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A hip dislocation occurs when the head of the thighbone

(femur) slips out of its socket in the hip bone (pelvis). In


approximately 90% of patients, the thighbone is pushed
out of its socket in a backwards direction (posterior
dislocation). This leaves the hip in a fixed position, bent
and twisted in toward the middle of the body. The
thighbone can also slip out of its socket in a forward
direction (anterior dislocation). If this occurs, the hip will
be bent only slightly, and the leg will twist out and away
from the middle of the body.

A hip dislocation is very painful. Patients are unable to move


the leg and, if there is nerve damage, may not have any
feeling in the foot or ankle area.

one is one of the hardest materials in the
body, and although relatively light in
weight, it has a remarkable ability to resist
tension and other forces acting on it.
Nature has given us an extremely strong
and exceptionally simple (almost crude)
supporting system without up mobility. The
calcium salts deposited in the matrix bone
its hardness, whereas the organic parts
(especially the collagen fibers) provide for
bone·s flexibility and great tensile strength.
The femur, or thigh bone, is the only bone in the
thigh. It is the heaviest, strongest bone in the
body. Its proximal end has a ball-like head, a
neck, and greater and lesser trochanters
(separrsted anteriorly by the intertrochanteric
line and posteriorly by the intertrochanteric
crest). The trochanters, intertrochanteric crest
and the gluteal tuberosity, located on the
shaft, all serve us sites for muscle attachment.
The head of the femur articulates with
acetabulum of the hip bone in a deep, secure
socket. However, the neck of the femur is a
common fracture site, especially in old age.
The femur slants medially as it runs downward
to joint with the leg bones; this brings the
knees in line which the body·s center of
gravity. The medial course of the femur is
more noticeable in females because of the
wider female pelvis. Distally on the femur
are the lateral and medial condytes, which
articulates the tibia below. Posteriorly, these
condytes are separated by the deep
intercondylar notch. Anteriorly on the distal
femur is the smooth patellar surface, which
forms a joint with the patella, or kneecap.
u  
  
Name: T. G. C.
Address: 109 A Tubigan
iñan, Laguna
Age: 37 y/o Gender: Male
Religious Affiliation: Catholic
Marital status: M

arried
Room #: 223
Chief complaint: Vehicular accident
Provisional diagnosis: Acute Traumatic hip dislocation R 2° to
vehicular accident
Attending physician: Dr. Montano
—   

The client experienced some chicken pox, measles, and mumps


when he was still a child. According to the client he is fully
immunized, DPT, MMR, OPV,
CG and Hepa
. Moreover, the
client still receives Hepa
vaccine every once a year, becuase
it is a requirement of their company. The last time the client was
hospitalized was because he suffered from whooping cough
and had his first encounter in a vehicular accident. The client
doesn·t remember what his medications are when he
experienced whooping cough. The client takes supplements
everyday such as Revicon multivitamins, once a day. The client
doesn·t have a history of foreign travel.
 —  u

Three and a half hours prior to accident, patient was a


passenger in a jeepney who they allegedly hit around of
soil after loosing the breaks. Patient brought to local
hospital. The client was admitted due to vehicular
accidents and complains pelvic pain.

 

The client is unable to recall any health history about his


family members.
— 
After the accident, the client perceived the
accident as part of life. As he verbalized,
-     
  
    
       The client
accepted what happened to him and
doesn·t perceive it as a problem. However,
due to the procedures that he is going
through, he is worried that the next
procedure would interfere with his work.
 — 
The client does not have any problems
regarding his senses and memory. The client
responds to the questions without
hesitations and coherent.
 

The client was confident on how he views
himself. As his wife also verbalized,
-   

   
He accepts opinions and views of others.
= — 
The client handles his emotional problem very
well; he always seeks for opinions from his
wife and family. The client was able to
manage his stress because his wife would
help relieve it by giving him a massage. The
client is verbal about his emotional
problems.
 
The client has a sexually active lifetsyle. They
use condom as their contraceptives.
— 
The client and his family seldom go out of
town during holidays. In terms of financial
matters, they are able to resolve it through
an open communication within the family.
When he and his wife would argue, they
would talk about it in a soft way and
immediately seeks out a remedy.
According to the client, -  
     
  — 
As part of the client·s culture, he always goes to
church every Sunday with his family and when he
thinks he needed it the most. He celebrates traditions
and festival in his town.

 
   
The client has good relationship with his wife. They
have been married almost for 7 years and currently
living in together. Even though the client is married,
he still doesn·t lose contact with his family. As for him
-      
   
      
 
 — 
The client recreation activity was to watch TV
with his wife this serves as their bonding time
together. At times when he is tired from
work, his wife would give him a massage
and also to relive his stress.
 =
The client resides in a studio type house. They
lived in a compund where there is less noise
surrounding their house. According to the
client, ´       

but the client perceives it as a
tolerable condition and not a problem.
= =


The client has sufficient salary to sustain the


daily needs for him and for his wife. And
they still have savings for their extra
wants. They have sufficient budget for
their health.
   —


The client is a Catholic but prefers the ways of
a Jehovah·s Witness. According to the
client, he prefers to be a Jehovah·s Witness,
because he is comfortable and he can
relate more in their traditions and culture.
He adds that being a Jehovah·s Witness it
strengthen his self -perception about life.
After the accident, the client plans to
convert himself and fully baptized as a
Jehovah·s Witness.
(  
The client respects his family as he respects
his wife. According to the client, faith is
one of the most important things in life.
ADL Before During Interpretation and
Hospitilization Hospitalization Analysis
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 ;
During the degenerative process the cartilage that lines the hip joint,
called hyaline cartilage, is damaged. The damage results from the
abnormal forces on the cartilage from the deformed hip socket.
Small fractures can occur in the cartilage also. Eventually an
enzyme is released that degrades the joint further and decrease the
synthesis of an important joint protectant called proteoglycans. The
cartilage becomes thinner and stiffer, further compromising its ability
to handle the stresses of daily movement and weight bearing.As the
problem progresses more enzymes are released, which now affect
the precursors to proteoglycans, molecules called
glycosaminoglycans and hyaluronate. Lubrication is negligible,
inflammation occurs, and the joint fluid can no longer nourish the
hyaline cartilage. This viscious cycle continues until pain occurs. The
body attempts to reduce this pain by stabilizing the hip joint. New
bone is deposited at the joint, both inside and out, along with some
of the ligaments and muscle attachments to the area. This causes
thickening and a decrease in the range of motion. This is the actual
arthritis noted on a radiograph, which will not go away and will
continue to progress.
V Hypothesis ² factors like physical, mechanical, nutritional, predispose the
normal physical functioning of the host but mechanical factor of agent
lowers the resistance and impairs physical mobility.
V
V Predisposing
o Host
V Male patient is 37y/o, he was born in the Philippines; He is a pure Filipino living
with his wife in Laguna. The pt. has a high level of self-esteem and
confidence. For his nutritional status He stated that he balances his food
intake, when he ate in a fast-food chain he sees to it that later that day he
essentially consume veggies or fruit, while he consumes small amount of
water. When it comes to the customs and tradition, they dominantly follow
the beliefs of Jehovah·s Witness but haven·t been baptized to the religion. To
both sides of his parents, there were no reported health problems. The
patient had a complete immunization and recently had a diarrhea and
fever. During the interview, the pt. felt puzzled and looked depressed when
his wife told him that he would be acquainted with an artificial hip joint to be
applied in his right hip in order for him to resume to his normal life. He had a
fringe benefit provided by the company he was working which pays for the
emergency health situation or accident. After the operation, he was not
able to move a lot and consumption of food intake lessened.
V
o Agent
V The patient undergone surgical operations
specifically close Reduction in the right hip
applying 3kg metal bag. After the operation,
the patient felt no pain and responds to
questions actively.
o Environment
V Assessing the environment, there was a
sufficient lightning in the room and garbage
was segregated and the room temperature
was warm.
E

A H
V Analysis
Host and agent increases the alteration in normal
functioning that makes them more powerful than the
environment thus causing impaired physical
immobility.

V Conclusion
Precipitating cause is predominantly impaired
physical immobility and greatly influenced by
secondary factors which was the application of 3kg
metal bag in his right leg.

V Recommendation
General health of the patient should be considered
Consume nutritious meals and normal fluid intake
(Healthy and balanced diet)
Minimize to extraneous movement
Maintaining dressing clean, dry and intact until fully
healed.
Oursing Problems Cues Justification
Identified
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  *8 This problem should be


    2 

 

" the 3rd priority. It should



 
 
  

 also be solved
because it is also it will


  
 


create more serious
 disease if it is not taken
18 seriously.
2 *


 
ased on client·s
priority, the client thinks
that sleep is something
important.
Resources are also
available to the family,
and the nurse
Cues Health Problem Analysis Goals and Nursing Rationale Evaluation
Objectives Interventions

Impaired Impaired
*8 Goal: after
·  mobility related mobility
2
Limitations
nursing
"  to hip
dislocation as independent, intervention
 
manifested by purposeful s, the client
  physical
 difficulty of will be able
movement of
  > moving. the body or of
to maintain
2 ·2" one or more or increase
   extremities. strength
 " and
The client had
 >
a vehicular function of
accident that affected
damages his and or
right hip
causing hip
compensat
dislocation. ory body.

The client is at
risk of having
fractures due
to changes to
age.
18 Fractures occur Objectives:
when the bone
2 

 is subjected to The client will
 '"  stress greater be able to:
that it can

 absorb. When Verbalize
the bone is understanding
""  broken, of situation and
adjacent individual
 "  structures are treatment
also affected, regimen and

" resulting in soft safety
2 

 tissue edema, measures.
hemorrhage Demonstrate
 into the muscles techniques or
and joints, joints behaviors that
 
dislocations, enable
ruptured ten- resumption of
 " dons, severed activities.
nerves, and Participate in
damaged ADLs and
blood vessels. desired activity

ody organs Maintain
maybe injured position of
by the force function and
that caused the skin integrity as
fracture evidenced by
fragments. After absence of
a fracture, the contractures
extremities foot drop,
cannot function decubitus, and
properly so forth.
because
normal
functions of
muscle depend
on the integrity
of the bones
K 
 
Reinforce the importance of taking medication regimen
for continuity of care and prevention of the
reoccurrence of the disease.
Encourage the patient to take the medication
compliance.
=
 
Tell the patient that she may have to decrease his
activities and may not be allowed to do any hard
exercises.
 
Advise patient to comply medications as prescribed by
the physician.
  

Advise patient to increase fluid intake to avoid dehydration
Advice the patient to follow balance diet, to check
P and his pulse rate
and ask someone to check her respiratory rate daily, and to have
adequate rest and sleep.

Teach the patient different ways to relieve strain and prevent further trauma
to joints
Cane or walker when indicated
Posture and body mechanics, avoid excessive weight bearing and
continuous standing
Educate the patient regular physical activities, strengthening exercises-
help keep or increase muscle strength, aerobic conditioning
exercises- improve cardiovascular fitness, help control weight, and
improve overall function. Range-of-motion exercises- help reduce
stiffness and maintain or increase proper joint movement and flexibility.
Instruct the patient to consult first the physician or physical therapist to
learn which exercises are appropriate and how to do them correctly,
because doing the wrong exercise


. Advise patient to eat her meals on time and to avoid


drinking cola·s or any beverages when stomach is empty.
Suggest the patient to eat healthy foods from all of the 5
food groups: fruits, vegetables, breads, dairy products,
meat and fish. Eating healthy foods may help her feel
better and have more energy. he may be told to eat
foods that are low in fat and salt.
 
Advise patient to have a strong faith in God and keep
praying. Advise patient to always pray to our lord and
never lose hope in any obstacle that we may encounter.
THANK YOU SO
MUCH Ë