Midyr Case Study New
Midyr Case Study New
Midyr Case Study New
In Partial Fulfillment
Of the Requirement in
________________________
Related Learning Experience (RLE)
A CASE STUDY ON
Presented by:
Eva U. Corpuz
Andres L. Bernabe
BSN III-A
Presented to:
Date:
July 18, 2020
Republic of the Philippines
UNIVERSITY OF NORTHERN PHILIPPINES
Tamag, Vigan City
2700 Ilocos Sur
College of Nursing
Website: www.unp.edu.ph Mail: unp_nursingvc@yahoo.com
CP# 09177148749, 09175785986
PEARSON Assessment 15
Diagnostic Procedures
a. Ideal 5
b. Actual
Pathophysiology
a. Algorithm 15
b. Explanation
Management
a. Medical and Surgical (Ideal and Actual) 5
b. Nursing Care Plan (NCP) 25
c. Promotive and Preventive Management 5
Drug Study 5
Discharge Plan 5
Updates 5
Organization/Documentation 2.5
Bibliography 2.5
TOTAL: 100
REMARKS:
______________________________________________________________________________
______________________________________
I. Introduction
II. Personal Information
III. Objectives
IV. Medical History
a. History of Past Illness
b. History of Present Illness
V. Anatomy and Physiology
VI. Diagnostic Procedures
A. Laboratory Test
B. Radiologic Findings
VII. Management
A. Medical
B. Actual
C. Nursing Care Plan
VIII. PEARSON Assessment
IX. Discharge Planning
X. Promotion and Prevention
XI. Drug Studies
XII. Bibliography
I. INTRODUCTION
Bones in our body are living tissues that requires blood supply to get nourish and
Avascular necrosis is the death of bone tissue due to a lack of blood supply. Also
called osteonecrosis, aseptic necrosis or ischaemic necrosis. it can lead to tiny breaks
Avascular necrosis of femoral head means that blood supply to the ball of hip joint is
steroid use; excessive alcohol intake; sickle cell disease or other blood cell disorders;
In the case of Patient Midyear who is 49 years of age has been using steroids due to
her severe allergy. For about 5 years she is using steroids. Since most of the patient
with avascular necrosis have no symptoms in early stages, she did not realize that
long term use of steroids causes blockage to the blood supply in the hip. The reason
are unknown but hypothesis is that increased fat globules in the blood which get
lodged in the vessels. When avascular necrosis worsens with time, eventually the
bone collapse and that is what happened to Patient Midyear. Seven months ago she
started to feel pain on her right hip and worsen when walking. This time she came
to the hospital complaining of hip pain on the right with associated unsteady gait,
and when she was examine by a doctor and results from her imaging test came, she
Patient Midyear was admitted at Northside Doctors Hospital on July 14, 2020 at 3:14
She was diagnosed of Avascular Necrosis Hip. And undergone Total Hip Arthroplasty.
Upon receiving the patient on July 18, 2020, patient is still un-conversant and lying on
bed.
This case study aims to identify and determine the general health problems and
needs of the patient with an admitting diagnosis of Avascular Necrosis Hip. This also
intends to help patient promote health and medical understanding of such condition
through the application of the nursing skills.
o To raise the level of awareness of patient on health problems that she may
encounter.
o To facilitate patient in taking necessary actions to solve and prevent the
identified problems on her own.
o To help patient in motivating her to continue the health care provided by the
health workers.
o To render nursing care and information to patient through the application of
the nursing skills.
The patient is diabetic and taking metformin and have had steroids for her severe
allergic reactions to seafood.
Hip joint is a large weight bearing ball and socket joint. The ball is formed by the upper part of
the thigh bone or femur which fits into a socket formed by the acetabulum which is part of the
large pelvic bone. The ball and socket are covered by a smooth glistening white tissue known
as cartilage. It helps in the smooth gliding of the ball in various movements about the joint such
as walking, running, squatting, sitting cross legged.
Interruption of blood flow to the bone. AVN often affects bones with a single terminal blood
supply, such as the femoral head, carpals, talus, and humerus. The earliest pathologic
characteristics of avascular necrosis are death of hematopoietic cells and adipocytes followed
by interstitial marrow edema.
Osteocyte necrosis occurs after approximately 3 hours of anoxia, but histological signs of
osteocyte death do not appear until approximately 24 to 72 hours after oxygen deprivation.
Interruption of the vascular supply and resultant necrosis of marrow, medullary bone, and
cortex are theorized to be caused by the mechanisms.
Vascular occlusion: This is characterized by the interruption of the extraosseous blood
supply via factors such as direct trauma (fracture, dislocation), non-traumatic stress, and
stress fracture.
Altered lipid metabolism: Animal studies have led to the hypothesis that increased levels
of serum lipids leads to lipid deposition in the femoral head, causing femoral hypertension
and ischemia. Lipid level lowering drugs in animals reverse this process. Corticosteroid
administration was associated with fat emboli in the femoral heads of rabbits.
Intravascular coagulation: Disorders of the coagulation system have been implicated in
the pathogenesis of AVN. Typically, it is a secondary event triggered by a familial
thrombophilia, hypercholesterolemia, allograft organ rejection, other disorders (infection,
malignancy), or pregnancy.
Healing process: Necrotic bone triggers a process of repair that includes osteoclasts,
osteoblasts, histiocytes, and vascular elements. Osteoblasts build new bone on top of the
dead bone, leading to a thick scar that prevents revascularization of the necrotic bone,
with resultant abnormal joint remodeling and joint dysfunction.
Primary cell death: Osteocyte death without other features of AVN has been seen in
renal transplant patients, as well as in patients receiving steroids and those who consume
significant amounts of alcohol.
VI. DIAGNOSTIC PROCEDURES
INR 1.09
Laboratory test
Borderline:200-239
High: >240
_____________________________________________________________________________________
_____________________________________________________________________________________
High: > 60
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B. Radiologic Findings
Lungs are devoid of active parenchymal densities and are opposed to the chest wall on
all sides
Diaphragm is intact.
IMPRESSION:
Radiologist - Sonologist
IMPRESSION:
Radiologist:
Medical
In the early stages of avascular necrosis, symptoms might be eased with medications and
therapy. The doctor might recommend:
Nonsteroidal anti-inflammatory drugs to relieve the pain associated with avascular
necrosis.
Lipid lowering drugs which are useful in people with high blood lipids/cholesterol
Anti-osteoporotic drugs which helps to decrease bone loss and pain.
Blood thinners used to prevent clots blocking the blood vessels
Physical therapy and precautions that is avoiding weight bearing on the affected limb
means slows down the collapse and physical therapy helps maintain active range of
motion.
Surgical
Surgical interventions depend on the patients age, the segment of bone affected and the
stage of the disease. Some of the various interventions are.
Core decompression
Multiple drills are done in the hip to reduce to reduce the pressure inside and
potentially allowing the bine forming cells to lay down new bone replacing dead
bone. The reduced pressure allows for increased blood supply to the bone. The
procedure is helpful when performed before the collapse of the bone and
cartilage.
Vascularised and Non-vascularized grafts
An attempt is made to reestablish the blood supply of the hip bone by inserting a
bone graft taken from another part of the body. Usually a part of fibula bone
along with its blood vessel is used as a graft. The grafted bone incorporates into
the hip bone and with its blood supply helps in revascularization.
The grafts can also be non-vascularized. Grafted bone not only provides
structural support but also supplies potential bone forming cells which creep in
substituting the dead bone, Muscle pedicle grafts can also be used. Again the
procedure is helpful only if performed in early stages of the disease.
Osteotomies
These are surgeries which change the segments of the ball of the hip which bear
weight. The diseased segment is surgically rotated so that the healthy segment
comes to lie under the weight bearing portion and relieves the pain and stiffness.
The diseased unloaded segment potentially starts to get healthy. The surgery is
useful in smaller lessions.
Total hip replacement/ Hip resurfacing
Majority of patient reports to the physicians when in pain and the disease
process is already in advanced stages. Total hip replacement is the best surgical
option, which not only relieves pain and stiffness but offers a faster rehabilitation
usually 8 weeks.
It involves replacing the hip joint with a prosthetic or artificial joint which
recreates the movements and biomechanics of the normal joint. It offers a
normal lifestyle even in advanced stages.
Actual
NURSING NURSING
DATA PLANNING RATIONALE EVALUATION
DIAGNOSIS INTERVENTION
“Haan pay Constipation Client will Encourage Fluid intake The patient
nagbawas” as related to maintain patient to helps make the were able to
verbalized by immobility as bowel increase stool soft and defacate
the carer evidenced by elimination in adequate fluid moist for
change in his normal intake unless easier
bowel habits pattern contraindicated elimination
DATA NURSING GOAL/OBJECTIV NURSING INTERVENTION RATIONALE EVALUATI
DIAGNOSIS E ON
Subjective P- Pain After 30 – 60 Independent Nursing Fears and
cues: “on a E- Related to minutes of Intervention: concerns can
scale of one their hip nursing Encourage verbalization of increase muscle Within 1
through ten, surgery interventions feelings about the pain. tension and lower hour the
how would you S- as and threshold of pain patient
rate your pain, evidenced administrating perception. was asleep
ma’am?” by their pain and
facial medication, the Collaborative Nursing comfortab
grimace. patient’s pain Intervention: Maintain a le.
should decrease Assist with patient- constant drug
Objective Cues: substantially. controlled analgesia or level avoids cyclic -Goal met.
“a nine, it really analgesia through epidural periods of pain,
hurts.” catheter. Administer aids in muscle
intermittent analgesics healing, and
routinely, as indicated, improves
especially 45 to 60 minutes respiratory
before respiratory function and
treatments and deep- emotional
breathing, and coughing comfort and
exercises. coping.
VIII. PEARSON ASSESSMENT
Elimination
Initial vital signs taken Initial vital signs taken Initial vital signs taken
as follows: as follows: as follows:
BP: BP:120/80 BP:120/80
Safety and Security PR: PR:90 PR:76
Temp: Temp:37.2 Temp:36.7
IV site intact and patent IV site intact and IV site intact and
well positioned with her patent well positioned patent well
bantay. with her bantay. positioned with her
bantay.
Discharge Summary
Date Admitted: July 14, 2020
Admiting Physician: Dr. Quilala
Admitting Diagnosis: Avascular necrosis of hip
Chief Complaint: Pain on the hip
Hospital Course: Patient was admitted and undergone Total Hip Arthroplasty
Attending Physician: Dr. Guzman
Education:
Follow up: Follow up check up for the removal of suture and to check if the
wound is healing properly
Diet: diebetic diet
Medication: Instruct patient how, when to take home medications.
Instruct patient to do deep breathing and coughing exercise to limit the chance of
pneumonia
Continue medication as per physician’s order.
Encourage exercise to strengthen muscles.
Encourage a healthy diet.
Be sure to keep the incision or wound clean and dry.
XI. DRUG STUDY
Book:
Medical –Surgical Nursing
Brunner and Suddarth’s
Vol 1&2, 10th edition
Medical –Surgical Nursing
Brunner and Suddarth’s
Vol 1&2, 14th edition
Nursing Care Plan
Guidelines for Individualizing Client Care Across Life Span
8th edition.
Internet:
https://www.google.com/search?
q=pathophysiology+of+intracerebral+hemorrhage&sxsrf=ACYBGNQVIxQbXze8n3VegdGtoG5XBGAwIA:1
575180782615&source=lnms&tbm=isch&sa=X&ved=2ahUKEwiSzITY5ZPmAhWrGqYKHe2pAasQ_AUoAX
oECA0QAw&biw=1024&bih=499#imgrc=88Hkizef9djUDM:
https://www.yumpu.com/en/document/view/45752570/nursing-care-plan-fever-nursing-crib
https://emedicine.medscape.com/article/
https://www.google.com/search?
q=tranexamic+acid&oq=tranexamic+acid&aqs=chrome..69i57j0l7.6438j0j4&sourceid=chrome&ie=UTF-8