SILLIMAN

UNIVERSITY
COLLEGE
NURSINGOF
PARESENTATION
ON
DISTURBANCES
AFFECTING
AUDITORY
PERCEPTION
FRACTURE
RESENTORS:

LLE BETH
GRACE C.V. AM-IS
BAROY
MELIE
NE L. J. BAIROY
CASTELLANO
DEN L. DANS
SECTION I2
 FRACTURES

A fracture is a break in the

continuity of bone and is defined
according to its type and extent.
 SPECIFIC TYPES OF FRACTURES
AVULSION – a fracture in which a fragment of bone has been
pulled away by a tendon and its attachment.

COMMINUTED – a fracture in which bone has splintered into

several fragments

COMPOUND – a fracture in which damage also involves the

skin or mucous membrane; also called an open
fracture

COMPRESSION – a fracture in which bone has been

compressed (seen in vertebral fractures)

DEPRESSED – a fracture in which fragments are driven inward

(seen frequency in fractures of skull and facial bones)

EPIPHYSEAL – a fracture through the epiphysis

GREENSTICK – a fracture in which one side of a bone is

broken and the other side is bent
IMPACTED – a fracture in which a bone fragment is driven into
another bone fragment

OBLIQUE – a fracture occurring at an angle across the bone

(less stable than a transverse fracture)

PATHOLOGIC – a fracture that occurs through an area of

diseased bone (eg, osteoporosis, bone cyst, Paget’s
disease, bony metastasis,, tumor); can occur without
trauma or a fall

SIMPLE – a fracture that remains contained, with no disruption

of the skin integrity

SPIRAL – a fracture that twists around the shaft of the bone

STRESS – a fracture that results from repeated loading

without bone and muscle recovery

TRANSVERSE – a fracture that is straight across the bone

shaft
GRADES FOR OPEN FRACTUR
GRADES FOR OPEN FRACTUR
Grade I – is a clean wound less than 1 cm
long.
GRADES FOR OPEN FRACTUR
Grade I – is a clean wound less than 1 cm
long.

Grade II – is a larger wound without extensive

soft tissue damage.
GRADES FOR OPEN FRACTUR
Grade I – is a clean wound less than 1 cm
long.

Grade II – is a larger wound without extensive

soft tissue damage.

Grade III – is highly contaminated, has

extensive soft tissue damage, and is
the most severe.
 CLINICAL MANIFESTATIONS
Pain
continuous and increase in severity until
the bone fragments are immobilized.

muscle spasms that accompany a fracture

begin within 20 minutes after the injury
and result in more intense pain that the
patient reports at the time of injury.

muscle spasms can minimize further

movement of the fracture fragments or
can result in further bony fragmentation or
malalignment.
 CLINICAL MANIFESTATIONS
Loss of function
the extremity cannot function properly
because normal function of the muscles
depends on the integrity of the bones to
which they are attached.

Pain contributes to the loss of function.

abnormal movement (false motion) may be

present.
 CLINICAL MANIFESTATIONS
Deformity
Cause :
Displacement

angulation

rotation of the fragments (either visible or

palpable) that is detectable when the limb is
compared with the uninjured extremity.
Deformity also results from soft tissue
swelling.
 CLINICAL MANIFESTATIONS
Shortening
In fractures of long bones, there is actual
shortening of the extremity because of the
contraction of the muscles that are attached
distal and proximal to the site of the fracture.

The fragments often overlap by as much as

2.5 to 5 cm (1 to 2 inches).
 CLINICAL MANIFESTATIONS
Crepitus

a grating sensation when the extremity is

examined with the hands.

It is caused by the rubbing of the bone

fragments against each other.
 CLINICAL MANIFESTATIONS
Swelling and discoloration
Localized edema and discoloration of the
skin (ecchymosis)

occur after as a result of trauma and

bleeding into the tissues.

These signs may not develop for several

hours after the injury.
 MEDIC MANAGEME
AL
Emergency Management NT
• Immediately after the injury, immobilize the body part before the
patient is moved. If an injured patient must be moved before splints
can be applied, support the extremity above and below the fracture
site to prevent rotation or angular motion.

• Splint the fracture, including joints adjacent to the fracture, to

prevent damage to the soft tissue.

• Apply temporary, well-padded splints, firmly bandaged over

clothing, to immobilize the fracture.

• Assess neurovascular status distal to the injury to determine

adequacy of peripheral tissue perfusion and nerve function. Be alert
for paresthesia or paralysis (compartment syndrome).

• Cover the wound of an open fracture with a clean (sterile) dressing

to prevent contamination of deeper tissues.
The principles of fracture treatment include reduction,
immobilization, and regaining of normal and strength through
rehabilitation.

• The fracture is reduced using a closed method (manipulation and

manual traction) or an open method (surgical placement of internal-
fixation devices to restore the fracture fragments to anatomic
alignment and rotation. The specific method depends on the nature
of the fracture.

• After the fracture has been reduced, immobilization holds the bone
in 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. Isometric and muscle-setting exercises are done to
minimize disuse atrophy and to promote circulation. With internal
fixation, the surgeon determines the extremity can withstand and
prescribes the level of anxiety.
Management of complications

• Treatment of shock consists of restoring blood volume and circulation,

relieving pain, providing adequate splinting, and protecting the patient from
further injury and other complications. See Nursing Management under
Hypovolevic Shock for additional information.

• Prevention and management of fat embolism includes immediate

immobilization of fractures and adequate support for fractured bones during
turning and positioning. Prompt initiation of respiratory support with prevention
of respiratory and metabolic acidosis and correction of homeostatic
disturbances is essential. Corticosteroids may be given as well as vasoactive
medications, fluid replacement therapy, and morphine for pain and anxiety.

• Compartment syndrome is managed by controlling swelling restrictive devices

(dressing or cast). A fasciotomy (surgical decompression with excision of
fibrous membrane covering and separating muscles) may be needed to relive
the constrictive with moist sterile saline dressings for 3 to 5 days. The limb is
splinted and elevated. Range-of-motion exercises may be performed every 4
to 6 hours.
•Nonunion (failure of the ends of a fractured bone to unite) is treated with
internal fixation, bone grafting (osteogenesis , osteoconduction,
osteoindunction), electronic bone simulation, or a combination of these.

•Management of reaction to internal fixation devices involves protection from

osteoporosis, altered bone structure, and trauma.

•Management of complex regional pain syndrome involves elevation of the

extremity, pain relief, range-of-motion exercises, and helping patients which
chronic pain, disuse atrophy, and osteoporosis. Avoid taking blood pressure or
performing venipuncture in the affected extremity.
 NURSING MANAGEMENT

Promoting Fracture Healing

• Provide pharmacologic and nonpharmacologic measures for pain
management.

• Monitor for signs of infection (if grafts were done, monitor the donor and
recipients sites)

• Provide patient education and reinforce information, avoidance of weight

bearing, wound care, signs of infiction, and follow-up care with the orthopedic
surgeon.

• For the patient receiving electrical stimulation for nonunion encourage

compliance with the treatment regiment. Include patient education regarding
daily use of the stimulator as prescribed and need for follow-up evaluation by
the orthopedist, who will evaluate the progression of bone healing with
periodic radiographic studies.
Managing Closed Fractures

• Encourage patients with closed (simple) fractures to return to their usual

activities as rapidly as possible, within the limits of the fracture
immobilization.

• Teach patients how to control swelling and pain associated with the
fracture and soft tissue trauma

• Teach exercises to maintain the health of unaffected muscles and to

strengthen muscles needed for transferring and for using assistive devices
(eg. Crutches, walker)

• Teach patient how to use assistive devices safely.

• Arranged to help patients modify their home environment as needed and to

secure personal assistant if necessary.

• Provide patient teaching, including self-care, medication information,

monitoring for potential complications, and the needed for continuing health
care supervision.
Managing Open Fractures
• The objectives of management are to prevent infection of the wound, soft tissue, and
bone and to promote healing of soft tissue and bone. In an open fracture, there is the
risk of osteomyelitis, tetanus, and gas gangrene.

• Administer tetanus prophylaxis.

• Perform serial irrigation and debridement to remove anaerobic organsisms.

• Administer intravenous antibiotics to prevent or treat infection.

• Perform aseptic dressing changes with sterile gauze to permit swelling and wound
drainage, with wound irrigation and debridement as ordered.

• Provide, or teach patient and family to perform, wound care to flap or skin graft after the
wound is closed in 5 to 7 days.

• Elevate, and teach patient and family to elevate, the extremity to minimize edema.

• Assess neurovascular status frequently.

• Take the patients temperature at regular intervals, and monitor for signs temperature at
regular intervals and monitoring for signs of infection.

• Promote intake of adequate nutrition to promote wound healing.

Managing fractures at Specific Sites
Maximum functional recovery is the goal management.

Clavicle

Humerus

Elbow

Wrist

Hand and Fingers

Rib

Pelvis

Tibia and Fibula

Femur and Hip

 NURSING PROCES: The Patient with a Hip Fracture

Assessment
Asses the elderly patient for chronic conditions that require close
monitoring. Examine the legs for edema due to congestive heart
failure, and assess for peripheral pulselessness from arteriosclerotic
vascular disease.
Nursing Diagnoses
• Pain related to fracture, soft tissue damage, muscle spasm, and
surgery
• Impaired physical mobility related to fractured hip
• 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
Collaborative Problems/Potential Complications
•Hemorrhage
•Pulmonary complications
•Neurovascular compromise
•Deep vein thrombosis
•Pressure ulcers

Planning and Goals

Major goals may include relief of pain, achievement of a functional
stable hip, wound healing, maintenance of normal urinary elimination
patterns, use of effective coping mechanisms to modify stress,
oriented and participating in decision making, ability to care for self
at home, and absence of complications.

Relieving Pain

Promoting Hip Function and Stability

Promoting Wound Healing

Promoting Skin Integrity

Promoting normal urinary elimination patterns

Promoting patient orientation and participation in decision
making

Promoting effective coping mechanisms

Monitoring and preventing potential complications

Promoting home and community-based care

Evaluation
•Expected patient outcomes
•Reports pain relief
•Engages in therapeutic positioning
•Exhibits normal wound healing and intact skin
•Maintains normal urinary elimination pattern
•Remain oriented and participates in decision making
•Demonstrates use of effective coping mechanisms
•Establishes effective communication
•Experiences no complications.
 BIBLIOGRAPHY
Black, J.M. & Jacobs, E.M. (1997). Medical-surgical nursing
clinical management for continuity of care. 5th ed. Philadephia:
W.B. Saunders Company.
 
Johnson, J.Y. (2008). Handbook for Brunner & Suddarth’s
textbook of medical-surgical nursing. 11th ed. Philadelphia:
Lippincott Williams & Wilkins.
 
Mosby. (2002). Mosby’s pocket dictionary of medicine, nursing,
and allied health. 4th ed. Singapore: Elsevier Science Pte Ltd
 
Porth, C.M. (1998). Pathophysiology concepts of altered health
states. 5th ed. Philadelphia: Lippincott.
 
Seely, R.R., et al (2007). Essentials of anatomy and physiology.
6th ed. New York, USA: McGraw-Hill Companies, Inc.

Smeltzer, S. C. & Bare, B. G. (2008). Brunner & Suddarth’s

textbook of medical-surgical nursing. (11th ed). Philadelphia:
Lippincott Williams & Wilkins.
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