Fractures

  1. General information
    1. A break in the continuity of bone, usually caused by trauma
    2. Pathologic fractures: spontaneous bone break, found in certain diseases or conditions (osteoporosis, osteomyelitis, multiple myeloma, bone tumors)
    3. Types
      1. Complete: separation of bone into two parts
        1. transverse
        2. oblique
        3. spiral
      2. Incomplete (partial): fracture does not go all the way through the bone, only part of the bone is broken.
      3. Comminuted: bone is broken or splintered into pieces.
      4. Closed or simple: bone is broken without break in skin.
      5. Open or compound: break in skin with or without protrusion of bone.
  2. Medical management
    1. Traction
    2. Reduction
      1. Closed reduction through manual manipulation followed by application of cast
      2. Open reduction
    3. Application of a cast
  3. Assessment findings
    1. Pain, aggravated by motion; tenderness
    2. Loss of motion; edema, crepitus (grating sound), ecchymosis
    3. Diagnostic test: x-ray reveals break in bone
  4. Nursing interventions
    1. Provide emergency care of fractures.
    2. Perform neurovascular checks on affected extremity.
    3. Observe for signs of compartment syndrome (swelling causes an increase within muscle compartment which causes edema and more pressure; irreversible neuromuscular damage can occur within 4 to 6 hours); signs include weak pulse, pallor followed by cyanosis, paresthesias and severe pain.
    4. Observe for signs of fat emboli (respiratory distress, mental disturbances, fever, petechiae) especially in the client with multiple long-bone fractures.
    5. Encourage diet high in protein and vitamins to promote healing.
    6. Encourage fluids to prevent constipation, renal calculi, and UTIs.
    7. Provide care for the client in traction, with a cast, or with open reduction.
    8. Provide client teaching and discharge planning concerning
      1. Cast care if indicated
      2. Crutch walking if necessary
      3. Signs of complications and need to report them

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