WESLEYAN UNIVERSITY- PHILIPPINES

Cushman Campus
Mabini Extension, Cabanatuan City, Nueva Ecija
COLLEGE OF NURSING

OPEN WOUND FRACTURE:TIBIA FIBULA

LEFT LACERATED WOUND

A Case Study Presented and Submitted to

The Faculty of the College of Nursing

Wesleyan University-Philippines

Cabanatuan City, Philippines

Presented by:

Joson, Lanze Ashley M.

Linsangan, Colyn Anne

Pacio, Heleina F.

Pagkalinawan, Alhena Mae I.

Parungao, Aeron Noriel S.

Pascual, Alessia A.

Petines, Shane Marie C.

Quibuyen, Christine Jean G.

Reyes, Magel Rose O.

BSN LEVEL 3 BLOCK 6

GROUP 3

FEBRUARY 2024

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 WESLEYAN UNIVERSITY- PHILIPPINES
Cushman Campus
Mabini Extension, Cabanatuan City, Nueva Ecija
COLLEGE OF NURSING

TABLE OF CONTENTS

I. Title Page ............................................................................................................ 1

II. Introduction .........................................................................................................3

III. Objectives ............................................................................................................3

IV. Patient’s Profile ...................................................................................................3

V. Nursing Health History .......................................................................................4

VI. Physical Assessment ........................................................................................

VII. Activities of Daily Living...............................................................................

VIII. Developmental Milestones ...............................................................................

IX. Pathophysiology ...............................................................................................

X. Laboratory Findings ........................................................................................

XI. Drug Study ......................................................................................................

XII. Treatment ..........................................................................................................

XIII. Problem Identification and Prioritization ...............................................

XIV. Nursing Care Plan ................................................................................................

XV. Discharge Planning ...............................................

XVI. Implications ........................................................................................

XVII. Health Teaching Plan ............................................................................

XVIII. Bibliography .......................................................................................

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 WESLEYAN UNIVERSITY- PHILIPPINES
Cushman Campus
Mabini Extension, Cabanatuan City, Nueva Ecija
COLLEGE OF NURSING

II. INTRODUCTION

An open fracture occurs when the fractured bone and/or fracture hematoma are exposed
to the external environment due to traumatic injury, with the skin wound often distant
from the fracture site. These injuries typically result from high-energy trauma but can
also occur with low-velocity trauma. Common symptoms include pain, swelling,
difficulty moving the limb, and abnormal positioning. A study in 2020 and 2019 found
road accidents to be the predominant cause of open fractures, with patients averaging
around 33 years old, with a total of 52 patients with 59 open fractures in2020 and 89
patients with 101 open fractures in 2019 met the inclusion criteria (J. Clin Orthop.
Trauma, 2021) The Roy Adaptation Model (RAM), developed by Sister Callista Roy, is a
nursing theory that underscores individuals' adaptation to their environment. It advocates
for holistic care, considering physiological, psychological, and socio-cultural factors
when managing patients with open wound fractures. RAM guides care by assessing
adaptation, diagnosing needs, setting goals, implementing interventions, and evaluating
effectiveness. (J. Breast Health, 2014)

III GENERAL OBJECTIVES

This study aims to broaden the students’ knowledge about Open wound fractures,
and it is designated to promote skills, gain understanding, and provide efficient
nursing care management in handling patients with Open wound fractures.

III. SPECIFIC OBJECTIVES

1. To define Open wound fracture.

2. Be acquainted with the pathophysiology of the case at hand.
3. To recognize the signs and symptoms of the case.
4. Understand the role of therapy in injury or trauma management.
5. Formulate nursing care plan to improve the health condition of the patient.
6. Using the studied theories and ideas of the injury or trauma, appropriately
implement nursing interventions necessary for the patient's condition

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 WESLEYAN UNIVERSITY- PHILIPPINES
Cushman Campus
Mabini Extension, Cabanatuan City, Nueva Ecija
COLLEGE OF NURSING

IV. PATIENT’S PROFILE

This case is about Patient X a 45 years old male patient from Rosario, Pasig City who is
brought via ambulatory to TDH before being transferred to POC and was diagnosed with
open tibia fibula left leg lacerated wound. Patient X was admitted to the hospital on
November 30, 2023 under the supervision of Dr. XYZ (Surgeon)

a. Name: Patient X
b. Address: Rios Compound, Rosario, Pasig City
c. Age: 45 years old
d. Gender: Male
e. Religion: Roman Catholic
f. Occupation: Taxi Driver
g. Marital Status: Married
h. Number of Children (if applicable): 2 sons
i. Chief complaint: left leg lacerated wound
j. Date of admission: November 30, 2023
k. Ethnicity: Filipino
l. Educational Attainment: Highschool Graduate
m. Admitting diagnosis/ final diagnosis: Open Tibia Fibula Left leg Lacerated wound

V. NURSING HEALTH HISTORY

a) HISTORY OF PRESENT ILLNESS

1. Signs and Symptoms

- Pain
- Edema
- Tenderness
- Abnormal movement and crepitus
- Loss of function
- Ecchymoses
- Visible deformity
2. Inclusive dates
- November 30, 2023
3. Precipitating and alleviating factors

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 WESLEYAN UNIVERSITY- PHILIPPINES
Cushman Campus
Mabini Extension, Cabanatuan City, Nueva Ecija
COLLEGE OF NURSING

Precipitating
- from crushing force or direct blow
- vehicular accident

Alleviating Factors
- Surgical Intervention
- Pharmacological Intervention
4. Effects on other body parts
- swelling of the leg
- Paresthesias and other sensory abnormalities
5. Interventions/treatment done
- Surgery
- Pain reliever
- antibiotics
6.Effects of treatment/ intervention done
- alleviated the swellness, pain, edema

b) HISTORY OF PAST ILLNESS

1. Heredo-Familial tendency (genogram with legend)

- none

2. OB history (for female patients)

- none

3. Immunization history (0-15 mos. only)

- none

4. Travel history

- none

5. Surgical Procedures done

- none

6. Hospitalizations

- none

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 WESLEYAN UNIVERSITY- PHILIPPINES
Cushman Campus
Mabini Extension, Cabanatuan City, Nueva Ecija
COLLEGE OF NURSING

7. Accident/ Injuries

- none

8. Childhood illnesses

- none

9. Socio-economic history

- Highschool graduate
- below average income level
- living with his 2 kids, 1 son and 1 daughter
10. Allergies

- none as claimed by the patient

VI. PHYSICAL ASSESSMENT (CEPHALOCAUDAL)

A.General Survey
-Open Wound Fracture
B. Measurement (Height, Weight, BMI, Vital sign)
Measurement:
-Height: 154.94 cm
-Weight: 55 kg
-BMI: 19.52
Vital Signs:
-Blood Pressure: 160/90 mmHg

Date Organ assessed Method Normal Actual findings Interpretation

findings And analysis
(with reference)
December 4,2023 HEAD Inspection -Headache - With a broken
-Lightheadedness bone, we may
feel faint, dizzy
or sick as a result
of the shock of a
breaking bone.
November 30, EARS Inspection Normal
2023

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 WESLEYAN UNIVERSITY- PHILIPPINES
Cushman Campus
Mabini Extension, Cabanatuan City, Nueva Ecija
COLLEGE OF NURSING

November 30, MOUTH AND Inspection Normal

2023 THROAT
November 30, THE Inspection Normal
2023 ABDOMEN Auscultation
Percussion
Palpation
November 30, LEGS, FEET Inspection -Swelling in the -Bacteria enters
2023 AND TOES Palpation area of distal the bloodstream
tibia through the open
-Pain and wound. The
restricted range bacteria which is
of motion on the carried by the
right leg blood, has
-Presence of infected the
wound and pus bone. The body’s
on the right ankle response is to
dilate capillaries
to increase blood
flow to the
affected area.
This results in an
increased
movement of
fluid to the
affected area.
Thus, swelling
occurs.

VII. ACTIVITIES OF DAILY LIVING (NARRATIVE FORMAT)

Functional Pattern Before Hospitalization During Analysis

Hospitalization (with reference and interpretation
after each pattern)
Health Perception- The patient stated that The patient stated Patient cannot function normally
Health health is a need for every that he cannot like before but his health values
Management individual, his health is consider himself as

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 WESLEYAN UNIVERSITY- PHILIPPINES
Cushman Campus
Mabini Extension, Cabanatuan City, Nueva Ecija
COLLEGE OF NURSING

Patter good because he doesn’t healthy like before increased.

have any illnesses before he and was idle
was admitted. He has little sometimes.
to no difficulty in accessing
health care facilities.

Cognitive- Patient stated that he does Patient stated that There is a slight change in a level
Perceptual Pattern not have any formal though he cannot of her thinking with regards to his
education. According to read nor write, he still disease.
him, he can only read can understand his
numbers and she cannot condition because the
read written letters or physician explained
words. everything to him in a
manner he could
understand.

Self-Perception- The patient stated that he He stated that his “Events or situations may change
Self-Concept views herself as functional. self-concept is the level of the self-concept over
Pattern He cited examples like altered. Sometimes, time. Illness and trauma can also
household chores and he said he thinks that affect the self-concept.”
earning a living through his he is a burden to his (Fundamentals of Nursing 7th Ed
job. mother because he is by Barbara Kozier p. 959 and
hospitalized and can 962)
only do minimal task.
Role-Relationship Patient’s wife as he stated The patient stated The patient is more dependent to
Pattern already passed away but he that he has a really his daughter during
said that both of them had a close relationship hospitalization.
good relationship with each with his daughter
other. right now because
she is the only one
taking care of her in
patient’s hospital.
Sexuality- The patient claimed that his The patients does not Sexuality and reproductive
Reproductive reproductive pattern when have an active sexual patterns are affected by the
Pattern the time that his wife is still life. changes that takes place in the
alive is good, though person’s body or in a person’s

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 WESLEYAN UNIVERSITY- PHILIPPINES
Cushman Campus
Mabini Extension, Cabanatuan City, Nueva Ecija
COLLEGE OF NURSING

refuses to talk about things life.

much deeper.

Value-Belief The patient stated that he is Patient stated that his After what happened, patient is
Pattern a Roman Catholic. He said belief to God still seeking for medical
that he believed that God remained the same assistance. Religious effort is still
will help him in his though the frequency part of the patient’s life.
problems. He usually goes of attending mass
to church every Sundays decreased.
and he does not believe in
Hilot and Albularyos.

Nutritional- The patient stated that he Patient stated that he An individual’s health status
Metabolic Pattern has a good appetite and eats is able to eat small greatly affects eating habits and
thrice a day. He usually eats frequent meals a day nutritional status (Fundamentals
vegetables but most of the due to decrease in of Nursing by Kozier p. 1178)
time, he prefers to eat meat. appetite because of Patient’s nutritional’s status has
his illness. been changed due to his
confinement and his diet.

Elimination The patient stated that she During his hospital There was a change in the
Pattern defecates every day and stay, the patient said frequency of the stool and the
urinates approximately 8 that he defecates urine.
times a day. every other day and
urinates
approximately 5
times a day.

Activity-Exercise Patient prefers doing The patient stated During the patient’s confinement,
Pattern household chores in their that his activity and there is quite changes in her
household, such as cleaning exercise pattern was activities and has quite
the house, cooking as his decreased due to restrictions for his actions.
exercise and activity hospitalization.
pattern.

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 WESLEYAN UNIVERSITY- PHILIPPINES
Cushman Campus
Mabini Extension, Cabanatuan City, Nueva Ecija
COLLEGE OF NURSING

Sleep-Rest Pattern The patient has normal The patient stated “Illnesses that causes physical
cycles of sleep. He sleeps 8 that he has a distress can result in sleep
hours a day and takes a nap disturbance in his problems. People who are ill
at 2-3pm. sleep pattern. His require more sleep than normal
hours of sleep are and the normal rhythm and
vary. wakefulness is often disturbed.
(Fundamentals of Nursing, 7th Ed
by Barbara Kozier, et al, p. 1117).

VIII. DEVELOPMENTAL MILESTONES (NOT APPLICABLE)

IX. COURSE IN THE WARD

The patient was brought to the Philippine Orthopedic Center on November 30,2023 with
precipitating factors of crushing force or direct blow from a vehicular accident. The patient was
admitted within the same day and run diagnostic examinations such as X-Ray imaging, complete
blood count test (CBC Test), and Procalcitonin test before proceeding to surgery the following
day, December 1, 2023. Assessments to the patient’s body were also made the same day and
such assessments include; head, ears, mouth and throat, the abdomen, legs, feet and toes using
Inspection,Palpation,Percussion, and Auscultation. After the surgery, the patient was given
medications as prescribed by the physician that was used to treat pain, swelling, as well as help
reduce the risk for infection. The patient was given a DAT(diet as tolerated) kind of diet up until
discharge. The patient was given health teaching on how to properly care for the wound in order
to make the healing process occur at a faster rate. After finding out the lab results and for it to be
not within range that needs intenisve care, after rigorous nursing interventions and diagnostic
testing, the patient is finally well and can be discharged, which was done at nine in the morning,
January 1, 2024.

X. ANATOMY AND PHYSIOLOGY (with picture and reference)

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 WESLEYAN UNIVERSITY- PHILIPPINES
Cushman Campus
Mabini Extension, Cabanatuan City, Nueva Ecija
COLLEGE OF NURSING

The Tibia

The tibia, often known as the shin bone, is a bone that spans the lower leg. It articulates with the
patella and femur at the knee joint and with the tarsal bones at the ankle joint. It is the main
lower limb bone that supports weight.

Proximally, there are five key features of the tibia:

1. It widens and forms two condyles —the lateral and medial—that articulate with the
condyles of the femur.
2. The intercondylar fossa, the small grove situated between the two condyles, is home to
two intercondylar tubercles. These tubercles serve as attachment points for several
internal ligaments that greatly strengthen the knee joint. On the anterior surface of the
proximal region and inferiorly to the condyles is the tibial tuberosity to which the patella
ligament attaches.
3. The shaft of the tibia is triangular and the soleus muscle, which gives the calf its
characteristic shape, originates on the posterior surface.
4. Distally, the tibia also widens to aid with weight bearing and it displays two key features.
The medial malleolus is a bony projection that articulates with the tarsal bones to form
the ankle joint. Laterally, there is the fibular notch that articulates with the fibula.

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 WESLEYAN UNIVERSITY- PHILIPPINES
Cushman Campus
Mabini Extension, Cabanatuan City, Nueva Ecija
COLLEGE OF NURSING

The Fibula
Although it does not articulate with the femur or patella proximally, the fibula crosses the lower
leg as well. It is not a bone that supports weight, but rather a location where muscles can attach
to it. The biceps femoris joins to the fibula head, which articulates with the lateral condyle of the
tibia proximally. Similar to the tibia, the fibula has a triangle-shaped shaft, and the muscles of
the numerus are responsible for the flexion and extension of the foot. These muscles, which
comprise the flexor hallucis longus, soleus, and extensor digitorum longus, among others, come
from the surface of the fibula.
The lateral malleolus of the fibula, which is more noticeable than the medial malleolus of the
tibia, is formed distally. Additionally, it forms the ankle joint by articulating with the tarsal
bones.

XI. PSYCHO-PATHOPHYSIOLOGY

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 WESLEYAN UNIVERSITY- PHILIPPINES
Cushman Campus
Mabini Extension, Cabanatuan City, Nueva Ecija
COLLEGE OF NURSING

XII. LABORATORY FINDINGS

Date Laboratory exam Normal values Result Clinical Nursing

Interpretation Responsibilities
with analysis
(with reference)
12/8/2023 Complete Blood
Count  to analyze the
 RBC COUNT  4.5 - 6.0  7.0 The CBC shows data to
 HEMATOCRIT  0.40 - 0.54  0.57 high hematocrit determine which
 HEMOGLOBIN  120 - 170 g/L  124 g/L amount & RBC results are out of
 150 - 450 x  300 count due of the range. If so, you
 PLATELET 10/L  10 open wound. have to notify
COUNT  5 - 10 x 10/L  70 the right person
 WBC COUNT  0.50 - 0.70  0-30 of these facts.
 LYMPHOCYTES  0.20 - 0.40  0-6
 MONOCYTES  0-0.10  0.01
 EOSINOPHILS  0-0.01
 BASOPHILS

XIII. DRUG STUDY

XIV. TREATMENT
Date Name of treatment Indication/ purpose Nursing
responsibilities

Dec 1,2023 Medication -manage pain, prevent Administer

Administration infection, and promote medications as
healing of the open prescribed to manage
wound fracture pain effectively,
sustained in the prevent or treat
vehicular accident. infection, reduce
inflammation and
promote healing

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 WESLEYAN UNIVERSITY- PHILIPPINES
Cushman Campus
Mabini Extension, Cabanatuan City, Nueva Ecija
COLLEGE OF NURSING

Explain the purpose,

dosage, and potential
side effects of each
medication to the
patient or caregiver.

Administer
medications via the
prescribed route (e.g.,
oral, intravenous,
intramuscular) while
adhering to aseptic
technique.

Document all
medications
administered,
including the type,
dose, route, and time
of administration, in
the patient's medical
record.

Monitor the patient for

adverse reactions or
side effects following
medication
administration and
report any concerns to
the healthcare team.

November 30,2023 Vital Signs -To monitor the Measure and record
Monitoring patient's vital signs for vital signs at regular
signs of distress or intervals, typically
complications. every 4 hours or as
directed by the
physician.

Assess the patient's

overall appearance and

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 WESLEYAN UNIVERSITY- PHILIPPINES
Cushman Campus
Mabini Extension, Cabanatuan City, Nueva Ecija
COLLEGE OF NURSING

behavior for signs of

distress or changes in
condition.

Monitor oxygen
saturation using pulse
oximetry and report
any abnormalities or
signs of respiratory
distress promptly.

Document vital signs

measurements
accurately and legibly
in the patient's medical
record.

Report any significant

changes or
abnormalities in vital
signs to the healthcare
team, including the
physician, for further
evaluation and
intervention.

Dec 2,2023 Assessment of Edema, -To assess and manage Assess the affected
Swelling, and Signs of edema, swelling, and limb for edema,
Infection signs of infection to swelling, redness,
prevent further warmth, and
complications. tenderness.

Measure and record

the circumference of
the affected limb to
monitor for changes in
swelling.

Inspect the wound for

signs of infection such
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 WESLEYAN UNIVERSITY- PHILIPPINES
Cushman Campus
Mabini Extension, Cabanatuan City, Nueva Ecija
COLLEGE OF NURSING

as increased redness,
swelling, warmth,
purulent drainage, or
foul odor.

Use aseptic technique

when inspecting the
wound to prevent
contamination and
infection.

Document assessment
findings accurately and
report any concerns or
changes in the patient's
condition to the
physician.

Educate the patient and

family members about
signs and symptoms of
infection and the
importance of
reporting any changes
promptly for early
intervention.

Dec 1,2023 Diagnostic Tests (X- -To assess the extent Schedule and
Ray, Complete Blood of the injury, monitor coordinate diagnostic
Count, Procalcitonin for potential tests, including X-ray,
Test) complications, and complete blood count
guide treatment (CBC), and
decisions. procalcitonin test, in
collaboration with the
healthcare team and
radiology/laboratory
staff.

Ensure patient
understanding of the

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 WESLEYAN UNIVERSITY- PHILIPPINES
Cushman Campus
Mabini Extension, Cabanatuan City, Nueva Ecija
COLLEGE OF NURSING

purpose and
procedures for each
test, providing
appropriate
instructions and
reassurance.

Monitor the patient for

any signs of
discomfort or adverse
reactions related to the
diagnostic tests and
intervene as needed.

Document the
completion of
diagnostic testing,
including patient
education, specimen
collection, and
communication of
results, accurately and
thoroughly in the
patient's medical
record.

Communicate any
abnormal findings or
concerns to the
healthcare team for
further evaluation and
treatment planning,
ensuring timely
follow-up and
continuity of care.

XV. PROBLEM IDENTIFICATION AND PRIORITIZATION

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 WESLEYAN UNIVERSITY- PHILIPPINES
Cushman Campus
Mabini Extension, Cabanatuan City, Nueva Ecija
COLLEGE OF NURSING

Nursing Diagnosis/ Cues Type and Rank Justification

Based on NANDA or Activities Actual According to ABC or Maslow’s

of daily living Risk Hierarchy of needs or triage
Possible
Wellness
Syndrome

XV1. NURSING CARE PLAN

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 WESLEYAN UNIVERSITY- PHILIPPINES
Cushman Campus
Mabini Extension, Cabanatuan City, Nueva Ecija
COLLEGE OF NURSING

ASSSESSMENT NURSING PLANNING NURSING RATIONALE EVALUA

DIAGNOSIS INTERVENTION
SUBJECTIVE Short Term: Short
-Incorporating knowledge
DATA: Knowledge -Assessment for knowledge deficit assessment as a routine Term:GO
deficit due to After 8 hours deficit practice allows the nurse to WAS ME
Chief limited of nursing identify and address gaps in After 8 ho
client understanding, leading
Complaint: access to intervention, to safer, more informed, and nursing
“Paano ba yung education the client will better-managed healthcare interventi
pag-aalaga sa and low verbalize experiences. the client
injury ko? First health understanding -Assess the motivation and -The client’s motivations able to
time kasi na literacy as of the disease willingness of the client to provoke them to search for verbalize
nangyari sa evidenced by process and learn. possible treatments and to understan
follow these treatments in
akin ito at hindi anxiety and treatment spite of their hardships and of the dis
ko alam ang confusion regimen. difficulties. process a
dapat gawin” as treatment
-Utilize learning assessment -Many learning assessment
verbalized by the Long Term: guides as available. guides are available for regimen.
patient nurses to use to assess the
After 1 week client’s readiness to
learn.Such guides facilitate
OBJECTIVE of nursing assessment but must be Long Ter
DATA: interventions, adapted to the responses, GOAL W
the client problems, and needs of each MET
client.
-Date of will correctly -Provide immediate feedback After 1 w
Admission: perform on performance. - Immediate feedback allows nursing
Nov. 30, 2023 necessary the learner to make interventi
corrections rather than
procedures practicing the skill wrongly. the clien
-Admitting and explain -Allow repetition of the now able
Diagnosis: reasons for information or skill. -Repeated practice allows correctly
clients to gain confidence in
Open Tibia actions, as their self-care ability. The perform
Fubula, Left Leg well as nurse should demonstrate the necessary
Lacerated identify their skill and give the learner procedure
ample opportunity for
Wound own stress practice, when special explain re
and risk equipment is involved. for action
-Visible factors and -Educate the client about the well as id
advantages of adhering to the
confusion and some prescribed regimen. -Clients who understand the their own
anxiety techniques effectiveness of the suggested and risk f
for handling treatment to reduce risk or to and some
promote health are more
them. likely to engage in it. technique
handling

XVII. DISCHARGE PLANNING (APPLICABLE ONLY IF THE PATIENT IS DISCHARGE)

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 WESLEYAN UNIVERSITY- PHILIPPINES
Cushman Campus
Mabini Extension, Cabanatuan City, Nueva Ecija
COLLEGE OF NURSING

M-Medication (only includes those that were prescribed by the physician and were required to be
taken at home)

Name of drug Dosage and Route Time Curative Side effects

frequency effects

E-Environment/ Exercises (if the physician did not order any particular exercise regimen for the
patient, just include those activities that may be essential to the patient’s faster recovery)

Type of activity/ allowed/ Procedure/ steps Use of Restriction Rationale

to be continued at home equipment (if
any)
Ankle Pumps While lying pillow in moderation To improve circulation in
down, lift your your legs, preventing blood
feet off the bed clots
and flex your
ankles to pump
the blood back
up your legs
Effective in improving pain,
in moderation function, and quality of life
Quadriceps Contractions None in patients with osteoarthritis
Tighten your of the knee
quadriceps (front
of thigh) muscles
by lifting your
leg off the bed,
hold for a few
seconds, and
then release. Improved muscle definition
Repeat this and tone, strengthened knee
exercise for 10- In moderation joints and supporting
Seated leg extension 15 repetitions Chair structures

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Cushman Campus
Mabini Extension, Cabanatuan City, Nueva Ecija
COLLEGE OF NURSING

Sit on a chair
with your feet
flat on the
ground. Lift your
left leg and
straighten it,
hold for a few
seconds, and
then release.
Repeat this
exercise for 10-
15 repetitions.

T-Treatment (Treatment includes those prescribed by the physician i.e., regular monitoring of
blood sugar, nebulization, etc)
Name of treatment Indication/ purpose Nursing responsibilities
- Wound care/ Infection -Wound care to encourage recovery and - Nurses train patients and their families
prevention prevent infection. The goal of wound on how to care for wounds, how to
care is to shield the wound from more recognize infection symptoms, and how to
harm or infection while simultaneously take care of themselves at home. To make
providing a sterile, moist environment sure that patients know how to take care
for the wound to heal. of their wounds, they also show
appropriate wound care practices.

H-Health teaching
1. Wound Care:
- Maintain a dry and clean wound. Wash the area gently with water and mild soap, or as directed
by your healthcare practitioner.
- As instructed by your healthcare practitioner, change the dressings. Keep an eye out for any
symptoms of infection, such as pus, increasing temperature, swelling, or redness.
-Refrain from removing any sutures or picking at scabs by yourself.

2. Infection Prevention:

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Cushman Campus
Mabini Extension, Cabanatuan City, Nueva Ecija
COLLEGE OF NURSING

-To stop the transmission of germs, wash your hands both before and after touching the wound.
- To shield the wound from external microorganisms, keep it covered with a sterile, clean
covering.
- Keep an eye out for infection-related symptoms such as increasing discomfort, redness,
swelling, or discharge. In case you have any alarming symptoms, get in touch with your
physician.

3. Mobility and Rehabilitation:

- Follow to any mobility limitations that your healthcare physician may have prescribed. This
might entail using crutches for assistance or refraining from bearing weight on the injured limb.
- Follow your doctor's advice and engage in mild activity to avoid muscle atrophy and increase
circulation.
- Attend physical therapy sessions as directed to restore your leg's strength and range of motion.

4. Nutrition and Hydration:

- Consume a well-balanced diet high in vitamins, minerals, and protein to aid in the healing
process and general recuperation.
- To promote recovery, stay hydrated by consuming lots of water.
- Avoid smoking and drinking since these behaviors might hinder the healing of wounds.

5. Follow-up Care:
- Keep up with all follow-up consultations with your physician to track the development of your
healing wounds.
- Ask any questions you may have regarding your wound or any worries you may have about the
healing process.

O-Out Patient ( Date of return/ Time/ Place: Room number and name of the institution /
Physician)
(1/04/2024/ 9:00 am/ room number 4 / Ward 3, Philippine Orthopedic Center)

D-Diet (It must be specific. Take mention examples for breakfast, lunch and dinner including its
servings and explain why these particular foods are essential to the client’s condition. Also,
provide a list of foods contraindicated to the patient. Provide a 3-day food meal. Furthermore,
show the diet prescription computation before filling the diet plan).

Meal Serving Rationale

Breakfast Scrambled eggs with whole 1 serving Breakfast is an important meal that kickstarts the

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Cushman Campus
Mabini Extension, Cabanatuan City, Nueva Ecija
COLLEGE OF NURSING

grain toast and a side of metabolism and provides essential nutrients to start
fruit such as melons or the day. For a patient with an open fracture, a
bananas balanced breakfast can help support energy levels
and aid in tissue repair and healing.
Snack (if Fresh fruits 1 serving all great options for snacks as they provide
applicable) vitamins, minerals, and fiber. They are also easy to
eat and transport
Lunch Grilled chicken breast with 1 serving A nutritious lunch is essential to refuel the body and
brown rice and steamed provide sustained energy throughout the day. Proper
broccoli nutrition at lunchtime can support wound healing
and recovery from injury.
Snack (if Nuts and seeds 1 serving all rich in protein, healthy fats, and vitamins that
applicable) support wound healing. They can also help prevent
muscle loss during recovery.
Dinner Steamed or roasted 1 serving Dinner is an opportunity to replenish nutrients,
vegetables for vitamins, promote healing, and prepare the body for rest and
minerals, and fiber. recovery during sleep. Including a balance of
macronutrients and micronutrients in the dinner
meal can support the healing process.

S-Spiritual and Sexual (if applicable) - These may include spiritual counseling, anger
management, family therapy, and reconciliation of conflicted relationships.

-Prayer and Meditation: To assist reduce tension and anxiety and create a sense of peace and
relaxation, encourage the patient to participate in prayer or meditation sessions. This can support
emotional health and the healing process.

-Mindfulness Practices: To assist the patient in focusing on the present moment and to encourage
relaxation and clarity, introduce mindfulness techniques like yoga, guided imagery, and deep
breathing exercises.

XVIII. IMPLICATIONS OF THE CASE TO THE FOLLOWING AREAS:

a. Nursing research

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Cushman Campus
Mabini Extension, Cabanatuan City, Nueva Ecija
COLLEGE OF NURSING

The case study not only introduces new information to enrich the diagnosis of the open fracture
but also incorporates a multifaceted analysis, considering various aspects of the patient's medical
history, laboratory results, socio-economic factors, and the evolving nature of the symptoms.
This comprehensive approach enhances the overall understanding of the case, contributing to a
more nuanced and effective diagnostic and treatment strategy.
b. Nursing Education
Their direct interaction with the patient gave them a deeper comprehension of the situation. The
case study evolves as a result of this smooth integration of practical experience, which highlights
the value of real-world application and practical skills in healthcare education while
simultaneously enhancing the theoretical understanding of open fractures. This all-encompassing
method is essential to creating a more thorough educational experience and preparing medical
practitioners to handle the complex and demanding aspects of patient care in a variety of clinical
settings.
c) Nursing practice (clinical)

A significant change occurs when the real-life interaction is effectively incorporated into their
RLE practice. Their clinical skills not only become much stronger, but when complex patient
scenarios arise, they also get a greater sense of confidence and readiness. Providing treatment to
a patient who is dealing with an open fracture directly becomes a crucial part of their training
experience, shaping them into more skilled and resilient medical professionals.

XIX HEALTH TEACHING PLAN

WOUND CRE

objective Content Methods of Time resources Methods of

instruction allocation evaluation
a. COGNITIVE  List of the a. Demonstration: Demonstrat  White  Question and
 Understand the risk ion board answer
Description: A 20-30  Handout verbalization.
importance of factors.
healthcare minutes
proper wound  Importanc professional  Pictorial  participants
care in open e of wound physically flipchart share their plans
fractures. caring. demonstrates proper Lectures and engage in a
 Identify signs  List step- wound cleaning and 10-15mins brief discussion.
and symptoms by-step dressing techniques.  Debrief on the
b. Lecture: practical session,
of infection in procedures
Laboratory addressing any
an open wound. . Description: An 15-30mins
 Recall the steps  Express informative challenges or
involved in feelings presentation is concerns.
cleaning and  Encourage delivered, covering Deductive
dressing an key concepts, signs 10mins
questions
of infection, and the
open wound. and

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Cushman Campus
Mabini Extension, Cabanatuan City, Nueva Ecija
COLLEGE OF NURSING

 Explain the inquiries. importance of Inductive

significance of adherence to 15minutes
regular follow- medications.
c. Laboratory:
up
Project
appointments Description: Method
for wound Practical sessions 5-10minutes
assessment. are conducted in a
b. AFFECTIVE controlled setting to
reinforce wound
 Develop a
care skills learned
positive attitude through
towards active demonstrations.
participation in d. Deductive:
personal wound
care. Present general
wound care
 Demonstrate
principles.
empathy and e. Inductive:
sensitivity when
discussing the Present specific
impact of an wound care
open fracture on scenarios related to
open fractures,
the patient's
allowing patients to
daily life. draw general
 Express a principles from
commitment to these examples.
maintaining a f. Project
clean and Method:
healthy
creating a
environment to personalized wound
facilitate the care plan.
healing process.
c. PSYCHOMOTOR
 Demonstrate the
proper technique
for cleaning an
open wound to
prevent infection.
 Exhibit proficiency
in applying
dressings and
bandages to
promote wound
healing.
 Practice correct
hand hygiene
procedures before
and after wound
care.

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Cushman Campus
Mabini Extension, Cabanatuan City, Nueva Ecija
COLLEGE OF NURSING

MOBILITYAND REHABILITATION
objective Content Methods of Time resources Methods of
instruction allocation evaluation
d. COGNITIVE  List of the g. Demonstration: Demonstration  White  Question
 Patients need to risk 20-30 minutes board and answer
Description: This  Handout verbalizatio
understand any factors.
method involves
mobility  Importanc showing patients  Pictorial n.
Lectures
restrictions e of how to perform 10-15mins flipchart  participants
related to their mobility exercises, mobility, share their
open wound, and and rehabilitation plans and
such as rehabilitati activities. Laboratory engage in a
avoiding certain h. Lecture: 15-30mins brief
on.
movements or  List step- Description: A discussion.
activities that by-step traditional method  Debrief on
Deductive
could hinder the procedures of instructing where 10mins the practical
healing process. . information is session,
 They need to presented verbally Inductive addressing
 Express
to the patients. 15minutes any
understand how feelings Laboratory:
these exercises  Encourage challenges
Description:
contribute to the questions Involves hands-on or concerns.
Project
overall healing and practice in a Method
and restoration inquiries. controlled 5-10minutes
of mobility. environment.
Deductive:
AFFECTIVE This method
 Patients should involves presenting
be motivated to general principles or
theories first,
actively
followed by specific
participate in examples or
their own care, applications.
recognizing the i. Inductive:
impact of their
efforts on the The opposite of
deductive, this
healing process.
method involves
 Building a presenting specific
sense of examples first,
responsibility followed by general
towards their principles or
health is crucial theories.
for adherence to j. Project
treatment plans. Method:
e. PSYCHOMOTOR creating a
 Patients need to personalized
show improvement exercise plan and
in their ability to movements.
move and perform
activities without
causing harm to the

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Cushman Campus
Mabini Extension, Cabanatuan City, Nueva Ecija
COLLEGE OF NURSING

open wound.
 Rehabilitation
exercises should
result in enhanced
mobility and
functionality.

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Cushman Campus
Mabini Extension, Cabanatuan City, Nueva Ecija
COLLEGE OF NURSING

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