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.
¨ 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.