INTRODUCTIONMandibular fracture is a frequent injury because of the mandible's prominence and relative lack of support.This is the second most common facial fracture in sports because of the anterior location on the skull. The most common cause of broken or dislocated jaw is accident or trauma involving a blow to the face. This may be the result of a motor vehicle accident, industrial accident, recreational/sports injury, or other accident. It may also result from assault.It is usually fractures in more than one place and occurs on opposite sides of the midline of the jaw. These fractures can either be displaced (more severe with bone ends separated and moved apart) or nondisplaced (bone ends aligned).The signs and symptoms of a displaced broken jaw includes gross deformity, malocclusion (teeth do not align when jaw is closed),oral bleeding,paresthesia or anesthesia of lower lip and chin,changes in speech,swelling,bruising to the floor of the mouth and mucous membrane tears. While the signs and symptoms of a nondisplaced broken jaw includes oral bleeding oozing between the teeth,point tenderness over the fracture site,pain on opening and closing the jaw,swelling and discoloration.The immediate treatment of a broken jaw is to focused on maintaining an open airway with the patient in a sitting position with the hands supporting the lower jaw. This position will allow the blood to flow forward and out of the mouth rather than back into the throat.Because the amount of force required to fracture the mandible is significant, care must be taken to evaluate the patient for possible concussion and/or brain injury also.To determine if the patient has any signs and symptoms ofconcussion,check for the following: dizziness, headache, confusion, nausea, ringing in the ears and inability to answer simple questions.An unconscious patient suspected concussion should be placed on the side with head tilt and jaw support after the mouth has been cleared of any broken or dislodged teeth.The jaw can be immobilized using an ace bandage or roller gauze but care must be taken to ensure that the jaw is not displaced posteriorly which may compromise the airway. The bandages can be wrapped under the chin and over the top of the head. A crushed ice pack can be applied to the area to reduce the amount of swelling. However, care must be taken that the weight of the ice pack does not displace the fracture. The goal of treatment is proper alignment of the jaw bone so the upper and lower teeth come together normally. Surgery is often required for moderate to severe fractures to align and immobilize the bone so it can heal.If the patient has sustained a nondisplaced jawbone fracture, the healing can be managed conservatively with analgesia and rest. To allow the fracture to heal properly, the patient should only eat soft foods for up to four weeks or as long as recommended by the treating physician.Most displaced jawbone fractures will require closed reduction and internal fixation for four to six weeks. While the patient jaw is wired shut, the patient should be consuming high-protein, high-carbohydrate liquid diets. It is normal for a patient to lose between 5% and 10% of his/her body weight during this time. If there is concern about the amount of weight lost, the patient should consult with a nutritionist.The patient is safe to light activities such as stationary cycling, walking, and light resistance exercises can be performed during the time of fixation to maintain muscle tone. Care should be taken not to increase the heart rate to a level where increased oxygen is needed for the muscles because the athlete is only able to breathe through his/her nose and not able to breathe through his/her mouth to increase the oxygen uptake. It is recommended that the athlete should not return to contact or collision sports until one to two months after the jaw is unwired. Available at: http://www.sportsmd.com/Articles/tabid/1010/id/24/Default.aspx?n=broken_jaw_(mandibular_fracture) [February, 2013]According to World Health Organization, fractures of the mandible have been reported to account for 36-70% of all maxillofacial fractures. All reports apparently show a higher frequency in males aged 21-30 .Other contributing factors, such as socioeconomic status, environment, alcohol use, and mechanisms, show greater variability. According to the national statistics of the Department of Health, The major cause of mandibular fracture was alleged assaults or mauling comprising 60 (43.5%) cases of the entire study. The symphysis was the part of the mandible most susceptible to fracture having 75 (54%) cases of the study.In the local statistics of Baguio General Hospital and medical center, maxillofacial fractures is 4th leading causes of major admissions. The group NPB-1 was assigned at Baguio General Hospital and Medical center last January 31 February 1-2 and 7-9, 3-11 shift ENT Ward under the supervision of Ms. Maureen M. Sabalburo. The group chose to defend this because it is the only case that is not under observation. Through this case study, we can be able to appreciate the process on how the condition progress by observing the patients signs and symptoms, knowing the risk factors, what are the specific kinds of problems that may lead to the patient current condition, diagnostic exams, surgical management, pharmacologic treatment and proper intervention. Our group aimed to review and analyze this case which will provide us with the right knowledge, skills, and attitude. It is also when the concept of the Nursing process is emphasized through actual practice and it provides necessary tool to enable the group to render quality nursing care to the patient by formulating nursing intervention and management through observation and interview to the patient as well as the family members.Lastly this case study will served as review material in our goal to become a member of health care providers.Goal:To provide quality and effective nursing care to our patient and to expand our understanding about Mandibular fracture.Objectives:This case study aims to: define Mandibular fracture and its effect to the body as a whole; perform comprehensive assessment of this condition to formulate appropriate nursing care plans suited for the client based on the assessment of findings; provide independent nursing interventions; be well prepared with the information regarding this condition and to share our knowledge not only to the patient but as well as the members of the patients family.

I.PATIENTS PROFILEName: Patient X

Age: 18 years old Date of Birth: October 04, 1994

Nationality: Filipino

Religion: Roman Catholic

Gender: Male

Civil Status: Single

Address: Loakan Liwanag, Baguio City

Occupation: Student

Ward: ENT Ward

Date of Admission: January 29, 2013

Time of Admission: 10:55 am

Chief complaint: Mandibular fracture, mandibular pain, swelling

Admitting Diagnosis: Mandibular fracture symphyseal areaOperation Performed: Open reduction and internal fixation, Maxillomandibular fixation

B. Patients Health HistoryB.1 History of Present Illness

Last Sunday of January 20, 2013, the patient was intentionally punched by his friend on the mandible. He did not experience loss of consciousness, bleeding, headache and dizziness. The following day, he noticed that his teeth where he was punched stood apart, he was then accompanied by his mother to consult a dentist and he undergo a panoramic view where it shows that he had a mandibular fracture. He was referred to an ENT physician for further management and was advised to undergo an operation. However, due to the lack of money at that time they were not able to buy titanium for his operation, he was then given an antibiotic as home medication.After a few days, swelling subsided and no mandibular pain but there is a presence of discomfort on the mandible. The patient came back for follow up 1 day prior to admission and was advised to undergo operation. Hence, admitted at Baguio General Hospital and Medical Center.B.2 History of Past IllnessThe patient has no history of previous operation and hospitalization. But he suffers from common cough and colds.

B.3 Social and Environmental HistoryPatient x is a student and lives with his parents and siblings, thus considering them a nuclear family. They live in a concrete house with good ventilation that is situated not far from central business unit. The patient is a non-smoker but he is an alcoholic beverage drinker. He drinks 1-2 bottle of 2x2 in a week.

CHAPTER 2 ASSESSMENT13 AREAS OF ASSESSMENTI. Psychosocial StatusA. GENERAL SOCIAL STATUSPatient X lives with his family in a semi-concrete house. He complies with nursing intervention such as vital signs done by student nurses. He has no religious beliefs that might affect the actions to healthcare delivery. He also openly interacts with the nurses and student nurses on duty. He described their family as nuclear; he lives with his brothers and parents. He is a high school graduate.II. Mental and Emotional StatusThe patient was oriented to person, time and place. He is responsive to stimuli and cooperates to hospital routines as well. He answered questions coherently and briefly during the interview. The patient was able to read and write and can speak Ilocano and Tagalog. He was also able to answer questions that are being asked.III. Environmental StatusThe patient was placed on the male ENT ward. This can accommodate 7 patients. The ventilation of the room was fair for it has windows. The comfort room is located in the left side of nurses station and it is estimated 5-6 meters away from the patients bed.IV. Sensory Status B. VISUAL ACUITYHis pupils constrict and converge as object moves in toward the nose; pupil responses are uniform in accommodation test with a distance of 3-4 feet away by the use of penlight. In assessing the extra ocular movements both eyes move in a smooth coordinated manner in all directions. The patient was able to differentiate color such as black, white, red, green and blue and can read as manifested by reading newspaper.C. AUDITORY STATUSPatient X sense of hearing was functional as evidenced by cooperative and responsive reaction to questions and instructions. Upon inspection there were no deformities, lumps or skin lesions on patients auricle and surrounding tissues. In addition to that, palpating the external ears there were no nodules noted, irregularities, redness, swelling or discharge. Both ears are symmetrical in alignment. Bilateral auditory canals contain moderate amount of dark-brown cerumen. By using the whisper test the patient identifies three words out of three words in 2 attempts with the distance of 1-2 feet.

D. OLFACTORY STATUSPatient x olfactory status manifest a good sensation of smell he was asked to close his eyes and he was able to identify the difference between the smell of alcohol, and perfume, there were no discharges and bleeding that was noted. Upon palpation, there were no noted tenderness of the sinuses, specifically the frontal, ethmoid, sphenoid and maxillary. E. GUSTATORY STATUSBefore the operation patient x oral mucosa was pale in color without ulcers, white patches, and nodules. He can distinguish the taste of the food whether it was sweet, sour or bitter. After the operation he verbalized that the operative site is painful with a pain scale of 9/10 and describes it as continues sharp pain. He has difficulty in speaking because of the braces on his upper jaw and titanium plate placed on his mandible.F. TACTILE STATUSPatient X has good tactile status wherein he responded to firm or light touch, sharp and dull objects, hot and cold, pricking, and any stimuli of touch. V. Motor StatusA. MUSCULOSKELETAL STATUSThere were no noted decreased on motor reflexes of the patient. He was able to perform activities of daily living with minimal assistance like when going to the comfort room and changing clothes. The muscle strength grading scale showed the following:

LeftRight5/55/55/55/5

Using Lovetts scale which graded the muscle strength, patient x has score of both the upper and lower extremities are 5/5 which is interpreted as full resistance against gravity. VI. Nutritional Status He weighs 60 kilograms and has a height of 5 feet 6 inches and a BMI of 21.35 shows that he is within normal range. After the operation the patient was on NPO temporarily, and then he was instructed to have cold diet. The patient has no known allergies to foods he prefers food like meat and vegetables.VII. Elimination StatusHe has regular elimination pattern, he claimed that it is formed, brownish in color and no presence of blood and mucus to the stool. The patient had a urine color of dark yellow and his urine output during the shift is 200-300 cc.VIII. Fluid and Electrolyte StatusHe was able to drink 3-4 glasses of water during the shift before the operation. After his surgery patient received D5LRS x KVO. IX. Circulatory Status The patients vital sign reveal a pulse rate of 82-83 beats per minute with normal rhythm. His capillary refill was normal (1-2 seconds). Slightly pale conjunctiva was noted. Patient x blood pressure ranges from 100/80 110/80 mmHg. X. Respiratory StatusThe patients vital signs reveal a respiratory rate of 21-22 breaths per minute. Upon observation and auscultation there were no adventitious breath sound heard on both lung fields. He does not have cough and nasal discharge. XI. Temperature StatusThe patients temperature ranges from 36.3-36.9C per axillary. No unusual feeling of warmth or cold that was verbalized by the patient. The patient wears comfortable clothes to protect himself from hot or cold environmental temperature, such as shirts and pajama. No unusual or significant perspirations, or night sweats were noted.XII. Integumentary StatusPatient x has a fair complexion; skin is not cyanotic and is warm to touch. Hair is black, not brittle, distributed terminally, and without presence of lice, or other parasites. Nails are short, slightly pale nail beds, round, hard, and immobile. XIII. Comfort and Rest StatusPrior to hospitalization, patient claimed to have 4-5 sleeping hours. Upon confinement, patient reported less hours of sleep with a noted deduction of 1-2 sleeping hours primarily because of a sharp continues pain that he felt on his wound which aggravated by talking. He reported that pain was decreased when given ample amount of rest and medication.

ResultsNormal Indication

ColorYellowClear/ ColorlessNormal

TransparencyTurbidSlightly turbid/cloudyNormal

SugarNegativeNegativeNormal

ProteinNegativeNegativeNormal

pH/ Reaction6.57.35-7.45Normal

Specific gravity1.0301.010 1.030Normal

Microscopic Findings

WBC/HPF0-1hpf0-2Within Normalrange

RBC/HPF1-2hpf0-4Within Normal range

Epithelial cells Occasional Negative - RareWithin Normal range

Mucus ThreadsMany NegativeHigh

Bacterial/LPFOccasional NoneWithin normal range

Amorphous materialoccasionalNone Within normal range

B. Laboratory result01/29/13Interpretation:The mucus threads are high in large amount and it indicates that there is an infection due to irritating chemical agent.

01/29/13Component and quality SI unitResult Rangeindication

WBC count 5.585-10x109/LNormal

Hemoglobin150Male: 140-170g/LNormal

Hematocrit0.44Male: 0.400.50Normal

Eosinophil 0.150-0.07 high

Neutrophils 0.460.50-0.70Low

Lymphocyte0.350.20-0.40Normal

Monocyte 0.040.0000-0.07Normal

Platelet count336150-400x9/LNormal

Interpretation: Patient x takes clindamycin for 1 week to treat infections and his mandibular fracture. Futher more when he is schedule for laboratory exam, his neutrophil became low while his eosinophil became high due to drug that his taken.This drug disrupt bacterial protein synthesis that can cause changes in the cell wall surface with decreases adherence of bacteria to host cells and increases intracellular killing of organism.

The Mandible (Lower Jaw)

Themandible,the largest and strongest bone of the face, serves for the reception of the lower teeth. It consists of a curved, horizontal portion, thebody,and two perpendicular portions, therami,which unite with the ends of the body nearly at right angles.

The Body (corpus mandibul).The body is curved somewhat like a horseshoe and has two surfaces and two borders.

Surfaces.Theexternal surfaceis marked in the median line by a faint ridge, indicating thesymphysisor line of junction of the two pieces of which the bone is composed at an early period of life

The internal surface is concave from side to side. Near the lower part of the symphysis is a pair of laterally placed spines, termed the mental spines, which give origin to the Genioglossi. Immediately below these is a second pair of spines, or more frequently a median ridge or impression, for the origin of the Geniohyoidei. In some cases the mental spines are fused to form a single eminence, in others they are absent and their position is indicated merely by an irregularity of the surface.

Above the mental spines a median foramen and furrow are sometimes seen; they mark the line of union of the halves of the bone. Below the mental spines, on either side of the middle line, is an oval depression for the attachment of the anterior belly of the Digastricus. Extending upward and backward on either side from the lower part of the symphysis is the mylohyoid line, which gives origin to the Mylohyoideus; the posterior part of this line, near the alveolar margin, gives attachment to a small part of the Constrictor pharyngis superior, and to the pterygomandibularraph. Above the anterior part of this line is a smooth triangular area against which the sublingual gland rests, and below the hinder part, an oval fossa for the submaxillary gland.

Theinternal surfaceis concave from side to side. Near the lower part of the symphysis is a pair of laterally placed spines, termed themental spines,which give origin to the Genioglossi. Immediately below these is a second pair of spines, or more frequently a median ridge or impression, for the origin of the Geniohyoidei. In some cases the mental spines are fused to form a single eminence, in others they are absent and their position is indicated merely by an irregularity of the surface. Above the mental spines a median foramen and furrow are sometimes seen; they mark the line of union of the halves of the bone. Below the mentalspines, on either side of the middle line, is an oval depression for the attachment of the anterior belly of the Digastricus. Extending upward and backward on either side from the lower part of the symphysis is themylohyoid line,which gives origin to the Mylohyoideus; the posterior part of this line, near the alveolar margin, gives attachment to a small part of the Constrictor pharyngis superior, and to the pterygomandibularraph. Above the anterior part of this line is a smooth triangular area against which the sublingual gland rests, and below the hinder part, an oval fossa for the submaxillary gland.

PATHOPHYSIOLOGY

Nursing Care Plan

DRUG NAMEINDICATION and CONTRAINDICATIONADVERSE EFFECTNURSING RESPONSIBILITY

Generic name: Ketorolac tromethamineBrand name: ToradolDosage: 30 mgFrequency: Every 6 hours x 4 dosesForm of drug: IntravenousClassification: Non-steroidal anti-inflammatory drugsACTION Produces anti-inflammatory analgesic, and antipyretic effects, possibly by inhibiting prostaglandin synthesis.Indication: Short-term management of moderately severe, acute pain for multiple-dose treatment.

Contraindication: Contraindicated in hypersensitive drug and in those with active peptic ulcer disease, recent GI bleeding or perforation, cerebrovascular bleeding, hemorrhagic diathesis, or incomplete hemostasis, and in those at risk for renal impairment from volume depletion or at risk for bleeding.

CNS: drowsiness, sedation, dizziness, headacheCV: edema, hypertension, palpitation, arrhythmiasGI: nausea, vomiting, dyspepsia, diarrhea, constipation, GI painSKIN: rush, diaphoresis

Correct hypovolemia before giving ketorolac Dont give drug epidurally or intrathecally because of alcohol content Teach patient signs and symptoms of GI bleeding including blood in vomit, urine or stool and black, cotarry stool. Tell him to notify prescriber if any of these occurs.

DRUGS STUDYDRUG NAMEINDICATION and CONTRAINDICATIONADVERSE EFFECTNURSING RESPONSIBILITY

Generic name: Tramadol hydrochlorideBrand name: UltramDosage: 50 mgFrequency: Every 6 hours prn for breakthrough pain.Form of drug: IntravenousClassification: Opioid analgesic

ACTION A centrally acting synthetic analgesic compound not chemically related to opiates. Thought to bind to opioid receptors and inhibit reuptake of norepinephrine and serotoninIndication: Moderate to moderately severe pain.

Contraindication: Use cautiously in patients at risk for seizures or respiratory depression; in patients with increased intracranial pressure or head injury, acute abdominal condition, or renal or hepatic impairment; or in patients with physical dependence on opioids.CNS: dizziness, vertigo, headache, sleep disorder, seizureCV: vasodilationEENT: visual disturbancesGI: nausea, constipation, vomitingGU: urine retention, urinary frequencyRespiratory: respiratory depression

Reassess patients levels of pain at least 30 minutes after administration Monitor CV and respiratory status Tell patient to take drug as prescribe and not to increase dose or dosage interval unless ordered by prescriber Warn patient not to stop drug abruptly

DRUG NAMEINDICATION and CONTRAINDICATIONADVERSE EFFECTNURSING RESPONSIBILITY

Generic name: CelecoxibBrand name: Celebrex Dosage: 200 mgForm of drug: OralFrequency: 1 tablet twice a dayClassification: Nonsteroidal anti-inflammatory.ACTION Thought to inhibit prostaglandin synthesis impeding cyclooxygenase-2 to produce anti-inflammatory, analgesic, and antipyretic.Indication: Acute pain

Contraindication: Use cautiously in patients with history of ulcers or GI bleeding, advance renal disease, dehydration, anemia and with heart failure. Use cautiously in elderly or dibilitated patients.

CNS: Dizziness, headache, insomia.GI: nausea, diarrhea, abdominal, flatulence.EENT: rhinitis, sinusitis.Respiratory: upper respiratory tract infection.

Muscoloskeletal: back pain. Patient with history of of ulcers or GI bleeding is at higher risk for GI bleeding while taking NSAIDs such as celecoxib. Instruct patient to report signs and symptoms of GI bleeding such as vomit with blood, urine, stool; or black, tarry stools. Instruct patient to take drug with food if stomach upset occurs. Inform patient that it may take several days he feels consistent pain relief.

DRUG NAMEINDICATION and CONTRAINDICATIONADVERSE EFFECTNURSING RESPONSIBILITY

Generic name: DexamethasoneBrand name: DecadronDosage: 8 mgForm of drug: IntravenousFrequency: Every 12 hoursClassification: Corticosteroids.ACTION Decreases the inflammation, mainly by stabilizing leukocyte lysosomal membranes; supresses immune response; stimulates bone marrow; and influences protein, fat, and carbohydrate metabolism.Indication: Inflammatory conditions, allaergic reactions, neoplasias.Contraindication: Use cautiously in patients with GI ulcers, renal disease, hypertension, osteoporosis, DM, hypothyroidism, cirrhosis, diverticulitis, nonspecific ulcerative colitis, recent intestinal anastomoses, thronboembolic disorder, seizures, heart failure, tuberculosis, active hepatitis, lactation. CNS: Headache, vertigo, seizures, depression.CV: Hypertension, heart failure, edema, thromboembolism.GI: Peptic ulceration, GI irritation, increased appetite, nausea, vomiting.GU: Increased urine glucose and calcium level.EENT: Cataracts, glaucomaMusculoskeletal: Muscle weakness, osteoporosis.Abrupt withdrawal: Fatigue, fever, dizziness, fainting, dyspnea, orthostatic hypotension. Determine whether patient is sensitive to other corticosteroids. Monitor patients weight, blood pressure, and electrolytes level. Watch for depression, or psychotic episodes, especially in high-dose therapy. Gradually reduce doseage after long term therapy. Tell patient not to stop drug abruptly or without prescribers consent. Instruct patient to take drug with food or milk. Warn patient for easy bruising.

DRUG NAMEINDICATION and CONTRAINDICATIONADVERSE EFFECTNURSING RESPONSIBILITY

Generic name: Penicillin G SodiumBrand name: CrystapenDosage: 5 million uForm of drug: IntravenousFrequency: Every 6 hoursClassification:Anti- infectivesACTION Inhibits cell- wall synthesis during bacterial multiplication.Indication: Moderate to severe systemic infection.Contraindication: Contraindicated in patients hypersensitive to drug or other penicillin and in those on sodium-restricted diets. Use cautiously in patients with other drug allergies, especially to cephalosporin, because of possible croos-sensitivity. CNS: Seizures, lethargy, confusion, and anxiety.CV: Heart failureGI: Nausea, vomiting and ischemic colitis.GU: Nephropathy

Before giving drug, ask patient about allergic reactions to penicillin. Observe patient closely. With lrge doses and prolonged therapy, bactericidal or fungal superinfection may occur. Tell patient to rport adverse reactions promptly. Instruct patient to report discomfort at I.V site.

DRUG NAMEINDICATION AND CONTRAINDICATIONADVERSE EFFECTNURSING RESPONSIBILITIES

Brand Name: MetoclopramideHydroclorideGeneric Name: Maxolon Dosage: 10 mgForm of drug: Intravenous Frequency: Every 6 hours PRN for nausea and vomitingClassification: Antiemetic,GI stimulantACTION: Stimulates motility ofupper GI tract without stimulating gastric, biliary, or pancreatic secretions; appears to sensitize tissues to action ofacetylcholine; relaxespyloric sphincter, which, when combined with effects on motility, accelerates gastric emptying.Indication: Disturbances of GI motility relief of symptoms of acute and recurrent diabetic gastro paresis nausea and vomiting. Stimulation of gastric emptying and intestinal transit of barium when delayed emptyingContraindication: Contraindicatedwith allergy to metoclopramide GI, hemorrhage, mechanical obstruction orperforation Epilepsy CNS: Restlessness, drowsiness, fatigue, insomnia, dizziness, anxietyCV: Transient hypertensionGI: Nausea, diarrhea

History: allergy to metoclopramide, GI hemorrhage, mechanical obstruction orperforation, depression. Monitor BP carefully during IV administration. Monitor for extra pyramidal reactions, and consult physician if they occur. Take this drug exactly as prescribed. Do not use alcohol, sleep remedies, sedatives; serious sedation could occur.

DRUG NAMEINDICATION AND CONTRAINDICATIONADVERSE EFFECTNURSING RESPONSIBILITIES

Generic name: Ranitidine HClBrand name: ZantacDosage: 50 mg Form of drug: IntravenousFrequency: Every 12 hoursClassification: Histamine-2 antagonistACTION:Competitively inhibits the action of histamine at the h2 receptors of the parietal cells of the stomach inhibiting basal gastric acid secretion and gastric acid secretion that is stimulated by food, insulin, histamine, cholinergic agonists, gastrin and pentagastrin.Indication: short-term treatment of active duodenal ulcer short term treatment and maintenance therapy active, benign gastric ulcer treatment of erosive esophagitis treatment of heartburn, acid indigestion, sour stomach

Contraindication: Allergy to ranitidine and lactation. constipation or diarrhea; nausea and vomiting; enlargement of breasts, impotence or decreased libido; headache Assess allergy to ranitidine Assess skin lesions; orientation, affect;pulse, baseline ECG; liver evaluation, affect, abdominal examination, normal output;CBC, LFTs, renal function test Administer drug with meals Provide concurrent antacid therapy to relieve pain Arrange for regular follow up including blood test to evaluate effects Report sore throat, fever, unusual bruising or bleeding, tarry stools, confusion, hallucinations, dizziness, severe headache, muscle or joint pain

SUMMARY OF FINDINGSWith the help of this study, our goal as a group were able to met and we were able to understand more about this condition. By applying good nursing interventions, giving health teachings to our patient and to his families, and by maintaining good holistic approach, we were able to have a good outcome regarding to his condition. The patient was admitted last September 12, 2012 at 7:35 am at Baguio General Hospital and Medical Center. He was diagnosed with Orchitis to consider Prostate Cancer under Observation. On our first day of duty (September 13, 2012) 3-11 shift we had him as our patient.The history of his present complaint is scrotal swelling and pain with palpable mass. Upon assessment, the initial vital signs are taken: Temperature of 37.2 degree Celsius, Respiratory Rate of 24 bpm, Pulse Rate of 92bpm and Blood Pressure of 110/70. Laboratory tests were done and the result of his Hemoglobin, Hematocrit, Eosinophil and Platelet count are within normal range. His HgbA1c, BUN, Creatinine, WBC count, Neutrophil and Bands are within High leveland his Lymphocyte is in low level. The drugs of the patient are Sulbactam-ampicillin, Ketorolac, Metoclopramide, Humulin, and Paracetamol.We used the 13 areas of assessment to assess the patient condition and gathered data through interview. We also provided health teachings such as encouraged him to do deep breathing exercises, and to do diversional activities like socialization with others to alleviate his pain.The health care team provided comfort measures, safety and precautions in giving care for the patient to ensure his optimal level of patients satisfaction.

EVALUATIONWithin the span of 5 days of rendering care to patient X, the group was able to identify potential problems and specific nursing interventions were provided with the help of health teachings and other interventions. Patient X was able to learn how to recognize signs and symptoms of infections, risk factors and possible complication of his condition. He was also able to verbalized the importance of taking medications and recognized the importance of compliance to treatment regimen in order to manage his condition.CONCLUSIONOur Objectives as a group were all met. First objective is to define Orchitis and its effect to the body as a whole. With this we were able to know more about the condition of our patient and we were able to expand our knowledge regarding this kind of disease.We also determined the causes that constitute to the onset of his condition. Through interview, we gathered information to assess the present condition of the patient and we determined the precipitating factors that affect his health condition.Next is we performed comprehensive assessment of his condition. By the used of 13 Areas of Assessment, we assess the overall condition of the patient and provided health teachings that will help him to improve and to give effective interventions.Also we provided independent nursing interventions. With the proper interventions and health teachings that we rendered we were able to help the patient to lessen the suffering and to prevent possible complications that may occur.Lastly the group will beupdated on the treatment of this condition. With the information that we gathered, weas a group will be able to recognized updates to improve the quality of care that we were going to implement effective nursing care. Our duty at Baguio General Hospital and Medical Center has been a memorable experience. The exposure had been an avenue for further development and enhancement of our skills and capabilities in rendering care and promoting holistic wellness to our clients. It reminded us again that the nursing profession entails a deep sense of responsibility and challenging tasks. After five days of exposure in the Surgical Ward. We were able to understand more about Orchitis, through obtaining cues and health history. We underwent extensive research in order to comprehensively understand more about the illness. We also completely assessed and identified the problems which come up with a five prioritization which lead us to formulate our Nursing Care Plan. We reviewed different treatments and medication that are applicable to the patients condition. We also provided health teachings that may help the patients to improve his condition.