Mariano Marcos State

University
College of Health
Sciences
DEPARTMENT OF
NURSING
Batacsubtitle
2906,style
Ilocos Norte
FRACTUR
Click to edit Master

E
BSN III-B
  1
GROUP

11/26/10
I. PERSONAL DATA

11/26/10
 Name: Ino Dulloog
 Address: Baay, Batac, Ilocos Norte
 Age: 56
 Hospital number: 579012
 Date and place of birth: July 27, 1953
 Civil status: Married
 Religion: Roman Catholic
 Educational attainment: Highshool graduate
 Occupation: Farmer
 Date of admission: December 26, 2009
 Admitting diagnosis: Fracture Close Tibia- fibula
proximal 3RD
 Admitting physician: Dr. Rasos and Dr. Agustin
 Final diagnosis: close tibia-fibula fracture-
proximal 3rd 11/26/10
II. ANATOMY AND
PHYSIOLOGY

11/26/10
Physiologically, the musculoskeletal system enables
changes in movement and position. The bony skeleton
provides support, protection and movable parts while
muscles facilitate movement.

Structures of the Muscular System

Muscles
They make up 40-50% of body weight.

Skeletal Muscles
• They are considered as the “living motor” which
provides active movement of the skeleton.
• These attaches to bones of the skeleton.
• Exert force on bones or skin and moves them.
• They are attached to the bones of the skeleton by very
thin extensions of fascia or by tendons. Fascia are thin
sheets of fibrous connective tissue. Tendons make
strong connections to bones.
• Thousands of their fibers are bundled together
11/26/10 by
Function:
 Produces movement- mobility of the
body as a whole reflects the activity
of skeletal muscles, which are
responsible for all locomotion and
manipulation.
Maintaining posture
Stabilizing joints
Generating heat- Generation of
body heat is a byproduct of muscle
activity. As ATP is used to power
11/26/10
11/26/10
 The skeletal system consists of two types of
connective tissue: cartilage and bone. Each of this
connective types consist of living cells, nonliving
intercellular protein fibers, and an amorphous (shapeless0
ground substance. The tissue cells are responsible for
secreting and maintaining the intercellular substances in
which they are housed. These substances provide the
structural characteristics of the tissue.
Two main types of intercellular fibers are found in
skeletal tissue: collagenous and elastic. Collagen is an
inelastic and insoluble fibrous protein. Because of its
molecular configuration, collagen has great tensile
strength; the breaking point of collagenous fibers found in
human tendons is reached with a force of several hundred
kilograms per square centimeters. Fresh collagen is
colorless, and tissues that contain large numbers of
collagenous fibers generally appeared white. The collagen
fibers in tendons and ligaments give these structure their
white color. Elastin is the major component of elastic fiber
11/26/10
Bone
The bone is a rigid connective tissue consisting of bone
cells, calcified intracellular substances, bone marrow, and its
chief organic constituents in collagen which is in CHON. It has
a strength of cast iron. 2/3 of the adult bone is inorganic
calcium salts(Ca-phosphate and Ca-carbonate). Ca Phosphate
is the primary ingredient for proper bone density. It has its own
blood vessel, lymphatic vessel and when fully developed has
20% water, organic material (CHON) of 30%-40%, Ca
salts(inorganic substance)Ca phosphate and Ca carbonate of
40%-50%.
Cartilage
Cartilage is a firm but flexible type of connective tissue
consisting of cells and intercellular fibers embedded in an
amorphous, gel like material. It has a smooth and resilient
surface and a weight-bearing capacity exceeded only by that
of bone. It is a type of dense connective tissue that can
withstand considerable tension. It is a semi opaque and has no
nerve for blood supply of its own. Because cartilage has no
11/26/10 of gases,
blood vessels, this tissue fluid allows the diffusion
Types of Bones
According to Distribution of Spaces Between Cells
 Compact bone- dense and with closely spaced lamellae-
concentric layers of mineral deposits.
 Spongy/ Cancellous bone- with wide space lamellae. Arrange
in irregular network of thin plates of bones called trabeculae.
According to Shape
 Long bones- length is greater than with. Found in
extremities; in femur wich is the longest bone of the body.
 Short bones- equal in with and thickness but irregular in
shape. (e.g. carpal and tarsal)
 Flat bones- thin and flat composed of thin layers of compact
bones and spongy bone. (e.g. cranial bone, ribs, scapula and
sternum)
 Irregular bones- bones not classified in others.(e.g.
vertebrae, hip bone,mandible)
11/26/10
 Anatomy of Bones
Gross Anatomy of Long Bones
1. Diaphysis/Shaft- main portion of long bones; body of bones.
Hollow cylinder of compact canal, which is field with bone,
contains medullary yellow bone marrow in adult located bet.
Epiphysis.
2. Epiphysis- the end of the diaphysis composed of spongy bone
covered by thin layer of compact bone, contains red marrow ,
where some RBC’s are manufactures during childhood and
adolescence; erythropoietin activity in the adult mainly occurs in
flat bones and vertebrae.
3. Metaphysis- it is made up of epiphyseal plate(growth plate) and
the adjacent bony trabeculae.
4. Growth plate- a thick flat plate of hyaline cartilage that provides
the framework for construction of the cancellous bone tissue
within the metaphysic.
5. Articular cartilage- covers the epiphysis. Thin layer of cartilage
covering epiphysis and forms articulation with another bones.
11/26/10
Types of Bone Cells
 Osteogenic cells- found mostly in the deep
layer of periosteum and in bone marrow.
Only bone cell that undergone mitosis and
develop to an osteoblast during stress and
healing. Unspecialized cells derived from
mesenchyme
Osteoblast- cell responsible in bone
formation; bone forming, repairing and
building. Usually found in the growing
portion s of bones, including the
periosteum. Secretes matrix mineralized
ground substance called osteoids.
Osteocytes – mature osteoblasts. The
11/26/10
 FUNCTIONS OF BONE AND THE SKELETAL
SYSTEM
 Support- serves as the structural framework for
the body by supporting soft tissues and
providing attachment point for the tendons of
most skeletal muscle
 Protection- protects many internal organs from
injury
 Assistance in movement- because skeletal
muscles attach to bones, when muscles
contract, the pull on bones. Together, bones and
muscles produce movement
 Mineral homeostasis- bone tissue stores several
minerals, especially calcium and phosphorus. On
demand, bone releases minerals into the blood
11/26/10
§ Blood cell production- within certain bones, a
connective tissue called red bone marrow produces
red blood cells, white blood cells, and platelets, a
process called hemopoiesis. Red bone marrow
consists of developing blood cells, adipocytes,
fibroblasts, and macrophages within a network of
reticular fibers. It is present in developing bones of
the fetus and in some adult bones, such as pelvis,
ribs, breastbones, backbones, skull, and ends of the
arm bones and thighbones
§ Triglyceride storage- triglycerides stored in the
adipose cells of yellow bone marrow are an
important chemical energy reserve. Yellow bone
marrow consists mainly of adipose cells, which store
triglycerides, and a few blood cells. In the newborn,
all the bone marrow is red and is involved in
11/26/10
hemopoiesis. With increasing age, much of the bone
FRACTURES
 Fracture, or discontinuity of the bone, is the
most common type of bone lesion. Normal bone
can withstand considerable compression and
shearing forces and, to a lesser extent, tension
forces. A fracture occurs when more stress is
placed on the bone than it is able to absorb.
 A fracture of the tibia or fibula is a fracture of
one of the two bones of the lower leg. This
fracture can occur anywhere between the knee
and ankle. The tibia is the most commonly
fractured long bone. Only the tibia bears weight,
but fracture of the tibia is often associated with
fracture of the fibula because force is
transmitted via the interosseous membrane that
connects the two bones. Isolated fracture of the
11/26/10
proximal or mid-shaft portions of the fibula is
§ The tibia is the major bone of the lower
leg, commonly referred to as the shin
bone. Tibia fractures can occur from many
types of injuries. Tibia fractures come in
different shapes and sizes, and each
fracture must be treated with individual
factors taken into account. When
determining treatment of a tibia fracture,
the following factors must be considered:
§ Location of the fracture,

§ Displacement of the fracture,

§ Alignment of the fracture,

§ Associated injuries,

§ Soft-tissue condition around the

fracture, and
11/26/10
§
Causes
Sudden Injury- most common fractures;
the force causing the fracture may be
direct, such as a fall or blow, or indirect,
such as a massive muscle contraction or
trauma transmitted along the bone.
Fatigue or stress fractures- fatigue
fracture results from repeated wear on a
bone; stress fractures in the tibia may be
confused with “shin splints,” a none
specific term for pain in the lower leg from
overuse in walking and running. Stress
fractures result from repetitive force (eg,
from overuse); they occur most often in
11/26/10
 Classification
Fractures are classified accdg. to location
(proximal, midshaft, distal), the direction or
fracture line (transverse, oblique, spiral),
and type (comminuted, segmental,
butterfly, or impacted).
Location
A long bone is divided into three parts:
proximal, midshaft, and distal. A fracture of
the long bone is described in relation to its
position in the bone.
Types
The type of fracture is determined by its
communication with the external
environment, the degree of11/26/10 break in
Classification of fracture by
communication with the
environment
Open or compound fracture- when
the bone fragments have broken
through the skin.
Closed fracture- no communication
with the outside skin.
It can be further divided into: Grade 1-
wound smaller than 1 cm with minimal
contamination. Grade 2- wound larger
than 1 cm with moderate
contamination. Grade 3- wound
11/26/10larger
Classification by pattern
 oblique-occurs at an oblique angle to the shaft.
 Linear- a fracture that is parallel to the bone's
long axis.
 Transverse- a fracture that is at a right angle to
the bone's long axis.
 Spiral- a fracture that seems to spiral around the
bone like a stripe on a candy cane.
 Classification by appearance
 Compression- common on the vertebrae.
 Comminuted- produced by high energy forces
(motor vehicle acccidennts) wherein bone
fragments are crushed.
 Greenstick- one side of the bone 11/26/10
is broken and
11/26/10
Clinical Manifestations
 Deformity- strong muscle spasm may
cause bone fragments to override;
therefore alignment and contour changes
occur. The deformity varies accdg. to the
type of force applied, the area of the bone
involved, the type of fracture produced,
and the strength and balance of the
surrounding muscles.
Swelling- due to localization of serous
fluids at the fracture site and
extravagation of blood in to adjacent
tissue.
Muscle spasm- involuntary muscle
11/26/10
HEALING
Five stages of the healing process
 hematoma formation- occurs during the first 48 to 72
hours after fracture. It develops as blood from torn vessels
in the bone fragments and surrounding soft tissue leaks
between and around the fragments of the fractured bone.
 cellular proliferation- the bone-forming cells, multiply
and differentiate into a fibrocartilaginous callus. Cellular
proliferation begins distal to the fracture, where there is
greater supply of blood.
 callus formation- fracture becomes ‘sticky’ as
osteoblasts continue to move in and through the fibrin
bridge to help keep it firm. This stage usu. occurs during
the third to fourth week of fracture healing.
 ossification- the final laying down of bone; safe to
remove the cast
 remodeling- resorption of the excess 11/26/10
bony callus that
DIAGNOSIS AND TREATMENT
Diagnosis is the first step in the care of
fractures and is based on history and
physical manifestations.
A splint is a device for immobilizing the
movable fragments of a fracture. Further
treatment depends on the general
condition of the patient, the presence of
associated injuries, the location of the
fracture and its displacement, and
whether the fracture is open or closed.

Three objectives for treatment

11/26/10
of
 Immobilization- immobilization prevents
movement of injured parts and is the single most
important element in obtaining union of the fracture
fragments. Immobilization can be accomplished
through the use of:
o External devices:
 Splints- metal splints or air splints may be used
during transport to a health care facility as a
temporary measure until the fracture has been
reduced and another form of immobilization
instituted
Casts- commonly used to immobilize fractures of
the extremities; they often are applied with a
joint in partial flexion to prevent rotation of the
fracture fragments.
External fixation devices - pins or screws are
inserted directly into the bone above and below
11/26/10
 § Traction- pulling force is applied to an
extremity or part of the body while a
counterforce, pulls in the opposite direction;
used to maintain alignment of the fracture
fragments and reduce muscle spasm.
• Manual traction- steady, firm pull that is
exerted by the hands
• Skin traction- pulling force applied to the
skin and soft tissues
• Skeletal traction- pulling force applied
directly to the bone
o
Internal fixation devices inserted during
surgical reduction of the fracture.
Preservation and Restoration of
Function- exercises designed to preserve
function, maintain muscle strength, and reduce
joint stiffness should be started early. After the
fracture has healed, a program11/26/10of physical
 The goal of rehabilitation is to
decrease pain and restore full function to
the lower limb. Modalities such as heat
and cold can be used to control pain and
edema. Rehabilitation emphasizes
restoring full range of motion, strength,
proprioception and endurance of all
adjacent joints while maintaining
independence in all activities of daily
living, if not contraindicated by the
fracture stability. Gait training using
appropriate assistive devices is indicated
to promote independent ambulation. The
individual may progress from11/26/10
walker to
PREDISPOSING FACTORS
1.Presence of underlying diseases- those with low
bone density( osteoporosis), bone tumors, bone
cancers or a brittle bone disease called osteogenesis
imperferta results to bone fragility.
2.Age- highest injury rate occurs in persons between
ages 15-24 because they are extremely active and
participates in contact sports. In elderly, as a result of
degenerative process, bones become fragile leading to
easier breaking of bones.
3.Sex- Injury rates are high for 15 - 24 years old males.
The risk in males is 2.5 times greater than females, due
to the involvement of males in hazardous activities.
However, during the menopausal stage, females have
an increased risk to fracture because during this stage,
ovaries stop producing estrogen, which normally
protects against bone loss. 11/26/10
5.Diet low in Ca, Phosphorous, and Vit. D-
Calcium and phosphorous are necessary for
strengthening the bones as well as
maintenance of density. Vitamin D on the other
hand hastens the reabsorption of Calcium. If
the bones are insufficient of Ca, Phosphorous,
and Vit. D, bones will become less dense and
weaker, causing it to break easily.
6.Lifestyle- A sedentary lifestyle contributes
to the moving of calcium out from the bones to
the blood causing a decrease in the bone
composition and strength. The bones will be
depleted with calcium and demineralization
process will occur making the bones to become
spongy and may gradually deform and fracture
easily. Vehicular accident, fall,11/26/10
and even
RISK FACTORS
1.People who work with heights. These people are at
high risk for fracture because of the nature of their job.
2. People who engages in high risk sports. These
people are at high risk because the sports they play
themselves is already risky and that it endangers their life
too.
OMPLICATIONS
1. Arterial damage- may consist of contused, thrombus,
lacerated, severed or spastic arteries.
arteries may also be constricted by casts that are too
tight.
Indications:
- absent pulse -continuing blood loss
- swelling - pain
11/26/10
- pallor - poor capillary feturns
2. Shock- laceration of large vessels and can cause bleeding
3.Compartment syndrome- fascia lining each compartment
(compartments are made of muscles, bones, nerves and
blood vessels) can not expand. Therefore any increase in
the compartment size due to bleeding or swelling will place
pressure on pliable structures within the compartment, such
as muscles, nerves and blood vessels. Compartment
syndrome can also develop if external pressure is applied,
such as from a cast or tight dressing.
S/S:
-uncontrollable pain - coolness
-weak active movement - pallor
-paresthesia – earliest sign - absent peripheral pulses-
latest sign
4. Volkman’s Ischemic Contracture
crippling condition of the hand or forearm arises from a
complication of a fracture around the elbow joint or forearm
bones
if not relieved, pressure causes ischemia and results in a
permanent, stiff, claw-like deformity of the arm and hand
11/26/10
S/S:
5. Fat Embolism- occurs 24- 48 hours after
the injury
develops when broken bones liberate fat
from the marrow cavity that embolizes to
the lungs and blood vessels which then
causes occlusion.
S/S:
-altered mental status
- tachypnea
- tachycardia
- hypoxemia
6. Infection 11/26/10
 
FACTORS THAT AFFECT BONE
HEALING
1. Age- older people heal slower than
younger people
2. Diabetics- decrease rate of healing
because of blood viscosity therefore
there is sluggish circulation
which decreases the blood supply into
the area
3. Infection 11/26/10
III. FAMILY BACKGROUND

11/26/10
  

Ino Dulloog

11/26/10
 The family is a group of persons united by
ties of marriage, blood or adoption,
constituting single household, interacting
and communicating with each other in their
respective social roles and creating and
maintaining a common culture. It is
composed of people who are emotionally
involved with each other and live in close
geographical proximity.
The client is an extended family since the
mother of Ino is with them. They are 9 in the
family: Mang Ino(56) and his wife Mang
Ada(54). They have 4 sons namely Aldo(32),
Emy(31), Enie(29), and Nickanor(21), 2
daaughters Eve(29) and Evy(24), and the
11/26/10
 Responsibilities at home are divided amongt the family
members. During the visit, there were no conflicts observed
between the family. However, like any other family,
misunderstandings between them do arise sometimes. They
solve it by open and peaceful conversations. In addition, Lola
Maria also gives pieces advice to them so that they can avoid
the same problem will not occur again. The family helps each
other in doing household chores for the family’s welfare. In
terms of rearing practices, both parents admitted that they
seldom hit their child since they think that the child would just
aggravate his tantrums. As much as possible they talk and
deal with the child in a well-mannered way.
 The family owns a 200 sq. meter of land which they use
for farming. The crops they harvest here are not sold but
primarily for family consumption. They also have a vegetable
garden at their backyard wherein they harvest tomato and
chili which is also for their own benefit. They also own a deep
well situated about 5 meters which they use for bathing,
cooking and drinking purposes. To ensure its potability, the
barangay health workers place chlorine at the deep well and
they cover it during rainy seasons. 11/26/10
 In relation to the family income,
they earn about Php 6,000/month. Ino
works a a farmer and stressed that,
they have two cropping seasons with
each season they are able to get 20
sacks of palay and each sack of palay
is worth about Php 1800. Therefore,
the family earns Php72,000 annually,
making up Php 6000/ month. The
family also receives foreign aid from
their daughter in law amounting to Php
2000. Evy, Ino’s daughter, who works
11/26/10
Monthly Allocation of Family
Expenses

11/26/10
 All in all, the family allocates Php 9000
for their monthly budget.
The breakdown of their monthly expenses
is as follows. The family allocates Php 2000
for food which includes meat, poultry
products and groceries like soy, cooking oil,
fish paste, fish sauce and etc. They usually
buy their foods and groceries at the public
market Batac. Php 1000 is allotted for their
electricity and Php 800 is for the gasoline of
their kuliglig while Php of 50 is apportioned
for their fertilizer and Php 300 is for the
shellane they are using. They also allocate
Pp 300 for miscellaneous that includes
toiletries and medicines. A fixed amount of
11/26/10
IV. HEALTH HISTORY

11/26/10
Family Health History
Based from the genogram, the hereditary disease that runs
in the family is hypertension. According to Ino, his mother
Juana has a hypertension which was diagnosed when she was
50 y/o during her check up in the RHU. Eve and Nickanor also
have hypertension which was both diagnosed during the
consultation in a medical mission. Medicines were prescribed
to them during the check-up however, due to financial
restrictions at that time, they were not able to avail the said
medicines and they eventually lost the prescriptions. The
family manages their hypertension by increasing their intake
of green leafy vegetables and chewing garlic and reducing
intake of high-cholesterol foods.
Gregorio, Ino’s father, had arthritis and died at the age of
80 because of a heart attack. According to Juana, Gregorio
was not diagnosed to have a heart problem because they
never went to a doctor for any consultation although he had
experienced recurring chest pains before he died. She also
claimed that Gregorio engages himself to cigarette smoking,
consuming 5-10 sticks per day. He also drinks 2-3 bottles of
11/26/10
liquor for 1 week for relax and fatiguerelieve fatigue. Juana, 96
 Marciano and Venabentura, Ino’s siblings, died at the ages
of 62 and 57 respectively. Marciano had cataract and died
because of a heart attack. He consumes 1 pack of
cigarette/day. Venabentura died because he was stabbed by
their neighbor due to a misunderstanding during a drinking
session in their neighborhood. Nicholasa, 60 y/o and Ino is 56,
y/o, have never experienced symptoms of hypertension. Only
Nickanor and Eve inherited hypertension.
The family is experiencing common illnesses such as cough,
colds, fever and headache. These illnesses were managed
through over-the-counter drugs—Solmux, 1 cap every 4 hours
for adults and Ambroxol, 1 tsp every 4 hours for the children for
cough, Neozep for colds, 1 tab every 4 hours both for children
and adults. For fever, the children take Paracetamol 1 tsp every
4 hours and 1 tab every 4 hours for adults—both until the fever
is gone. The family also considers the use of herbal medicines
such as the use of oregano decoction and drinking of calamansi
juice for cough. But when the condition of a family member is
not relieved by the management aforementioned, they go to a
11/26/10
health center for consultation. The family goes to the RHU
 The family members also suffered from chicken pox and
managed it by avoiding the intake of poultry products due
to their belief that eating such foods would only contribute
to the itchiness of the skin. They also practice wearing
black clothes to lessen the itchiness as claimed by Juana.
They also suffered from measles and mumps. They
managed their mumps by applying “anil” until it heals.
With regards to the family’s immunization, Ada claimed
that she was able to submit her children for immunizations
and vaccinations. But when asked about the yellow cards,
she said that she cannot remember where she kept it and
she is not sure if all their children had a complete
immunization.
As with their vices, Gregorio used to smoke everyday
and could consume 5-10 sticks of cigarette. They firmly
believed that his cigarette smoking caused him to suffer
from a heart disease that eventually led to his death. All of
Ino’s children are fond of carbonated beverages and they
usually consume 2 liters in a day. Their usual activities are
doing household chores and farming. Ino 11/26/10
admits that he
Past Health History
The patient suffered common childhood illnesses such as
chickenpox, fever, mumps and measles. The patient said that
when he was young they used to consult the “albularyo” since
medical science was not popular or known then. Fever was
managed by taking in paracetamol, coughs and colds were
managed by Solmux and Ambroxol in which all medications
are prescribed by the RHU physician of Batac City. They also
use boiled oregano, drinks calamansi juice and have plenty of
rest as a form of management for these conditions. When he
had chickenpox when he was young, they used to cover him
with black linen and put him near a smoke of onion.
With regards to Ino’s immunizations, he told us that he
cannot recall if he had immunizations and he also verbalize
that “Idi ngamin panawen mi balasang ko ket han pay nga uso
dagita ken meysa pay awan pay unay doctor idi isu nga
albularyo lang ti papapanan mi kada nanang ko idi”. He has
never been hospitalized until now. The patient does not have
any allergic reactions to his environment, food, drinks, and
medications.
11/26/10
Ino drinks alcoholic beverages thrice a week with his son
C. Present Health History
 
It was the 26th of December at around 1:00 pm, the
patient and his youngest son went to plow their land
with their kuliglig. Suddenly the patient felt the
kuliglig was moving wrongly to the left but still he
kept on going so that they could finish earlier and
then the kuliglig turned and dropped down on his left
lower leg. His son came running to his side and
helped him push away the kuliglig. When they finally
pulled his leg out, his leg just bent downwards and he
felt much pain. His son carried him home and rushed
him to the hospital. He was admitted at the MMMH
and MC with an admitting diagnosis of fractured tibia-
fibula proximal 3rd.
  11/26/10
V. DEVELOPMENTAL DATA
Erik Erikson’s Developmental Theory
Erik Erickson, a German Psychoanalyst, proposed the
psychosocial theory of development. This theory states that
life is composed of sequence of levels of achievement and
each stage indicates a certain task to be achieved. He
believes that maturation of bodily functions is linked with
expectations of society and culture in which the person lives.
A successful resolution would indicate a support to the
person’s ego while a failure to resolve the crises is damaging
to the ego. When needs are met, a healthy or positive
personality is developed and the individual moves to the
future stages with particular strength; but if not, an
unhealthy outcome occurs which will influence future
relationships.
According to Erickson’s developmental theory, the
primary developmental task of the adulthood is to achieve
Generativity. It is the willingness to care for and guide
others. Generativity is being creative and productive and it
can be achieved with their children and the others through
11/26/10
 A negative resolution would be evident by the person who is
selfish and self-centered. The person is unable to share his
potential to others which can serve as their guidance. This could
develop due to a failure in the earlier tasks which resulted to the
difficulty in achieving a higher developmental task.
In the case of our client, Ino is able to achieve the
developmental task completely. Positive indications of achieving
the task include productivity and concern for others. Ino is
productive in the sense that he can raise his 6 children well and
that they have enough food to eat for their everyday living. He
always see to it that all of them could eat their meals thrice a day
and that he could support and sustain all his children’s needs and
offer some help to his daughter who is already married but has a
hard time raising her own family financially. Ino is also concerned
to what is happening to his friends and neighbors as well as his
relatives. He sees to it that he is able to talk to his friends and
relatives even just once every two weeks to know how they are
doing. He also attends wake and burials as a way of sympathizing
to the bereaved family. He would also show his love and concern
to his family by always talking to them and asking how the day
has been and by telling that he loves them.
11/26/10
Analysis: Based on the cues presented, Ino was able to
 
Robert Havighurt’s theory
Robert S. Havighurst theorized that there are
developmental task one must accomplish all throughout life.
He believes that learning is basic to life and that people
continue to learn throughout life. According to him,
developmental task is a task which arises at or about a certain
period in the life of an individual, successful achievement of
which leads to his happiness and to success with later tasks,
while failure leads to unhappiness in the individual,
disapproval by the society and difficulty with later task.
 
Ino is 56 y/o and is under the middle age period. The following
are his tasks:
• Achieving adult civic and social responsibility
• Establishing and maintaining an economic standard
of living
• Assisting teenage children to become responsible &
happy adults
• Developing adult leisure-time activities
11/26/10
• Relating oneself to one’s spouse as a person
 Ino loves to mingle or interact with other people and
he is always attentive and conversant to what the other
person is saying. With regards to his social
responsibilities, he always participate programs in their
barangay like Clean & Green, and Fiestas. When it
comes to economic standard of living, Ino together with
his wife is involved in decision making. Ino sees to it
that he could provide for the basic needs of his family
although there are 7 of them living together in the
same roof. He raised his children properly and
responsibly. Ino’s leisure time is to go and have some
talks with his friends and neighbors after his work.
Whenever he faces any problem, he always talks to his
wife and asks for pieces of advice on how to solve his
problems. At his age, he already accepted the
physiologic changes that he undergoes right now like
his declining strength and he had already adjusted to
the aging of his mother.
11/26/10
VI. LEVELS OF
COMPETENCIES

11/26/10
Analysis: There was a significant change in the
patient’s physical competency due to the
immobility and weakness brought about by his
condition. He was not able to perform the activities
of daily living since his health requires ample rest.

11/26/10
Analysis: There is a significant change in our patient’s
emotional level of competency during his hospitalization
as brought about by the fear and anxiety of the result of
his condition. His condition also affects his way of
communicating to others which makes him difficult to
11/26/10
Analysis: There is a significant change in Ino’s social level
of competency because he cannot attend the barangay
gatherings before as he used to as brought about by his
condition because he easily gets tired and 11/26/10
this hinders him
Analysis: There is no change in the mental competency
of the client. Although he was a bit disturbed about his
condition, it did not alter his mental competency since
he remained to be oriented and mentally competent by
answering appropriately all the questions11/26/10
asked to him.
Analysis: There was no alteration with regards to
spiritual aspect of Ino except for not being able to
attended the Sunday mass during the
hospitalization. His faith in God got stronger
11/26/10
despite of his illness because he sees it as a
VII. PATTERNS OF
FUNCTIONING

11/26/10
11/26/10
Analysis: There is no change in the amount
of food intake of the patient before the
illness and during the hospitalization
(before surgery) because the patient was
ordered for a full diet. However, there is a
decrease in the amount of food intake on
the night before the surgery until the
evening of the day of the surgery because
the patient was ordered NPO post-midnight.
This is indicated for the purpose of
decreasing the workload of the stomach
therefore preventing the stimulation of the
vagal nerve which increases the
hydrochloric secretion, thus neutralizing or
buffering hydrochloric acid, inhibiting acid
secretion, decreasing the activity of pepsin,
and to eradicate helicobacter pylori. Then
11/26/10
the patient was ordered soft diet because
 Before the accident theBefore Surgery:
patient drinks 6-8During hospitalization
glasses of water a daybefore surgery the
approximately 1380-patient drinks 4-6
1840cc and drinks 1glasses of water a day
bottle of Gin sharedapproximately 1000-
with his sons thrice
1200cc.
every week.  
  After Surgery:
During hospitalization
after surgery the
patient was on NPO
then 4-6 glasses a day
after the surgery.
Analysis: there is a change in the amount of fluid intake of
the patient before the illness and during the hospitalization
because the patient was ordered for NPO before the surgery.
Then he resumed his usual drinking pattern a day after the
surgery for he is already in full diet.
11/26/10
 Before Surgery:
During hospitalization before surgery the
patient voided 6-10 times at daytime and 2
times at night, estimated at 1000-1300 cc
per day. Given from the patient’s chart he
voided 1000 ml at 12/26/09; at 12/27/09 he
voided 600ml and at 12/28/09 he voided
1000ml. the color of the urine on those given
days was yellow and was slightly turbid.
After Surgery:
During hospitalization after surgery the
patient voided 3-7 times a day estimated at
600-1000 cc per day. Given from the
patient’s chart he voided 800 ml at 12/30/09
and 500ml at 12/31/09. The patient’s urine
was yellow and was characterized as slightly
Analysis: There was a change in his urine elimination. Before
turbid.
illness, the patient had normal bladder elimination but
because of the decreased oral fluid intake after the surgery
due to NPO, it resulted to the decreased in urine output.
However, his bladder elimination resumed his normal
11/26/10
function a day after the surgery because of the change in the
 Before Surgery:
During
hospitalization
before surgery he
did not eliminate.
After Surgery:
During
hospitalization after
surgery he
eliminated once.
The color was
brown and it was
hard and dry in
Analysis: There is a decrease inconsistency
the frequency
of bowel elimination due to a decrease in
activity and a change in the environment.
11/26/10
 Before Surgery:
During hospitalization before
surgery the patient slept at 10
pm with a length of 3-6 hours. At
night before he slept he prayed.
He took naps every afternoon.
After Surgery:
During hospitalization after
surgery the patient slept at
10pm with a length of 3-6 hours.
At night before he slept he
prayed. He took naps every
afternoon.

Analysis: There is a change in the

sleeping pattern of the patient in terms
of duration because of the change in
environment (noisiness), pain and
11/26/10
 Before illnessBefore Surgery:
the patientDuring hospitalization before
takes a bath 2surgery the patient takes a bath
times a day atonce a day at 8:00-9:00 in the
6:30-7:30 in themorning using sponge and
morning andsoap, classified as partial bed
dusk usingbath.
shampoo and
After Surgery:
soap thus
having aDuring hospitalization after
complete bath. surgery the patient takes a bath
once a day a 9:00-10:00 in the
 
morning using sponge and
soap, classified as partial bed
Analysis: There bath.is a change in the
frequency and type of bathing pattern of
the patient because of his condition
11/26/10 and