![]() ![]() ![]() The fractured site is assessed for signs and symptoms of infection.īased on the assessment data gathered, the nursing diagnoses developed include:. ![]() The patient with open fracture is assessed for risk for osteomyelitis, tetanus, and gas gangrene. The patient with close fracture is assessed for absence of opening in the skin at the fracture site. Nursing AssessmentĪssessment of the fractured area includes the following: Nursing management for close and open fractures should be differentiated. Fracture reduction refers to the restoration of the fracture fragments to anatomic alignment and positioning and can be open or closed depending on the type of fracture.In an open fracture, the wound should be covered with a sterile dressing to prevent contamination of the deeper tissues.Adequate splinting is essential to prevent the movement of fracture fragments.Immediately after injury, if a fracture is suspected, it is important to immobilize the body part before the patient is moved.Management of a patient with a fracture can belong to either emergent or post-emergent. Coagulation profile: Alterations may occur because of blood loss, multiple transfusions, or liver injury.Urine creatinine (Cr) clearance: Muscle trauma increases the load of Cr for renal clearance.Increased white blood cell (WBC) count is a normal stress response after trauma. 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).Arteriograms: May be done when occult vascular damage is suspected.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.X-ray examinations: Determines location and extent of fractures/trauma, may reveal preexisting and yet undiagnosed fracture(s).To determine the presence of fracture, the following diagnostic tools are used. Compartment syndrome in an extremity is a limb-threatening condition that occurs when perfusion pressure falls below tissue pressure within a closed anatomic compartment. After fracture of long bones and or pelvic bones, or crush injuries, fat emboli may develop. Hypovolemic shock resulting from hemorrhage is more frequently noted in trauma patients with pelvic fractures and in patients with displaced or open femoral fractures.Localized edema and ecchymosis occur after a fracture as a result of trauma and bleeding into the tissues.Ĭomplications of fractures may either be acute or chronic. When the extremity is gently palpated, a crumbling sensation, called crepitus, can be felt.There is an actual shortening of the extremity because of the compression of the fractured bone.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.After a fracture, the extremity cannot function properly because the normal function of the muscles depends on the integrity of the bones to which they are attached. The pain is continuous and increases in severity until the bone fragments are immobilized.The clinical signs and symptoms of a fracture may include the following but not all are present in every fracture: ![]() When the muscles have reached their limit in contraction, it could lead to serious fractures. Twisting the joints in a sudden motion leads to fractures. Forces that come into contact with the bones and crush them could also result in fractures. Being hit directly by a great force could cause fractures in the bones. An open fracture is one in which the skin or mucous membrane wound extends to the fractured bone.įractures may be caused by the following: A closed fracture is one that does not cause a break in the skin. A comminuted fracture is one that produces several bone fragments. An incomplete fracture involves a breakthrough only part of the cross-section of the bone. A complete fracture involves a break across the entire cross-section of the bone and is frequently displaced. There are several kinds of fracture that may occur in a bone:
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