, the time and

distance allotted for our visit only. No interviews were made with the previous

physicians attending to our patient.

c. Objective of the study

At the end of 4 day-care to the patient, I will be able to do the following:

1. Assess and monitor the health status and vital signs of my patients.

2. Identify actual and potential health problems of the patient.

3. Plan for the patient’s care

4. Perform nursing interventions (medications included) effectively and

efficiently

5. Evaluate patient’s response and reaction and

6. Impart health teachings to our patient

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II. PATIENT’S PROFILE

Name: RED

Gender: Male

Age: 37 years old

Birthdate: January 6, 1976

Place of Birth: BUKIDNON

Address: Manolo fortich,bukidnin,

Status: Married

Religion: Roman Catholic

Nationality: Filipino

Height: 5Ft. & 5inches Tall

Weight (present): 65 kg

Educational Attainment: High School Graduate

Occupation: CAA

Income: 3000/month

Chief Complaints: tenderness of face

Admitting Diagnosis: Multiple injuries secondary to vehicular accident.

Admission Date: January 29, 2013

Admission Time: 07:30p.m.

Attending Physician: DRA. Cynthia M. Woo

Hospital: CAMP EVANGELISTA STATION HOSPITAL

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III.DEVELOPMENTAL THEORY

1Erik Erikson Psychosocial Theory

Later Adulthood: 20-45 years old

Ego Development Outcome: intimacy vs. isolation

Basic Strengths: LOVE

This stage takes place during young adulthood between the ages of

approximately 19 and 40. During this period of time, the major conflict centers on

forming intimate, loving relationships with other people.

While psychosocial theory is often presented as a series of neatly defined,

sequential steps, it is important to remember that each stage contributes to the next. For

example, Erikson believed that having a fully formed sense of self (established during

the identity versus confusion stage) is essential to being able to form intimate

relationships. Studies have demonstrated that those with a poor sense of self tend to

have less committed relationships and are more likely to suffer emotional isolation,

loneliness, and depression.

Erikson believed it was vital that people develop close, committed relationships with

other people. Success leads to strong relationships, while failure results in loneliness

and isolation

Robert Havighurst Theory of Developmental Task

Middle Adult (Ages 30-60)

Assisting teenage children to become responsible and happy adults. * Achieving adult

social and civic responsibility. * Reaching and maintaining satisfactory performance in

one’s occupational career. * Developing adult leisure time activities. * Relating oneself

to one’s spouse as a person. * To accept and adjust to the physiological changes of

middle age. * Adjusting to aging parent

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IV. HEALTH HISTORY

a.      History of Present Illness

Sustained injury secondary to Vehicular Accident(motorcycle passenger)

last January 13, 2013, brought to Adela Ty Memorial Hospital, where skull x-ray was

done. Brought to CESH for further evaluation and management.

b. Past Medical History

Client has no known medical history and this is the first time that he was being

hospitalized. He has previous illnesses such as fever, cough and colds but only

managed at home and no consultation was done and no medication were taken.

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V. MEDICAL MANAGEMENT

a. Medical Orders with Rationale

Date/time Doctor’s Order Rationale of Order

01-29-2013

@ 7:30 a.m

Please admit to surgical ward To provide surgical management of the pt.

Please secure consent to care

To provide understanding in the part of the client including significant others for any medical, surgical, and nursing intervention and also for legal documentation purposes.

NPO temporarily To secure the patients’ status while he is under observation for any unusualities and any untoward complications

LABS: CBC with Platelet Count, Blood Typing, Urinalysis, Chest Xray – PAV

To check or evaluate any deviation from normal in blood count, blood typing to check for what type of blood the patient has for possible blood transfusion and urine analysis to check for infection., cxray shows if there are any problems related to the bones and inner organs on the chest

It could also be seen through this lab tests if there is a possible internal bleeding.

Meds:1. Cephalexin 500mg POevery 8 hrs.,

An antibacterial used to treat for bacterial infection/ prophylaxis treatment post operatively.

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3.Mefinamic acid 500mg PO every 8 hrs, with BP Precaution, hold if BP is ≤90/60mmHg.

A non-opiod analgesic for acute to severe pain

Refer accordingly To Inform the attending physicians for any complications and untoward reactions

02-01-13 Continue Meds For continuity of treatment regimen

Ambulate This is to promote blood circulation, to prevent the risk of pressure ulcer

Refer accordingly To Inform the attending physicians for any complications and untoward reactions

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b. Laboratory Results

COMPLETE BLOOD COUNT

Jan 30, 2013 

Test Results Reference Rationale

WBC

RBC

22.9

 

4.30

(5,000-10,000)mm3

 

(4.2-5.0)mm3

Indicates infection; acute stress/trauma

Within normal values

Hemoglobin 11.6 (13.7-16.7)g/dL May indicate bleeding; acute stress/trauma

Hematocrit 34.6 (40.5 -49.7)% May indicate bleeding; acute stress/trauma

Lymphocyte 3.0 (17.4 -46.2 )% Indicates bacterial infections; acute stress/trauma

Platelet count adequate (150,000-450,000) Within normal limit

Blood Typing “B”(+) Blood Type “B” it’s signifies a need for a donor with a blood type “B+”

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URINALYSIS

February 3, 2013

Color: Yellow Proteins: Negative

Clarity : Slightly hazy Glucose: Trace

pH: 6.0 Blood: ++

specific gravity: 1.026

Epithelial Cells: Few Casts:

Pus Cells(WBC): 2.3 Finely Granular: 0 – 1

RBC : 0 – 2 hyaline: 0 – 1

Bacteria: Few Mucus threads: Plenty

Indicates Bacterial Infection in the body and a possible internal bleeding due to the blunt trauma of the chest as evidenced by the presence of blood in the urine.

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c. Drug Study

Generic Name: Cephalexin

Date Ordered: January 29, 2013

Classification: Antibiotic

Dose/Frequency/Route: 500mg PO every 8hrs

Mechanism of Action: This drug binds to one or more of the penicillin-

binding proteins (PBPs) which inhibits the final

transpeptidation step of peptidoglycan synthesis in

bacterial cell wall, thus inhibiting biosynthesis and

arresting cell wall assembly resulting in bacterial

cell death

Specific Indication: Treatment of infections of lower respiratory tract,

urinary tract, skin and skin structures.

Contraindication: Hypersensitivity to cephalosporins.

Side Effects: Nausea, vomiting, diarrhea, stomach pain

Headache, dizziness

Sleep problems (insomnia)

Vaginal itching or discharge.

Nursing Precaution: a. Advise patient to take with meals to enhance absorption.

If tablet must be crushed, mix with food or beverage.

b. Advise patient to maintain normal fluid intake while using

this medication.

c. Instruct patient to report these symptoms to health care

provider: bruising, bleeding, muscle or joint pain.

d. Instruct patient to seek emergency care immediately if

wheezing or difficulty breathing occurs.

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Generic Name: Mefinamic acid

Date Ordered: January 29, 2013

Classification: Non-Opioid Analgesic

Dose/Frequency/Route: 100mg IVTT every 8hrs RTC X24hrs then PRN

Mechanism of Action: Binds to opioids receptors and inhibits the reuptake of norepinephrine and serotonin.

Specific Indication: Moderate to severe pain

Contraindication: Acute intoxication withopioids or psychoactive

drugs

Side Effects: CNS: Sedation, Dizziness, Headache, and Confusion

CV: Hypotension, Tachycardia, Bradycardia Dermatologic: Sweating

Nursing Precaution: Administer with food if GI upset occurs;

Monitor patient response,

Give the drug before the pain becomes

intense

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VI. ANATOMY AND PHYSIOLOGY

THE SKELETAL SYSTEM

Humans are born with over 270 bones, some of which fuse together into a longitudinal axis, the

axial skeleton, to which the appendicular skeleton is attached.

The axial skeleton (80 bones) is formed by the vertebral column (26), the rib cage (12 pairs of

ribs and the sternum), and the skull (22 bones and 7 associated bones). The upright posture of humans

is maintained by the axial skeleton, which transmits the weight from the head, the trunk, and the upper

extremities down to the lower extremities at the hip joints. The bones of the spine are supported by

many ligaments. The erectors spinae muscles are also supporting and are useful for balance.

The appendicular skeleton (126 bones) is formed by the pectoral girdles (4), the upper limbs

(60), the pelvic girdle (2), and the lower limbs (60). Their functions are to make locomotion possible and

to protect the major organs of locomotion, digestion, excretion, and reproduction.

Function

The skeleton serves six major functions.

Support

The skeleton provides the framework which supports the body and maintains its shape. The pelvis, associated ligaments and muscles provide a floor for the pelvic structures. Without the rib cages, costal cartilages, and intercostal muscles, the heart would collapse.

Movement

The joints between bones permit movement, some allowing a wider range of movement than others, e.g. the ball and socket joint allows a greater range of movement than the pivot joint at the neck. Movement is powered by skeletal muscles, which are attached to the skeleton at

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various sites on bones. Muscles, bones, and joints provide the principal mechanics for movement, all coordinated by the nervous system.

Protection

The skeleton protects many vital organs:

The skull protects the brain, the eyes, and the middle and inner ears. The vertebrae protect the spinal cord. The rib cage, spine, and sternum protect the human lungs, human heart and major blood

vessels. The clavicle and scapula protect the shoulder. The ilium and spine protect the digestive and urogenital systems and the hip. The patella and the ulna protect the knee and the elbow respectively. The carpals and tarsals protect the wrist and ankle respectively.

Blood cell production

The skeleton is the site of haematopoiesis, the development of blood cells that takes place in the bone marrow.

Storage

Bone matrix can store calcium and is involved in calcium metabolism, and bone marrow can store iron in ferrotin and is involved in iron metabolism. However, bones are not entirely made of calcium, but a mixture of chondroitin sulfate and hydroxyapatite, the latter making up 70% of a bone.

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VII. PATHOPHYSIOLOGY

DIAGNOSIS: Multiple injuries secondary to vehicular accidentl.

DEFINITION: In medical terminology, blunt trauma, blunt injury, non-penetrating trauma or blunt force trauma refers to type of physical trauma caused to a body part, either injury or physical attack; latter usually being referred as a blunt force trauma. Abdominal blunt trauma is the most common type of trauma attributed from car – to- car collisions, concussion, abrasion, laceration or bone fracturing characterized by severe abdominal pain, tenderness, rigidity, and bruising of the external abdomen. Abdominal trauma presents a

risk of severe blood loss and

PATHOPHYSIOLOGY:

Physical trauma due to vehicular accident

Breakage in skin

tissue damage

bone cannot withstand the outside body

caused breakage of bone

nerve endings that surrounds bone contain pain fibers

these fibers become irritated when bone is broken or bruise

series of bleeding internally or externally

blood is associated to swelling (edema)

swelling causes pain

muscles that surrounds the injured area may go into spasm when they try to hold the broken bone

and these spasm causes further pain

resulting in immobilization of the injured lower extremity

Gender (male)Substance abuse

Driving under influence of drugs and alcohol.Alcohol Drinking

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NURSING SYSTEM REVIEW CHART

Name: RED Date:January 30, 2013

Vital Signs:

Temp:36.6˚ C Pulse:82bpm BP: 110/80mmHg Respiration:17cpm

Tenderness on face

Generalized weakness; restless

Skin dry, warm to touch

Complaints of pain on site scale

of 8/10

Low salt – low fat diet

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IX. IDEAL NURSING MANAGEMENT

NURSING DIAGNOSIS: Infection, risk forRisk factors may include

Inadequate primary defenses; perforation; peritonitis; abscess formation

Invasive procedures,

Possibly evidenced by

[Not applicable; presence of signs and symptoms establishes an actual diagnosis.]

DESIRED OUTCOMES/EVALUATION CRITERIA—PATIENT WILL:Wound Healing: Primary Intention (NOC)

Achieve timely wound healing; free of signs of infection/inflammation, purulent drainage, erythema, and fever.

ACTIONS/INTERVENTIONS

Infection Control (NIC)

Independent

Practice/instruct in good handwashing and aseptic wound care. Encourage/provide perineal care.

Inspect incision and dressings. Note characteristics of drainage from wound/drains (if inserted), presence of erythema.

RATIONALE

Reduces risk of spread of bacteria.

Provides for early detection of developing infectious process, and/or monitors resolution of preexisting peritonitis.

ACTIONS/INTERVENTIONS

Infection Control (NIC)

Independent

Monitor vital signs. Note onset of fever, chills, diaphoresis, changes in mentation, reports of increasing abdominal pain.

RATIONALE

Suggestive of presence of infection/developing sepsis, abscess, peritonitis.

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Obtain drainage specimens if indicated.

Collaborative

Administer antibiotics as appropriate.

Prepare for/assist with incision and drainage (I&D) if indicated.

Gram’s stain, culture, and sensitivity testing isuseful in identifying causative organism and choice of therapy.

Antibiotics given before appendectomy are primarily for prophylaxis of wound infection and are not continued postoperatively. Therapeutic antibiotics are administered if the appendix is ruptured/abscessed or peritonitis has developed.

May be necessary to drain contents of localized abscess.

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NURSING DIAGNOSIS: Pain, acute

May be related to

Presence of wound on the injured part and Presence of surgical incision

Possibly evidenced by

Reports of pain

Restlessness

Autonomic responses

DESIRED OUTCOMES/EVALUATION CRITERIA—PATIENT WILL:

Pain Level (NOC)

Report pain is relieved/controlled.

Appear relaxed, able to sleep/rest appropriately.

ACTIONS/INTERVENTIONS

Pain Management (NIC)

Independent

Assess pain, noting location, characteristics, severity (0–10 scale). Investigate and report changes in pain as appropriate.

RATIONALE

Useful in monitoring effectiveness of medication, progression of healing. Changes in characteristics of pain may indicate developing abscess/peritonitis, requiring prompt medical evaluation and intervention.

ACTIONS/INTERVENTIONS

Pain Management (NIC)

Independent

Provide accurate, honest information to patient/SO.

RATIONALE

Being informed about progress of situation provides emotional support, helping to decrease anxiety

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Keep at rest in semi-Fowler’s position.

Encourage early ambulation.

Provide diversional activities.

Collaborative

.

Administer analgesics as indicated.

Gravity localizes inflammatory exudate into lower abdomen or pelvis, relieving abdominal tension, which is accentuated by supine position.

Promotes normalization of organ function, e.g., stimulates peristalsis and passing of flatus, reducing abdominal discomfort.

Refocuses attention, promotes relaxation, and may enhance coping abilities.

Decreases discomfort of early intestinal peristalsis and gastric irritation/vomiting.

Soothes and relieves pain through desensitization of nerve endings. Note: Do not use heat, because it may cause tissue congestion.

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Anxiety related to threat of Health Status

INTERVENTIONS RATIONALE

Independent:

Explain procedures to be done, equipment and rationale for therapy to patient and family.

Encourage patient to verbalize fears concerning diagnosis and prognosis.

Provide privacy for patient and significant others.

Explain sensations patient will experience before procedures and routine care measures.

Provide for periods of uninterrupted rest and sleep.

Dependent:

Administer antianxiety medications as indicated: alprazolam, diazepam, lorazepam, flurazepam.

Increasing knowledge assist in alleviating fear and anxiety.

Accurate information about the situation reduces fear, strengthens nurse-patient relationship and assist patient to deal realistically with the situation.

Allows needed time for personal expression of feelings; may enhance mutual support and promote more adaptive behaviors.

Predictability and information can decrease anxiety for patient.

Conserves energy and enhances coping abilities.

Promotes relaxation/rest and reduces feelings of anxiety.

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Actual Nursing Management

1.

S “sakit ang akung samad” as verbalized by the patient.

O facial grimace, guarding, restlessness, , pain scale

rated at 8/10

A Acute pain .

P

Short term:

At the end of 4hours the patient’s pain will be reduced

into a tolerable level from 8/10 to 6/10.

I

Provided with comfort measures such as fanning or

removed clothings near at bedside.

Provided with diversional activity e.g talking with

the patient.

Encouraged patient to verbalized concerns

Instructed not to move/touched the affected part.

Administered Tramadol 100mg IVTT every 8hrs

Round the clock

E At the end of 4hrs, the patient’ was able to verbalized

tolerable level of pain rated 6/10

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2.

S -

O -

A Risk for infection related to surgical incision

PAt the end of 30 minutes the patient will verbalize

understanding on the importance of wound cleaning and

preventing infection.

I

Provided universal precaution e.g. handwashing.

Provided daily wound dressing

Encouraged to dry wound and change dressing

aseptically

Taught proper wound dressing

Encouraged proper hygiene

Instructed to take medication cephalexin 500mg I

cap TID religiously

E After 30 minutes of nursing intervention, patient was able

to verbalize understanding on the importance of a clean

and proper wound dressing.

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3.

S “kanus-a kaha ni matangtang ning tahi sir?

O- Anxious/restlessness- Expression of fear- Preoccupied

A Anxiety related to change in health status.

P

At the end of 1 hour, the client will be able to minimize anxious behavior.

I

1. Spent times with the client.- Non- care related time spent with anxious patient

builds trust and reduces tension2. Allowed client to express feelings verbally

- This may allow patient to identify anxious behaviors and discover source of anxiety

3. Provided a comfortable stress free environment.- To relieve anxiety

4. Taught client relaxation technique- These measures can restore psychological and

physical equilibrium5. Provide privacy for patient and significant others.

- Allows needed time for personal expression of feelings; may enhance mutual support and promote more adaptive behaviors.

- 6. Provided treatment information on an ongoing basis.

E Goal met. At the end of 1 hour, the client has been able to minimize anxious behavior.

X. EVALUATION AND IMPLICATION25

During the initial assessment, patient Mr. RED was in a dire condition, sustaining

serious injuries. The incident will surely be a traumatic experience to him considering

that he feels Iikes his family no longer needs him to sustain their needs although he was

anxious, restless at first but the support of his family really gave him the courage that

they can.

In response to his condition, care was given to him. His vital signs were

monitored every 4 hours, I & 0 every hour to closely monitored his kidney functioning.

Medications due for him were given and wound dressing was done everyday. Advocacy

in nursing was definitely applied in his care, accepting his minute requests so as to

alleviate his suffering as much as possible. His temperature was also monitored

because of some changes due to his status post condition.

In caring for patient Mr. RED, I have not only contributed to the betterment of his

health, but also to the improvement of myself as student nurses. Any circumstance

during the time of caring for patient Mr. RED added to the skills, knowledge and attitude

which will surely be beneficial in the future.

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XI. REFERRALS and RECOMMENDATION

HEALTH TEACHINGS

Name of patient:RED

Medications

Instructed client as well as the significant others about the indications and

mechanisms of actions of each drug that the doctor ordered so that without

hesitation they will really comply all the medications given with them.

Adherence to the medication promotes improvement of condition.

Exercise

Encouraged frequent changes of position according to his comfort like sitting on

bed if his body can tolerate and by turning to sides to prevent bedsores.

Avoid over strenuous activities

Encouraged passive range of motion to promote proper circulation and prevent

muscle atrophy/complication brought by immobility.

Instructed also the client at home to balance his daily activities especially when

discharged.

Encouraged patient to do deep breathing exercises/ Relaxation Technique

Treatment

Advised/Emphasized the importance to adhere to treatment regimen. That is to

facilitate faster improvement of present condition and prevent complication.

Bed rest is important to prevent over fatigability then ambulate with in tolerable

limits

Encouraged to apply lotion such as Johnson lotion and petroleum jelly to his dry

and cracked skin to prevent further skin injury.

Advised to have a regular check up at the nearest health center/health care

provider for check up monitoring.

Increased fluid intake up to 6-8 glasses a day

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Outpatient (CHECK-UP)

Instructed the client’s family to come back one week after discharged for further

follow-up and evaluation of the client’s health condition. This is very important so

that the health condition of the client will be evaluated if there is better

improvement. The physician should see and examine the physical appearance of

the client.

Diet

Taught the importance of eating green leafy vegetables such as alugbati,

malunggay, saluyot because this will prevent constipation especially at this time

because his peristalsis decreases due to limited movement

Encouraged low salt intake. The use of salt as a flavoring agent needs to be

controlled because this is usually the cause of fluid retention.

Encouraged intake of vitamin C, such as home made lemonade and oranges

because the patient has post surgical incision that will aid in healing.

Increased intake of protein because this is important for skin integrity.

Increased intake of fruits and vegetables because this can provide vitamins and

minerals for nutrition.

The family or the significant others is advised to comeback on the scheduled

date of visit with the physician together with the referral form given during time of

discharged on the exact time/date and place specified for monitoring/rechecking of his

condition. The family is also encouraged to monitor the patient and to not allow the

patient to do strenuous activities that would be a cause of further exacerbation of the

injured area. We encouraged the patient’s family to let the patient eat more fruits and

vegetables as well to have rich in fiber to prevent constipation. And lastly encouraged

the family or the significant others to have regular visit to the health center or clinic and

avoid self-medication or taking medications out of what is being prescribed.

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XII. PROGNOSIS

The attending physician, as well as those who gave care and studied the case of Mr. RED came up with good prognosis basing from the aforementioned indicators, and justified as follows:

A. Knowledge of the disease condition

The diagnosis for this criterion is good because he showed understanding in the importance of compliance/adhering to treatment regimen, although he has a positive attitude but lacks financial aspect was really an impact on him considering as well that he is the only person who works in the family

B. Extent of the disease

The extent of the disease was good .

C. Availability of medications and compliance

Not good, because sometimes he can take those medication needed but as much as they wanted to still there would be a times that they don’t have sufficient funds for treatment regimen compliance.

D. Attitude and willingness to take the medications and follow treatment regimen

Good prognosis because he was able to take his medications on time and followed the treatment regimen for management of his condition with a positive attitude for compliance and cooperation although there would be a time that he can’t deny that he missed some dosage due to financial aspect

E. Family support

Mr. RED’s wife was always there for him supports and helps the patient cope with stress and anxiety.

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XIV.Bibliography

Douges, M.E. et.al., (2002).. Nurse’s pocket guide: diagnosis, interventions & rationales. (8th Edition).Philadelphia: F.A. Davis Company.

Douges, M.E. et.al., (2002).. Nursing care plan: guidelines for individualizing patient care (6th Edition) Philadelphia:

F..A. Davis Company.Gulandick, M. et.al., Nursing care plan. (3rd Edition)           

Ignatavicius, D.D. & Workman, M.L. (2006). Medical-surgical nursing: critical thinking for collaborative care. (5th Edition). St. Louis, Missouri: Elsevier Saunders.

           

Kozier, B. et.al., (2004). Fundamentals of nursing: concepts, process & practice. (7th Edition). Philippines: Pearson Education South Asia PTE Ltd.

Smeltzer, S.C.& Bare, B.G. (2004).Textbook of medical-surgical nursing(10th

Edition, Volume 2). Philadelphia: Lippincott Williams and Wilkins. pp 553-538.

Spratto, G.R. & Woods, A.L. (1994). Nurse’s drug reference. USA: Delmar Publishers Incorporated.

Ulrich & Canale. (2005). Nursing care planning guides. (6th Edition).

Webliography:

www.mayoclinic.com/INJURIEs

www.yahoo.com/fall

www.google.com/images/lungs

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