Care of patient with fracture (1)

introduction
causes
classification
principle of fracture management

1. CARE OF PATIENT WITH FRACTURE

2. INTRODUCTION Fracture is defined as a break in the continuity of a bone.Fractures occur when a bone is subjected to more stress than it is able to absorb. 2

3. CAUSES Fracture may occur from several specific causes and are categorize as follow: 1. Direct Force - In direct force fracture , a bone is subjected to more stress than it can absorb from an impact with a solid object. for example, a direct blow as a baseball bat or a crushing force such as some automatic accidents. 2. Twisting - an indirect force may cause a break in a bone at a location other than the site of the twisting force. this type of injury is common in skinning accidents. 3

4. muscle contraction - in another indirect force fracture , powerful contraction of a muscle may cause the muscle to tear away from the bone, often fracturing or avulsing part of the bone in the process.this type of injury may occur during a grand mal seizure. this type fracture is seen in soldier in an injury known as grenade throwers fracture . the humerus is fractured as a result of the muscular contractions in throwing a hand grenade.. Pathological fracture - bones that have become weakened from age or diseases are easily fractured, often from just a slight movenment. Fatigue or stress fracture - this type of injury may occur when a bone has been subjected to reapeted stress.associated with sports enthusiasts and soldier.

5. open / close 1 condition of the bone 2 Tissue damage 3 classification of fracture 5

6. soft tissue damage a great amount of soft tissue damage often accompanies a fracture: a. complicated fracture - A fracture that is associated with a large amount of nerve, bloodvessel, and soft tissue damage is called a complicated fracture. b. uncomplicated fracture - A fracture without other damage would be reffered to as an uncomplicated fracture. The nature and extent of the damage depends upon the type and direction of the force causing the fracture.

7. The direction of the fracture line in relation to the bones longitudinal axis: linear - A fracture line that runs parallel to the bones axis. Longitudinal - A fracture line that runs along the length of , but not parallel to,the bones axis. Transverse - A fracture line that runs across or at a right angle to , the bones axis. Oblique - A fracture line that is slant across the bones. Spiral - that runs across the bone at an oblique angle and coils or spiral around the bone

8. OPEN / CLOSE An open / compound fracture is one in which there is an open wound associated with the fracture site. In a close or simple fracture there is no break in the skin associated with the fracture.

9. ACCORDING TO CONDITION OF BONES complete Incomplete Displaced Impacted or Compressed Depressed Comminuted Geenstick

10. SIGN AND SYMPTOMS pain deformity false motion: abnormal mobility at the fracture site Discolouration Edema Crepitus Loss of Function Shortening of an extremity

11. PRINCIPLES OF FRACTURE MANAGEMENT In treating a fracture the objectives of the teatment are as follow: a. To regain and maintain the normal alignment of the injured part. b. To regain normal function of the injured part. c. To achieve the above objective for the patient in the shortest time possible. The principles of fracture management are reduction, immobilization and rehabilitation: A. Reduction - Reduction is the process of restoring the bone ends into their normal anatomical position. This is accomplished by open or close manipulation of the affected area, referred to as open reduction and closed reduction.

12. B. Immobilization - Immobilization is neccasary to maintain fracture reduction until healing occurs. Immobilization may be occomplished by external or internal fixation. - Method of external fixation include casts, splints, and continuous traction. - Internal fixation devices include pins, wires, screw, rods, nails , plates. These devices attached to the sides of the bone orinserted through the bone. provide internal immobilization of the bone. C. Rehabilitation - rehabilitation is the regaining of strength and normal function in the affected area. specific rehabilitation for each patient will be based upon the type of fracture and the methods of reduction and immobilization used. the physician will generally consult with the physical therapist to develop an individualized rehabilitation plan for each patient. this plan is noramally implemented and controlled by the physical therapy department.

13. NURSING MANAGEMENT OF A PATIENT WITH A FRACTURE Nursing care of a patient with a fracture, whether casted or in traction, is based upon prevention of complications while healing.By performing an accurate nursing assessment on a regular basis,the nursing staff can manage the patients pain and prevent complications. ASSESSMENT 5 P's - PAIN PULSE PALLOR PARESTHESIA PARALYSIS

14. MANAGING CLOSED FRACTURES Instruct the patient regarding the proper methods to control edema and pain(e.g, elevate extremity to heart level , take analgesics as prescribed). Teach excercises to maintain the health of unaffected muscle and to strengthen muscle needed for transfering and for using assistive devices, (e.g, crutches ,walker). Teach patient how to use assistive devices safely. Arrange to help patients modify their home environment as needed and to secure personal assistance if necessary. Provide patient teaching including self care , medication information , monitoring for potential complication and the need for continuing health care supervision.

15. MANAGING OPEN FRACTURES the objectives of the management are to prevent infection of the wound, soft tissue and bone and to promote healing of bone and soft tissue . In an open fracture, there is the risk of osteomylitis , tetanus and gas gangrene. Administer IV antibiotics immediately upon the patients arrival in the hospital along with tetanus toxoid if needed. perform wound irrigation and debridement. Elevate the extremity to minimize edema Assess neurovascular status frequently. Take the patients temperature at regular intervals and monitor for signs of infection.

16. RELIEVE PAIN Provide analgesics and anti inflammatories as ordered to relieve pain and swelling. Ensure proper positioning and alignment to minimize discomfort and promote pain relief. Assess for compartment syndrome if patient has a cast in place to prevent neurovascular complications Apply ice as ordered to decrease swelling and pain. Teach alternative measure of pain relief to maximize means to relieve pain.

17. PROPER POSITIONING Position the affected limb properly to prevent dislocation,use abduction if a prosthesis was inserted , but use a neutral position if another internal fixation device was inserted. Turn the patient on the nonoperative side as prescribed to facilitate circulation and recovery while easing tired muscle and relieving pressure; prop the operative limb with an abduction pillow if the patient has a prosthesis or with pillows if the patient has another internal fixation device

18. MAINTAIN PHYSICAL MOBILITY Encourage independence to promote mobility. Utilize other discipline such as occupational and physiotherapy to encourage and promote patient mobility. Provide equipment and resources such as crutches and wheelchairs to improve mobility.

19. MAINTAIN NEUROVASCULAR HEALTH Assess and monitor frequently for compartment syndrom. Assess for swelling of affected limb. keep limb elevated above heart level to minimize edema administer anti inflammatory agents as ordered monitor for increasing pain even after analgesic administration.

20. MAINTAIN NUTRITIONAL STATUS Provide regular diet as prescribed and monitor bowel sounds,a patient with good bowel sounds who is passing flatus can receive regular foods. Monitor fluid intake and output and iv infusions intake should be 3000ml daily output should include 2300 ml of urine and 300 to 700 ml of insensible water loss and perspiration. MAINTAIN FLUID INTAKE AND OUTPUT STATUS

21. PREVENT COMPLICATION Encourage deep breathing and coughing every 2 hours and use an incentive spirometer every 1 to 2 hours to prevent complications. assess skin and provide skin care to pressure area (heal,back,sacrum,shoulders,elbows) encourage the patient to perform foot and ankle exercises,including dorsiflexion and plantar flexion to increase venous return and prevent thrombophebitis.

22. PREVENT INFECTION cover any breaks in the skin with clean or sterile dressing. PROVIDE CARE DURING CLIENT TRANSFER immobilize a fractured extremity with splint in the position of the deformity before moving the client, avoid strengthening the injured body part if a joint is involved. support the affected body part above and below fracture site when moving the client.

23. PROVIDE CLIENT AND FAMILY TEACHING Explain prescribed activity restrictions and neccessary lifestyle modification because of impaired mobility. Teach the proper use of assistive devices , as indicated. Administer prescribed medications,which may include opiod or nonopiod analgesics and prophylactics atibiotics for an open fracture.

24. PATIENT EDUCATION REGARDING DIFFERENT FACTORS THAT AFFECT FRACTURE HEALING FACTOR THAT ENHANCE FRACTURE HEALING : immobilize of fracture fragement maximum bone fragment contact sufficient blood supply proper nutrition excersise - weight bearing for long bones hormones - growth ,thyroid,calcitonin,vitamin D,anabolic steroids. FACTOR THAT INHIBIT FRACTURE HEALING : extensive local trauma bone loss inadequate immobilization space or tissue between bone fragement infection local malignancy age (elderly person heel more slowly)

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