Medical- Surgical Management ( Femur)

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IDEAL

ACTUAL

DIAGNOSTIC /LABORATIES PROCEDURE
CBC
Is a series of test used to evaluate the
composition and concentration of the cellular
components of blood. As a preoperativetest to
ensure both adequate oxygen carrying capacity
and hemostasis.

Urinalysis
Urinalysis is a test that evaluates a sample of the
urine.They detect the byproducts of normal and
abnormal metabolism,cells,cellular fragments,
and bacteriainurine.

DONE
July 29, 2014
July 30, 2014

DONE
August 02, 2014

Chest X-ray.
A diagnostic test that uses invisible
electromagnetic energy beams to produce
images of internal tissues, bones, and organs
onto film.Used to evaluateorgans andstructures
withinthe chest for symptoms of diseases.

Blood Typing
To identify what blood group to anticipate blood
transfusion should the patient requires.

Serology
is a blood test to detect the presence of
antibodies against a microorganism. Certain
microorganisms stimulate the body to produce
antibodies during an active infection.
Blood Chemistry
Is the chemical composition of the blood.
This is done to assess a wide range of conditions
and the function of organs.

DONE
July 29, 2014
July 30, 2014

DONE
July 29, 2014

DONE
July 30, 2014

Usually it check the electrolytes, the minerals
that help keep the body’s fluid levels in balance,
and are necessary to help the muscles, heart, and
other organs work properly.
Levels of various substances in the blood can
provide clues to a patient’s condition, ranging
from the presence of a liver disorder to a
pregnancy.
Creatinine
Test is used to assess kidney function.This test
measureshow effectively the kidneys arefiltering
smallmolecules.
Sodium
Plays a major role in regulating the amount of
water in the body.
Low level can be caused by loss of sodium
through diarrhea or vomiting.
High level can be caused by intake of too much
salt or not enough water.
Potassium
Essential to regulate how the heart beats.
Low levels can be caused by use of diuretics, low
dietary intake, severe vomiting or diarrhea,
certain medications, alcohol abuse, and other
medical conditions. It can cause muscle weakness
and heart problems.
High levels can be caused by having kidney
problems and excessive intake of potassium
supplement.
Chloride
Helps maintain a balance of fluids in the body.
Changes in the chloride level are usually
associated with changes in the sodium level;
when one goes up the other goes down and vice
versa.
When there is too much or too little acid in the
blood, chloride is an important clue that helps
doctors determines the cause of the acid
abnormality.

Computed Tomography
is a procedure that assists in diagnosing tumors,
fractures, bony structures, and infections in the
organs .

Prothrombin time (PT)

is a blood test that measures how long it takes
blood to clot. A prothrombin time test can be
used to check for bleeding problems. PT is also
used to check whether medicine to prevent
blood clots is working.

MEDICATION
Analgesic/ NSAIDs
Physiologic Mechanism
• Decreased pain and inflammation caused by
arthiritis
Pharmacologic Mechanism
• Prevention of M Inhibits the enzyme COX-2.
This enzyme is required for the synthesis of
prostaglandins.
• Has analgesic, anti-inflammatory, and
antipyretic properties.
Analgesics
Physiologic Mechanism
• Decreased pain.
Pharmacologic Mechanism
• Binds to mu-opioid receptors.
• Inhibits reuptake of serotonin and
norepinephrine in the CNS.
Anti- infectives/ Second generation
Cephalosporins
Bind to bacterial cell wall membrane, causing cell
death.

Celecoxib 200 mg 1 tab
BID ( 07-29-14 to 08-12-14)

Tramadol 50 mg 1 tab
every 6 hrs. ( 07-29-14 to 08-12-14)

Cefuroxime 500 mg 1 cap
PO x 5 days (07-29-14 to 08-04-14)

Calcium Supplements
For bone healing and tissue repair

TREATMENT
Reduction of Fractures
The fracture is reduced (' setting“ the bone) using
a closed method ( manipulation and manual
traction { eg. splint or cast, skeletal}

Immobilization
After the fracture has been reduced,
immobilization holds the bone in correct position
and alignment until union occurs. Immobilization

DONE

DONE

Is accomplished by external or internal fixation.

EXERCISE
Rehabilitation
Function is maintained and restored by
controlling sweeling by elevating the injured
extremity and applying ice as prescribed.
Passive ROM exercise
To decrease muscle rigidity due to
immobolization
Turning to sides
To facilitate circulation and prevent pressure
ulcer
Restlessness, anxiety, and discomfort are
controlled using a variety of approaches
(eg. reassurance, position changes, pain relief
strategies, including analgesic agents.)

DONE

DONE OFTEN

DONE OFTEN

DONE

Isometric and muscle- setting exercises are done
to minimize disuse atrophy and to promote
circulation.

DONE OFTEN

With internal fixation, the surgeon determines
the amount of movement and weight-bearing
stress the extremity can withstand and
prescribed the level of activity.

DIET








Adequate intake of food rich in Iron
Hemoglobin formation
Formation of hemoglobin happens to be the chief
function of this mineral. Not only that, being a
part of hemoglobin, it gives the dark red shade to
the blood and also aids in transporting oxygen to
the body cells.
Muscle function

DAT

Iron is a vital element for muscle health.
Brain function
High protein diet with milk
To improve bone strength and facilitate healing

DIET AS TOLERATED

SURGERY
ORIF ( Open Reduction with Internal Fixation)
Bone fragments are directly visualized. Internal
fixation devices are used to hold bone fragments
in position until solid bone healing occurs; they
may be removed when the bone is healed. After
wound closure, splints or casts may be used for
additional stabilization and support.

Skeletal Traction Left Tibia
Skeletal traction is an efficient method of
treating compound, extensively
comminuted, oblique fractures of the
femur.
In the presence of extensive wounds of soft
tissue and bone, skeletal traction is
definitely the treatment of choice

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