ANATOMY AND PHYSIOLOGY The human renal system is made up of two kidneys, two ureters, the urinary bladder,

and the urethra. In addition to the production of urine the renal system has many other functions. One quarter to one fifth of cardiac output passes through the kidneys at all times. This means that the kidneys filter approximately 1.2 litres of blood every minute. It is therefore not surprising that even slight abnormalities of renal function quickly lead to electrolyte disturbances. If untreated death will occur. The kidneys are two bean shaped organs of the renal system located on the posterior wall of the abdomen one on each side of the vertebral column at the level of the twelfth rib. The left kidney is slightly higher than the right. Human kidneys are richly supplied with blood vessels which give them their reddish brown color. The kidneys measure about 10cm in length and, 5cm in breadth and about 2.5 cm in thickness. The kidneys are protected by three highly specialized layers of protective tissues. The outer layer consists mainly of connective tissue which protects the kidneys from trauma and infection. This layer is often called the renal fascia or fibrous membrane. The technical name for this layer is the renal capsule. The next layer (second layer from the exterior) is called the fascia and it makes a fibrous capsule around the kidneys. This layer connects the kidneys to the abdominal wall. The inner most layer is made up of adipose tissue and is essentially a layer of fatty tissue which forms a protective cushions the kidney; and the renal capsule (fibrous sac) surrounds the kidney and protects it from trauma and infection. The kidneys receive their oxygenated blood supply from the renal arteries which come off the abdominal portion of the aorta. Venous blood from the kidneys drains into the renal veins to join the abdominal portion of the inferior vena cava. The hilum of the kidneys is located toward the smaller curvature. The opening in the hilum allows for the entry and exit of blood vessels and nerves. The funnel shaped extension of the kidneys is called the renal pelvis and it connects the kidneys to the two ureters. This structure facilitates the collection of the urine from the kidneys and drainage to the urinary bladder.

The ureters are tubes that are 25-30cm long and lined with smooth muscle. These tubes help carry urine to the bladder. The muscular tissue helps force urine downwards. They enter the bladder at an angle, so urine doesnt flow up the wrong way. The kidney consists of over a million individual filtering units called nephrons. Each nephron consists of a filtering body, the renal corpuscle, and a urine-collecting and concentrating tube, the renal tubule. The renal corpuscle is an assemblage of two structures, the glomerular capillaries and the glomerular capsule.

DISCHARGE PLANNING AND RECOMMENDATIONS Medication Continue all medications prescribed by the physician. Keep a list of medicines: Keep a written list of the medicines, amounts, and frequency of taking medicines. Bring the list of medicines or the pill bottles upon seeing the caregivers. Do not take any medicines, over-the-counter drugs, vitamins, herbs, or food supplements without first talking to caregivers. Take the medicine as directed: Always take the medicine as directed by caregivers. Call the caregiver if medicines are not helping or if it has side effects. Do not quit taking your medicines until you discuss it with your caregiver. Exercise & Environment The patient who had a surgical procedure requires Physical Therapy three times a week and other supportive measures for safety. If the patient is hospitalized, weight and fluid intake and output are measured and recorded daily.When nutritional status improves and strength increases, the nurse encourages the patient to increase activity gradually. Activity and mild exercise, as well as rest, are planned. Treatment Doctor will advise bed rest and certain restrictions in diet. He/she will also prescribe medicine for pain and would advise daily wound dressing.

Health Teachings Out-patiet Encourage family members to continue medications prescribed by the physician and to follow standard of care instructed by the doctor. If worsening or development of adverse effects and complications would occur, the patient should contact the physician immediately. Make a follow-up appointment with the doctor as directed by staff nurse. Diet DAT is given to the patient with Orif (plate) Fibula with syndamotic screw. This particular diet is only givern when client can now tolerate any food he desires that is nutritious, if this will not lead to any complications and if the client needs further monitoring for lab test. Spiritual Encourage positive reinforcement for self-care behaviors. Instruct family to assist client with the situation. Encourage the family to engage in spiritual activities together to help keep the faith stronger and to promote a deeper spiritual lifestyle CONCLUSION At the end of the case study, the fourth year BSN students were able to determine what Orif (plate) fibula with syndamotic screw is, the pathophysiology and its treatment. With this increase in knowledge, the students were able to help the patient promote health and medical understanding of such condition through the application of the nursing skills. They were also able to raise the level of awareness of patient on health problems that he may encounter before every procedure. Avoid medication that would worsen the condition DO NOT TAKE herbal supplements Do exercises Daily wound dressing Take prescribed medications as directed

We can therefore conclude that our whole experience at Manila Naval Hospital Surgical Ward made us realize a lot of things. During our 7-3 shifts, we learned that the tasks and skills needed in that area are not that simple and easy to do. It entails a lot of effort and patience. We were able to exhibit the lessons we have learned during our NCM lecture. Close monitoring, administering medications as prescribed, plotting and charting have been done by each one of

us. We were able to enhance making the nurses progress notes as well. We were also able to practice the appropriate nursing care in handling and dealing with surgical patients. This opportunity gave us the privilege to refresh our minds on the nursing responsibilities being on surgical ward and we were able to further develop our skills that would allow us to become more proficient nursing students.