Compression Fracture Patho

8/10/2019 Compression Fracture Patho

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CURRENT MEDICAL DIAGNOSIS: Compression Fracture - Fractures

DEFINITION OF CURRENT MEDICAL DIAGNOSIS: Fracture resultin !rom a crus"in !orce on t"e #erte$rae% Fracture is a &isruption in t"econtinuit' o! t"e $one%

SOURCE: (((((((((Me&-Sur Nursin: Critical T"in)in in *atient Care- +t" e& ,.//0(((((((((((((((((((((((((((((((((((((((((((((((((

*AT1O*12SIOLOG2:A !racture occurs 3"en $one is su$4ecte& to more

!orce t"an it can a$sor$% A compression !racture

results !rom a crus"in !orce t"at "as cause&

&amae to t"e $one% In t"is case5 it is t"e T"oracic

/ #erte$rae% T"e &irection o! a !racture line is

also use& to classi!' !ractures% T"e !racture line

ma' $e o$li6ue5 spiral5 or alon t"e lent"3ise

plane o! t"e $one% As a result o! a T/

compression !racture5 comes se#ere acute $ac)

pain% Lo3 $ac) pain can rane !rom mil&

&iscom!ort lastin a !e3 "ours to c"ronic

&e$ilitatin pain%

ETIOLOG2:

Ma' $e &ue to osteoart"ritis5 DDD5 &irect7in&irect

#iolence5 or muscular contraction%

Falls5 su&&en t3istin o! t"e spine5

trauma7strainin% Li!tin "ea#' o$4ects an&

puttin e8cess pressure on t"e spinal column%

Li!tin incorrectl'% T"ose patients at ris) !or !alls

,el&erl'7c"il&ren0 ((((((((((((((((((

CLINICAL MANIFESTATIONS

,Sins 9 S'mptoms0:Loss o! t"e po3er o! mo#ement5 pain 3it" acute

ten&erness o#er t"e site% S3ellin7$ruisin5 &e!ormit'

an& possi$le s"ortenin5 unnatural mo$ilit'5 an&

crepitus% Ma' "a#e so!t tissue in4uries in#ol#in

muscles5 arteries5 #eins5 ner#es in area o! !racture%

Guar&in5 "'po#olemic s"oc)5 muscle spasms5

ecc"'mosis% Decrease in "ei"t5 "ematoma% *ain

3orse 3it" stan&in73al)in% Limite& spinal

mo$ilit'%

LA7RADIOGRA*1IC FINDING USUALL2

*RESENT:

Dianosis o! a !racture usuall' is con!irme& $'

ra&iorap"ic tests% ;-ra's an& $one scans are use& to

i&enti!' !ractures%

Urine: T"e urine can $e sample& !or mar)ers o!

increase& $one turno#er5 3"ic" occur in persons 3it"

osteoporosis% loo& tests suc" as a $asic meta$olic

panel5 c"emistr'5 an& CC ,complete $loo& count0

s"oul& $e o$taine& in an' in&i#i&ual presentin 3it"

an osteoporotic compression !racture% T"'roi&

!unction tests s"oul& also $e o$taine& in patients 3it"

MEDICAL MANAGEMENT

,Inclu&e Treatments 9 Me&ications0Splintin o! t"e !racture site an& 4oints

a$o#e7$elo3 to limit mo#ement7!urt"er

&isplacement% Col& pac) to site an& ele#ate

a$o#e le#el o! "eart to limit pain an& s3ellin%

Re&uction $' cast until union "as ta)en place%

*"'sical t"erap' a!ter union is complete to

restore site to complete !unction% S)eletal

traction 3it" pins place& in $one an& "el& in

place $' pulle' an& 3ei"t s'stem% one

stimulation ma' $e necessar' to promote

"ealin% Monitor #ascular an& neuroloical

status o! t"e lim$ &istal to !racture site o!ten%

Analesia to relie#e pain or opioi&s i! multiple

!ractures or !ractures o! lon $ones are a!!ecte&%

Anticoaulants to pre#ent D


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)no3n or suspecte& t"'roi& &'s!unction% maintain t"e $one?s s"ape an& strent"%

DISC1ARGE *LANNING,Client E&ucation0:

Report sins o! impaire& circulation ,col&ness5

num$ness5 tinlin5 &iscoloration5 an& c"anes

in mo$ilit'0 an& teac" "o3 to care !or cast or

splint an& t"e correct use o! assisti#e &e#ices%

Teac" pre#ention o! !alls ,remo#in clutter5

3ell lit rooms5 appropriate s"oes7soc)s5 etc0%

@ell $alance& meals to promote "ealin%

Follo3 MD or&er !or acti#it' an& 3ei"t

$earin% E&ucate patient on appropriate $race

an& "o3 to 3ear it correctl'% A&e6uate calcium

inta)e to pre#ent osteoporosis% Turn usin small

series o! steps%

CLIENT DEVELOPMENTAL STATUSFor each of the following theorists, ientif! the e"elo#$ental stage of the client accoring to age% Then note theeecte e"elo#$ental tas's for that stage (i%e%, )re#ro*ction an creati"it!+ for Fre*s Genital, post-pubertystage-% Ne&t, note how the client is acco$#lishing these e"elo#$ental tas's while in the hos#ital setting% .ow isthis hos#itali/ation affecting their #s!chosocial stat*s at ho$e0 1o* o nee to incl*e Piaget entr! e"en for a*lts,since cognition can 2e a"ersel! affecte 2! illness, e$entia, $eications, anesthesia, e"elo#$ental eficits, etc%(The e"elo#$ental tas's nee to 2e incl*e in the conce#t $a#-%


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Lun Scan: CO*D Itc"' Decrease& Car&iac OutputNon-stemi MI 7 @ea) Impaire& Com!ort

* /.7 1R No appetite Ris) !or Constipation

O /H RR . Ris) !or Electrol'te Im$alanceilateral &epen&ent e&ema in an)les Ris) !or De!icient Flui& 2Platelets 2*5-55 459 2>4 45* -----------

?


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1ct ;*8->9 ;>5 ;4* @ ;* @ ----------- ;8*

3MP

0a 2;-2 2;9 2;8 2;9 25 2;8 =l- low d%t diuretic B@asixC causing increased excretion of electrolytes=reatinine- high d%t history of =1F and cardiomegaly=,4- elevated d%t cardiac disorders! =,P+! hypothyroidismGlucose- high d%t stress! type 4 diabetes! medication side effects : =ipro!@asix! $ynthroid

D ;*-*4 4 2 5 ;> ; @=#- 9>-258 99 255 99 9* @ 94 @ 4> 48 1 4) 4* 4)=reatinine 5*>-255 25 1 2* 1 2* 1 25 1 24 1=,4 45-;4 ;4 ; 1 ; 1 5 1 5 1Glucose )*-99 22; 1 22; 1 22 1 25) 1 224 1

ClottingFactors(.e$atolog!-

P' ----------- ----------- ----------- ---------- -----------P'' ----------- ----------- ----------- ---------- -----------

#0? ----------- ----------- ----------- ---------- -----------

$ed ?ate ----------- ----------- ----------- ---------- -----------

Misc%.e$atologies

=PD ----------- ----------- ----------- ---------- ----------- 'roponin '- high d%t impaired cardiac function as a result of "# andmyocardial damage after coronary artery bypass'roponin 5559 552) 1 552; 1 5529 1 -----------

Li"erF*nctionTests(Che$istr!-

' 5 ---------- ----------- >4$G,' 5-5 ----------- 28 ---------- ----------- 42Albumin ;*-> ----------- 48 @ ---------- ----------- ;5 @

Misc%Che$istries

=a 8)-254 88 8; @ 92 92 89 =a- low d%t low albumin levels"=1=- low d%t iron-deficiency anemia' Protein- low d%t heart failure immobiliHation

"g ----------- ----------- ----------- ---------- -----------

Phosphorus ----------- ----------- ----------- ---------- -----------

"=1= ;2-;> ;5* @ ;5* @ ;2) ----------- 49) @'otal Protein )5-8* ----------- ** @ ---------- ----------- )*

A37p1 ----------- ----------- ----------- --------- -----------

P=,4 ----------- ----------- ----------- ---------- -----------

1=,; ----------- ----------- ----------- ---------- -----------

P,4 ----------- ----------- ----------- ---------- -----------

Other;(List Na$ean

Nor$al4ange-


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@K" J 4*-5 242 @ 99 @ 9* @ >> @ @K"- low d%t anemia! renal cystsE,$ J 2-) 28 5* @ 5; @ 58 @ E,$- low d%t stress and possible s%e of lasixA%2 44:28Acute mild compression fracture of superior endplate of '24 ertebral body producingapproximately 4*J loss of vertebral body height centrally

=' pelvis )%>%2 44:;40o acute fracture or dislocation $een mild degenerative changes at both hip (oints $acroiliac(oints and pubic symphysis

"?# lumbar w%o contrast )%8%2 24:;42 Acute compression fractures superior endplate '24 with loss of vertebral height centrally ofapproximately 4*J 'here is minimal retropulsion of the superior endplate into the centralcanal with no significant central spinal canal stenosis4 $ignal abnormality noted with the $4 and $; vertebral bodies incompletely evaluated mostlikely the result of acute in(ury in this patient with acute '24 fracture; "ild multilevel degenerative changes

Probable bilateral subcentimeter renal cysts* @eft adrenal nodule measuring 48cm which has remained stable when compared to ='scan on $eptember 8!455

,ther +iagnostic 'ests- B+ates ?esultsC

)%22%2 2;; @ung $can"atched defects consistent with =,P+

CU44ENT MEDICATIONS


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AlpraHolamLanax

54* mgP,

5955

4255

Antianxiety!


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@evothyroxine $od$ynthroid

>* mcg P, 5955 1ormone%'hyroidPreparations

?eplacement ofthyroid hormones!

increasesmetabolic rate of

body tissue

2*mcg%kg%d

ay

'o treathypothyroidism byrestoring normal

hormonal balance

#nsomnia!#rritable!

O1?!arrhythmias 1eat

intolerance

Assess apical pulse and


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CU44ENT MEDICATIONS


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4O>?9?>>A3 Criteria for E"al*ation of Conce#t Ma##ing an Scoring 4*2ric4e"ise @?9>9>B

Criteria E&e$#lar! Satisfactor! Nees I$#ro"e$ent Unsatisfactor! Score

'he following criteria will be used to evaluatestudent performance of competencies related toconcept mapping

POINTS

>% E&ceeseectations aso*tline in thelearning acti"it!criteria%?% Consistentl! oesall or al$ost all ofthe following;

POINTS

>% Meetseectations 2! f*ll!aressing thelearning acti"it!criteria%?% Does $ost or$an! of thefollowing;

> POINT

>% Does not f*ll!$eet eectations2! inco$#letion orfail*re to f*ll!aress the learningacti"it! criteria%?% Does $ost or$an! of thefollowing;

@ POINTS

>% Does not $eeteectations 2aseon the learningacti"it! criteria%?% The assign$ent isnot s*2$itte%% Consistentl! oesall or al$ost all ofthe following;

I% Clinical Pre#9Pre8Clinical Manager Data;U#ate Sections as A##lica2le on Da! ?

2 $im=hart Pre-=linical "anager includesdiagnosis section4 $im=hart ,rder Entrygeneral orders

include activity and mobility! alerts! codestatusQ nutrition orders Bdiet and fluidsC

; $im=hart Admission 1istory completed inPatient =harting section Ball areasC

Pathophysiology sheet is completeaccording to assigned text sources relevant to client admission

* +evelopmental status notes Erikson!Freud! Piaget stages! expected tasks! how client meets in hospital

% @ab and diagnostic test sheets completedwith interpretation of results for individualclient

a% All areas are

co$#letel! anacc*ratel! recorewith *#ates note

2% Ientifies all la2an9or iagnosticres*lts for s#ecificclient

a% So$e areas are

not aresse, no*#ates are note

2% Ientifies alla2nor$al la2 an9oriagnostic res*ltsfor s#ecific client

a% Inacc*ratel!

recors an9or$isinter#rets ata

2% Inacc*ratel!recors an9or$isinter#rets la2an iagnosticres*lts for s#ecificclient

a% Fails to re#ort #re8

clinical ata

2% Fails to ientif!la2 an9oriagnostic res*ltsfor s#ecific client


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II% Plan of Care Ma#9N*rsing Process For$atan Content;

2 6symptomsC9 'he meaning of relationships within

concepts is indicated by connecting lineswith linking words or abbreviations Br%t!amb! patient will! nurse will! etcC

25 Goals and outcomes are measurable22 $tated nursing care is appropriate for

specific client24 +ata from the initial assessment is listed in

black2; ,ngoing assessment as collected is listed

in red2 $hapes or symbols are outlined using the

=oncept "ap =olor Dey2* 'he plan of care is legible2) Assessment data is integrated into the

concept care map2> =ross-links between concepts illustrate

valid relationships uni.ue to the client usingred lines with linking words

a% All n*rsingiagnoses arecorrectl! n*$2ere2ase on #riorit!

2% #entifies fi"e (-or $orerelationshi#s2etween conce#ts

c% 4e"ises theconce#t $a# 2aseon e"al*ation of theo*tco$es

% ientifies $orethan a##ro#riate9#riorit!n*rsing iagnosis

a% Correctl!#rioriti/es highest#riorit! iagnosis2*t incorrectl!n*$2ers others

2%#entifies three (-or $orerelationshi#s2etween conce#ts

c% So$e re"isionsare $ae

% ientifies a##ro#riate9#riorit! n*rsingiagnosis

a% Incorrectl!#rioriti/es alln*rsing iagnosis

2% Ientifies lessthan three (-relationshi#s2etween conce#ts

c% Few re"isions are$ae

% ientifies few than a##ro#riate9#riorit! n*rsingiagnosis

a% Does not #rioriti/ean! n*rsingiagnosis

2% Fails to ientif!or incorrectl!ientifiesrelationshi#s2etween conce#ts

c% No re"isions are$ae

% Fails to ientif!a##ro#riate9#riorit!n*rsing iagnosis


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III% Doc*$entation; (Incl*es Si$Chart an9or.os#ital Co$#*ter Charting-;

2 $ystems Assessment data are completeand accurate for each day of care assess$ents anclient careinter"entions inSi$Chart% Asnarrati"e co$$entsreflecting clientstat*s%%

2% On Da! ?,oc*$ents narrati"e#h!sical assess$entnote thate$onstrates#ro2le$ sol"ings'ills an acc*ratel!

reflects client stat*s%

a% Da! > Si$Chartoc*$entation hasso$e co$#onentsthat fail to acc*ratel!reflect client stat*s%

2% Fails to acc*ratel!oc*$ent Da! ?narrati"e #h!sicalassess$ent note toreflect client stat*s,e$onstrating #oorecision $a'ing an

#ro2le$ sol"ings'ills%

a% Da! > Si$Chartoc*$entationcontains erroneo*s,irrele"ant ata thato not reflect clientstat*s%

2% Da! ? narrati"eassess$ent notecontain erroneo*s,irrele"ant ata withno #ro2le$ sol"ings'ills e$onstrate%

IV% Self8E"al*ation2 $tudent completed self-evaluation using 6'he

=offeehouse7 on


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CONCEPT MAP =E1;

NursingDiagnosis

Green

Assessment

Purple

Pathophysiology

Blue

Interventions

Yellow

PlanningGoals,Outcomes

Orange

Evaluation

Re

Lin'ing Line Arrow Cross8Lin' Line Arrow Lin'ing

Compression Fracture Patho

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