Narsing managent for fractwed peatiem

A fracture is the medical term used for a broken bone. They occur when the physical force

 exerted on the bone is stronger than the bone itself.  They commonly happen because of car accidents, falls or sports injuries. Other causes are low bone density and osteoporosis, which cause weakening of the bones. Fracture is sometimes abbreviated FRX or Fx, Fx, or #.

Types of Fracture

There are many types of fractures, but the main categories are complete, incomplete, open, closed and pathological. Five major types are as follows:

1.    Incomplete: Fracture involves only a portion of the cross-section of the bone. One side breaks; the other usually just bends (greenstick).

2.    Complete: Fracture line involves entire cross-section of the bone, and bone fragments are usually displaced.

3.    Closed: The fracture does not extend through the skin.

4.    Open: Bone fragments extend through the muscle and skin, which is potentially infected.

5.    Pathological: Fracture occurs in diseased bone (such as cancer, osteoporosis), with no or only minimal trauma.

Nursing Care Plans

Nursing care of a patient with a fracture, whether casted or in traction, is based upon prevention of complications during healing. By performing an accurate nursing assessment on a regular basis, the nursing staff can manage the patient’s pain and prevent complications. On emergency trauma care basic include triage, assessment and maintaining airway, breathing, and circulation, protecting the cervical spine, and assessing the level of consciousness.

Here are eight (8) nursing care plans for fracture: 

1.    Risk for Trauma: Falls

2.    Acute Pain

3.    Risk for Peripheral Neurovascular Dysfunction

4.    Risk for Impaired Gas Exchange

5.    Impaired Physical Mobility

6.    Impaired Skin Integrity

7.    Risk for Infection

8.    Deficient Knowledge

9.    Other Nursing Diagnoses

10. See Also and Further Reading

·         Complete fracture. A complete fracture involves a break across the entire cross-section of the bone and is frequently displaced.

·         Incomplete fracture. An incomplete fracture involves a break through only part of the cross section of the bone.

·         Comminuted fracture. A comminuted fracture is one that produces several bone fragments.

·         Closed fracture. A closed fracture is one that does not cause a break in the skin.

·         Open fracture. An open fracture is one in which the skin or mucous membrane wound extends to the fractured bone.

Causes

---

Fractures may be caused by the following:

·         Direct blows. Being hit directly by a great force could cause fracture in the bones.

·         Crushing forces. Forces that come into contact with the bones and crush them could also result in fractures.

·         Sudden twisting motions. Twisting the joints in a sudden motion leads to fractures.

·         Extreme muscle contractions. When the muscles have reached its limit in contraction, it could lead to serious fractures.

Clinical Manifestations

---

The clinical signs and symptoms of a fracture may include the following but not all are present in every fracture:

·         The pain is continuous and increases in severity until the bone fragments are immobilized.

·         Loss of function. After a fracture, the extremity cannot function properly because normal function of the muscles depends on the integrity of the bones to which they are attached.

·         Displacement, angulation, or rotation of the fragments in a fracture of the arm or leg causes a deformity that is detectable when the limb is compared with the uninjured extremity.

·         There is actual shortening of the extremity because of the compression of the fractured bone.

·         When the extremity is gently palpated, a crumbling sensation, called crepitus, can be felt.

·         Localized edema and ecchymosis. Localized edema and ecchymosis occur after a fracture as a result of trauma and bleeding into the tissues.

Complications

---

Complications of fractures may either be acute or chronic.

·         Hypovolemic shock resulting from hemorrhage is more frequently noted in trauma patients with pelvic fractures and in patients with displaced or open femoral fractures.

·         Fat embolism syndrome. After fracture of long bones and or pelvic bones, or crush injuries, fat emboli may develop.

·         Compartment syndrome. Compartment syndrome in an extremity is a limb-threatening condition that occurs when perfusion pressure falls below tissue pressure within a closed anatomic compartment.

Assessment and Diagnostic Findings

---

To determine the presence of fracture, the following diagnostic tools are used.

·         X-ray examinations: Determines location and extent of fractures/trauma, may reveal preexisting and yet undiagnosed fracture(s).

·         Bone scans, tomograms, computed tomography (CT)/magnetic resonance imaging (MRI) scans: Visualizes fractures, bleeding, and soft-tissue damage; differentiates between stress/trauma fractures and bone neoplasms.

·         Arteriograms: May be done when occult vascular damage is suspected.

·         Complete blood count (CBC): Hematocrit (Hct) may be increased (hemoconcentration) or decreased (signifying hemorrhage at the fracture site or at distant organs in multiple trauma). Increased white blood cell (WBC) count is a normal stress response after trauma.

·         Urine creatinine (Cr) clearance: Muscle trauma increases load of Cr for renal clearance.

·         Coagulation profile: Alterations may occur because of blood loss, multiple transfusions, or liver injury.

Medical Management

---

Management of a patient with fracture can belong to either emergent or post-emergent.

·         Immediately after injury, if a fracture is suspected, it is important to immobilize the body part before the patient is moved.

·         Adequate splinting is essential to prevent movement of fracture fragments.

·         In an open fracture, the wound should be covered with sterile dressing to prevent contamination of the deeper tissues.

·         Fracture reduction refers to restoration of the fracture fragments to anatomic alignment and positioning and can be open or closed depending on the type of fracture.

Nursing Management

---

Nursing management for close and open fractures should be differentiated.

Nursing Assessment

Assessment of the fractured area includes the following:

·         Close fracture. The patient with close fracture is assessed for absence of opening in the skin at the fracture site.

·         Open fracture. The patient with open fracture is assessed for risk for osteomyelitis, tetanus, and gas gangrene.

·         The fractured site is assessed for signs and symptoms of infection.

Diagnosis

Based on the assessment data gathered, the nursing diagnoses developed include:

·         Acute pain related to fracture, soft tissue injury, and muscle spasm.

·         Impaired physical mobility related to fracture.

·         Risk for infection related to opening in the skin in an open fracture.

Planning & Goals

Main Article: 8 Fracture Nursing Care Plans

Planning and goals developed for a patient with fracture are:

·         Relief of pain.

·         Achieve a pain-free, functional, and stable body part.

·         Maintain asepsis.

·         Maintain vital signs within normal range.

·         Exhibit no evidence of complications.

Nursing Interventions

Nursing care of a patient with fracture include:

·         The nurse should instruct the patient regarding proper methods to control edema and pain.

·         It is important to teach exercises to maintain the health of the unaffected muscles and to increase the strength of muscles needed for transferring and for using assistive devices.

·         Plans are made to help the patients modify the home environment to promote safety such as removing any obstruction in the walking paths around the house.

·         Wound management. Wound irrigation and debridement are initiated as soon as possible.

·         Elevate extremity. The affected extremity is elevated to minimize edema.

·         Signs of infection. The patient must be assessed for presence of signs and symptoms of infection.

Evaluation

The following should be evaluated for a successful implementation of the care plan.

·         Pain was relieved.

·         Achieved a pain-free, functional, and stable body part.

·         Maintained asepsis.

·         Maintained vital signs within normal range.

·         Exhibited no evidence of complications.

Discharge and Home Care Guidelines

After completion of the home care instructions, the patient or caregiver will be able to:

·         Control swelling and pain. Describe approaches to reduce swelling and pain such as elevating the extremity and taking analgesics as prescribed.

·         Care of the affected area. Describe management of immobilization devices or care of the incision.

·         Consume diet to promote bone healing.

·         Mobility aids. Demonstrate use of mobility aids and assistive devices safely.

·         Avoid excessive use of injured extremity and observe weight-bearing limits.

Documentation Guidelines

The focus of documentation should include:

·         Client’s description of response to pain and acceptable level of pain.

·         Prior medication use.

·         Level of function.

·         Ability to participate in specific or desired activities.

·         Signs and symptoms of infectious process.

·         Wound/ incision site.

·         Plan of care.

·         Teaching plan.

·         Response to interventions, teaching, and actions performed.

·         Attainment or progress toward desired outcomes.

·         Modifications to plan of care.

·         Long term needs.