Saturday, June 28, 2008
acute cruciate ligament injury...I. BIOGRAPHIC DATA
Name: Mr. BASKETBOLISTA
Address: Taguig City
Age: 25 years old Gender: Male Religious Affiliation: Roman Catholic
Marital Status: Single Occupation: Military Service Man
Room and Bed #: Surgical ward Bed #2
Chief Complaint: Pain in right knee
Admitting Diagnosis: Anterior Cruciate Ligament with Tear
Reason for admission: For further evaluation and management
Attending Physician: Capt. Dino Flores
II. NURSING HISTORY
A. Past Health History
The client experienced fever and convulsions during his childhood years. He acquired chickenpox when he was 12 and measles when he was 17. He cannot recall if he was fully immunized or not. He just states that in his service as a military, they were given vaccination annually but he cannot recall the indication of it. He has no known allergies to any foods and drugs. Presently, he is diagnosed of acute cruciate ligament (ACL) which was started 2 weeks before the consultation. He is currently taking Mobic as analgesia.
B. History of Present Illness
The client went to Manila Naval Hospital last June 20, 2008 with the chief complain of severe pain and swelling at the right knee. Two weeks prior to admission, he experienced pain on the right knee which was first thought to be a sprain. According to him, the pain scale rate 8. He applied cold compress on the affected area for 20 minutes daily to alleviate pain. The client had been playing basketball since grade school and at his age, he already experienced 13-16 times of sprain all in the same leg (right). One week prior to admission, aside from pain, there is also a presence of swelling in his right knee. He said that it was the first time he would be confined in a hospital for playing basket ball. He verbalized, “Sa lahat ng sprain ko, ngayon lang tumagal ang sakit ng lampas 2 weeks”, which indicated that what happened to him is not just a simple sprain. Synovial fluids have been removed from his right knee twice since confinement. He was diagnosed having Anterior Cruciate Ligament Injury. He was advised by the physician to undergo arthroscopy.
C. Family History
His father died when he was 21 years old due to complications secondary to diabetes. Two of his siblings are hypertensive. Two of his uncles also have diabetes mellitus. The patient claimed that his maternal side has no heredo-familial disease.
III. PATTERNS OF FUNCTIONING
A. Psychological Health
Mr. Basketbolista describes himself as a strong and out-going kind of person. He is well satisfied in earning enough money and gives a part of it to his mother. As a bachelor, he enjoys mingling with his friends and co-army. Whenever problems or difficulties arise, he often times keeps it to himself or share it with his closest friend.
The client’s highest educational attainment is college graduate. He usually makes his own decisions when it comes to his health and body. However, whenever it comes to his health he chooses to go to a physician whenever he feels sick. The client easily understands and answers questions clearly, simple and precise. At present the client has no problem with speaking, writing or reading.
Interpretation and Analysis:
Over all, the client is currently happy and contented with his life. Even though he goes through stressful events he knows how to cope up with it. He has friends and family members in which they build and maintain meaningful relationships. The client also builds knowledge and skills and also strives to do his best for his future.
B. Socio-Cultural Patterns
Being an army is a fulfilled childhood dream to him. As an army, he is obliged to be far from home and be in a place where his service is needed. According to him, he is satisfied to the compensation he is getting from it. The client is on his second year on this profession and has a rank of Second Lieutenant (SL). He is still single and as of now, it is his mother that he considered as the most significant to him.
Interpretation and Analysis:
The financial needs of people of his age should be enough to meet his needs including of his dependents. It is this time that one plans for his future, builds his own home and starts his own family. Being satisfied and happy to your profession is important for if one wants something, he will never lose interest on it.
C. Spiritual Patterns
The client is a Roman Catholic. He seldom goes to church because of his profession- sometimes, church is not available. However, he never forgets to say a prayer before going to bed. He believes that everything happens for a reason and he became an army for a reason.
Interpretation and Analysis:
During this age, a person may not be an active member of the church because of the responsibilities they have to face.
IV. ACTIVITIES OF DAILY LIVING
Activities of Daily Living Before Hospitalization During Hospitalization Interpretation / Analysis
Nutrition According to the client, his usual diet preferences are vegetables fish and meat.
-The client’s diet is DIET AS TOLERATED. Normal
Elimination According to the client he usually urinates 8 times in a day. He feels no pain or discomfort while urinating.
And defecates 2 to 3 times a day. The client reported that he only urinates 4 times a day.
The client has changes in her bowel movement. He only defecates once a day. Immobilization and sedentary lifestyle decrease peristaltic movement.
Exercise Engages in vigorous exercises. Every Tuesday and Thursday, the client exercise from 1pm to 5pm as part of their routine; then plays basketball every Sunday for 4 hours. The only exercise the client performed was walking and limited range of motion exercises. Limiting patient’s activities prevents the possibility of exacerbating the injury of Anterior Cruciate Ligament.
Hygiene The client takes a bath once or twice a day. He brushes his teeth every after meal and makes sure her body is maintained clean as much as possible. The client still takes a bath once or twice.
He brushes his teeth every after meal and makes sure her body is maintained clean as much as possible.
A healthy hygiene contributes to the client’s overall wellness. The client is aware of the importance of having a good hygiene.
Substance use The client doesn’t drink alcoholic drinks or caffeine nor take any illegal drugs. The client does not smoke nor drink alcoholic drinks or caffeine nor take any illegal drugs. Avoiding such substance use contributes to the client’s health and wellness and prevents the occurrence of certain diseases.
Sleep and Rest The client reported that he sleeps 4-5 hours minimum and at the most 6 hours everyday. He does not take any naps.
During the client’s hospital stay, he sleeps 14-16 hours a day. Rest periods are needed by the client to be well. Changes in the sleep and rest pattern of the client can be due to her adjustments in the change in location (from home to the hospital setting).
Sexual Activity The client said that he is active.
The client has no sexual activity at all. Sexual activity may need to be curtailed or eliminated due to the case of the client.
V. PHYSICAL ASSESSMENT
Measurements Normal Values Actual Findings Interpretation and Analysis
Temperature 36.5-37.5 36.2 Normal
Pulse rate 60-100 72 Normal
Respiratory Rate 12-20 19 Normal
Blood Pressure Systolic:100-130
Diastolic: 60-90 110/80 Normal
Body Part Normal Findings Actual Findings Analysis / Interpretation
Head
Symmetrical, smooth skull contour, no area of tenderness, proportion Symmetrical, smooth skull contour, no area of tenderness, proportion Normal
Hair Shiny, black hair, no signs of dandruff Black, curly hair with no dandruff Normal
Face
Symmetrical, clear no pimples, no scar Symmetrical, no pimples, no scar Normal
Eyes Symmetrical and align, pink palpebral conjunctivae Symmetrical and align, pink palpebral conjunctivae Normal
Ears No discharge, no hearing loss, no tinnitus No discharge, no hearing loss, no tinnitus Normal
Nose Symmetrical, no discharge, no colds Symmetrical, no discharge, no colds Normal
Mouth No lesions, no sore throat, no hoarseness, moist buccal mucosa, lips not chapped No lesions, no sore throat, no hoarseness, moist lips Normal
Neck Supple and bilateral Supple and bilateral Normal
Chest
Symmetrical chest expansion, no retractions, no crackles, no murmurs Symmetrical chest expansion, no retractions, no crackles, no murmurs Normal
Upper extremities No edema, full equal pulses, symmetrical No edema, full equal pulses, symmetrical Normal
Skin Good skin turgor, no dermatoses, no lesions
No lesions, good skin tugor Normal
Abdomen Flabby, soft Flabby, soft Normal
Lower Extremities No edema and swelling, symmetrical Swelling of right knee Deviation from normal: swollen knee. (Fundamentals of Nursing 7th edition, Kozier; p.601)
VI. Laboratory and Diagnostic Examination Results
June 2 , 2008 Blood Chemistry
Differential Count
• Eosinophils
• Segmenters
• Lymphocytes
• Monocytes NORMAL
5-10x10 9/ L
0.55 - 0.65
0.25 - 0.35
0.02 - 0.06 ACTUAL FINDINGS
7.8 X 10 3 /L
0.64
.34
.02 INTERPRETATION
Normal
Normal
Normal
Other Diagnostic Procedures:
ECG revealed Left Axis Deviation
Interpatation: It is easiest to define axis by quadrants. A normal axis is defined as lying within the limits of 0° and +90°. LAD (Left Axis Deviation)
For Arthroscopy
VII. Medications
Generic Name Dosage Indications Contraindications Adverse Reactions Nursing Responsibilities
Meloxicam
(NSAID)
Brand name:
Mobic
15 mg/day
The lowest effective dose should be used for each patient. Meloxicam therapy usually is started at 7.5 mg daily. Some patients require a dose of 15 mg daily, but this dose should be taken only under the direction of a physician. Meloxicam may be taken with or without food.
Meloxicam is used to treat tenderness, swelling and pain caused by the inflammation of osteoarthritis and rheumatoid arthritis.
Meloxicam blocks the enzymes that make prostaglandins (cyclooxygenase 1 and 2) and reduces the levels of prostaglandins. As a result, inflammation and its accompanying symptoms are reduced.
Active Peptic Ulceration
Severe hepatic insufficiency
Children below 15 years old
Pregnancy and lactation
Patients who develop signs of asthma, nasal polyps, angioedema, or urticaria
• diarrhea
• constipation
• sore throat
• cough
• runny nose
• fever
• blisters
• rash
• hives
• itching
• swelling of the eyes, face, tongue, lips,throat, arms, hands, feet, ankles, or lower legs
• difficulty breathing or swallowing
• hoarseness
• pale skin
• fast heartbeat
• unexplained weight gain
• upset stomach
• excessive tiredness
• lack of energy
• yellowing of the skin or eyes
• pain in the right upper part of the stomach
• flu-like symptoms
• cloudy, discolored, or bloody urine
• back pain
• difficult or painful urination
do not take if allergic to aspirin or other NSAIDs
Meloxicam should be used with caution in combination with blood thinning medications such as warfarin (Coumadin) because of an increased risk of bleeding.
Never take it with aspirin-it may increased risk for developing an ulcer.
Persons who have more than 3 alcoholic beverages per day may be at increased risk of developing stomach ulcers when taking meloxicam or other NSAIDs.
use caution engaging in activities requiring alertness such as driving or using machinery
VIII. Pathophysiology
IX. Ecologic Model
Hypothesis: Hyper extension is the cause of anterior cruciate ligament injury.
Agent
Host
Environment
ANALYSIS:
The anterior cruciate ligament (ACL) is probably the most commonly injured ligament of the knee. In most cases, the ligament is injured by people participating in athletic activity. As sports have become an increasingly important part of day-to-day life over the past few decades, the number of ACL injuries has steadily increased. This injury has received a great deal of attention from orthopedic surgeons over the past 15 years, and very successful operations to reconstruct the torn ACL have been invented. (http://www.eorthopod.com/public/patient_education/6506/anterior_cruciate_ligament_injuries.html)
Movements of the knee that place a great strain on the ACL can cause damage to the ligament. Hyperextension of the knee, that is, if the knee is straightened more than 10 degrees beyond its normal fully straightened position, is a very common cause of an ACL tear. This position of the knee forces the lower leg excessively forward in relation to the upper leg. Activities placing the knee into hyperextension and /or the tibia into excessive inward rotation can be from either an outside force or non-contact in nature.
The types of sports that have been associated with ACL tears are numerous. Those sports requiring the foot to be planted and the body to change direction rapidly (such as basketball) carry a high incidence of injury. In this way, most ACL injuries are considered noncontact. (http://www.ehealthmd.com/library/acltears/ACL_causes.html)
CONCLUSION AND RECOMMENDATION:
I therefore conclude that hyperextension of the knee is the main cause of anterior cruciate ligament injury.
The initial goals of treatment immediately after injury is to reduce pain and swelling and regain range of motion and strength. Even if surgery is likely, achieving as much knee motion and strength as possible can greatly reduce complications after surgery. Immediately after an ACL injury, the so-called R.I.C.E. treatment is recommended.
R.I.C.E. stands for:
Rest - The individual is advised to rest the knee from weight-bearing activities allowing the swelling to settle.
Ice - Placing a cold compress or ice pack on the knee is helpful in controlling inflammation as well as helping to reduce pain.
Compression - Utilizing an ace wrap for compression around the knee is beneficial to control the swelling.
Elevation - Lying down with the leg elevated higher than the level of the chest is helpful in controlling and reducing swelling.
XI. Discharge Plan
MEDICATIONS
Take prescribed medications by the physician with the given dose and frequency to promote and maintain faster recovery.
ELIMINATION
Mobilization is encourage to increase peristalsis.
Increase fluid intake is adviced.
TREATMENT:
Consult physician
Consult physical therapist
Ice may be applied for 20 to 30 minutes several times a day
HEALTH EDUCATION:
Keeping the affected area elevated above the level of the heart
Encourage brisk walking.
OUT PATIENT FOLLOW-UP
Have regular physical check-up with physician at least once a year
DIET
Maintain a balanced diet.
Drink lots of fluids particularly water.
SEXUAL INTERACTION
Can have an intercourse if the client can tolerate.
0 eavesdropped
