International patient safety goals by JCI

Safety goals

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27. The principles of fracture treatment include
reduction, immobilization and regaining of normal
function and strength through rehabilitation.
•The fracture is reduced “setting” the bone using a closed method
(manipulation and manual traction (e.g. splint or cast) or an open
method (surgical placement of internal fixation devices like pins,
wires, screws, plates, and nails) to restore the fracture fragments to
anatomic alignment and rotation. The specific method depends on the
nature of the fracture.

28. •After the fracture has been reduced, immobilization holds the bone in
the correct position and alignment until union occurs. Immobilization
is accomplished by external or internal fixation.
•Function is maintained and restored by controlling swelling by
elevating the injured extremity and applying ice as prescribed.
•Restlessness, anxiety, and discomfort are controlled using a variety of
approaches (e.g. reassurance, position changes, pain relief strategies,
including analgesic agents).

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30. Nursing Management
1.Prevent infection
•Cover any breaks in the skin with a clean or sterile dressing.
2.Provide care during client transfer.
•Immobilize a fractured extremity with a 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 the fracture site when
moving the client.
3.Provide client and family teaching.
•Explain prescribed activity restrictions and necessary lifestyle modifications
because of impaired mobility.
•Teach the proper use of assistive devices, as indicated.

31. 4. Administer prescribed medications, which may include analgesics
and prophylactic antibiotics for an open fracture.
5. Prevent and manage potential complications.
•Observe for symptoms of life-threatening fat embolus, which may include
personality change, restlessness, dyspnea, crackles, white sputum, and
petechaieover the chest and buccal membranes. Assist with respiratory
support, which must be instituted early.
•Observe for symptoms of compartment syndrome, which include deep,
unrelenting pain; hard edematous muscle; and decreased tissue perfusion
with impaired neurovascular assessment findings.
•Monitor closely for signs and symptoms of other complications.
6. Patient education regarding different factors that affect fracture
healing

32. 7. Factors that enhance fracture healing
•Immobilization of fracture fragments
•Maximum bone fragment contact
•Sufficient blood supply
•Proper nutrition
•Exercise: weight bearing for long bones
•Hormones: growth hormone, thyroid, calcitonin, vitamin D, anabolic steroids

33. 8. Factors that inhibit fracture healing
•Extensive local trauma
•Bone loss
•Inadequate immobilization
•Space or tissue between bone fragments
•Infection
•Local malignancy
•Metabolic bone disease (Paget’s disease)
•Irradiated bone (radiation necrosis)
•Avascular necrosis
•Intra-articular fracture (synovial fluid contains fibrolysins, which lyse the
initial clot and retard clot formation)
•Age (elderly persons heal more slowly)
•Corticosteroids(inhibit the repair rate)

34. Nursing Diagnosis
•Painrelated to fracture, soft tissue damage, muscle spasm, and
surgery
•Impaired physical mobility related to fractured _____
•Impaired skin integrity related to surgical incision
•Risk for impaired urinary elimination related to immobility
•Risk for disturbed thought process related to age, stress of trauma,
unfamiliar surroundings, and drug therapy
•Risk for ineffective coping related to injury, anticipated surgery, and
dependence
•Risk for impaired home maintenance related to fractured hip and
impaired mobility