FRACTURE

 

A fracture is a break or disruption in the continuity of the bone. Fractures occur when a bone is subjected to more stress than it can absorb.

Fractures are treated by one or a combination of the following closed reduction-alignment of bone fragments by manual manipulation without surgery, open reduction, alignment of bone fragments by surgery, internal fixation-immobilization of fracture site during surgery with rods, pins, plates, screws, wires or other hardware; immobilization through use of casts, splints, traction, posterior molds, etc; external fixation, immobilization of bone fragments.

 

NURSING INTERVENTIONS

 

      Assess age.

      Assess pain characteristics: Location, quality/character, severity, onset, duration, precipitating factors, relieving factors.

      Maintain immobilization and support of affected part. Immobility prevents further tissue damage and muscle spasm.

      Elevate affected part to decrease vasocongestion.

      Anticipate need for analgesics.

      Administer muscles relaxants if necessary.

      Assess amount of bleeding from external wound.

      Note amount of bleeding on cast.

      Administer IV fluids and/or blood products as ordered.

      Assess distal to fracture site every 2-4 hours for 48 hours until stable, then every 8 hours. Observe for: color, sensation, movement, capillary refill, swelling, pulses, pain.

      Encourage exercise of unaffected part distal to site as allowed to promote circulation.

      Report any vascular compromise to physician immediately.

      Prepare patient for surgical intervention (fasciotomy).

      Assess wound and/or pin site for:

-Local signs or infections

-Skin tension around pins.

      Monitor vital signs every 2-4 hours until stable, then every 8 hours.

      Keep dressing dry and intact. Give cure care as ordered.

      Administer antibiotics as ordered.

      Administer tetanus toxoid as indicated.

      Perform appropriate pin site care:

-Provide care to all pin sites every 8 hours.

      Encourage and teach importance of diet with adequate amounts of proteins, calcium, vitamin C, D, and A, and calories which are essential for bone and tissue healing.

      Perform flexion and extension exercises to proximal and distal joints of affected extremity when indicated.

      Assist up to chair or wheelchair when ordered.

      Assess immobilized extremity for redness/breakdown.

      Notify physician :

-         If cast cracks or breaks.

-         Of foul odor under cast.

-         Of any fresh drainage through cast.

-         Of broken areas of skin around cast.

-         Of pain or burning under cast.

-         Of warm areas under cast.

      Write all the observations on the patient's chart.