1-48. NURSING M A N A G E M E N T OF A PATIENT W I T H A FRACTURE a. N u r s i n g care of a patient w i t h a fracture, w h e t h e r casted or in traction, is based u p o n prevention of complications w hi le healing.

By performing an accurate n u r s in g assessmenton a regular basis, t h e nu rs i ng staff c a n m a n a g e t h e patient's pain a n d p r ev en t complications. b. When assessing a patient w i t h a fracture, ch ec k t h e "5 P's"--pain, pulse, pallor, paresthesia, a n d paralysis. ( 1 ) Pain. Determine w h e r e t h e pain is located a n d if it is w or s e or better? Wor sening pain may indicate increased edema, lack of adequate blood s u pp ly , or ti ssue damage. ( 2 ) Puls e. C h ec k t h e peripheral puls es , especially th os e distal to t h e fracture site. Compare a ll puls es w i t h t ho s e on t h e unaffected side. Puls es s h o u l d be s tr on g a n d equal. ( 3 ) Pallor. O b s e rv e t h e color a n d temperature of t h e skin, especially a r o u n d t h e fracture site. Perform t h e capillary refill (blanching) test. ( 4 ) Paresthesia. Ex am in e t h e injured area fo r increase or decrease in sensation. C a n t h e patient detect tactile stimulation s u c h as a b l u n t t o u c h or a sharp pinprick? Does t h e patient complain of n u m b n e s s or tingling? ( 5 ) Paralysis. C he ck t h e patient's mobility. C a n he wiggle hi s toes a n d fingers? C a n he m o v e hi s extremities? c. A l l n u r s i ng assessment findings s h o u l d be documented in t h e patient's ch ar t so t h a t comparison c a n be m a d e w i t h no te s m a d e at b o t h earlier a n d later dates. In this w a y , t h e patient's progress c a n be followed a n d ch an ge s in s tatus ar e easily recognized. In addition to t h e five P's mentioned above, t h e patient's l ev el of consciousness a n d temperature s h o u l d be checked regularly. M e n t a l status c h a n g es a n d temperature elevation c ou ld indicate t h e presence of infection. Reposition t h e patient as necess ary to relieve pressure areas. C he ck a ll dressings, bandages, casts , splints, a n d traction equipment to e n s u r e t h a t n ot hi ng is causing constriction or pressure. F requent a n d t h o r o u g h checking a n d observation on t h e part of t h e n u r s ing staff will promote healing a n d pr ev en t complications armymedical.tpub.com/.../md09160050.htm

1. Provide emergency management when situation warrants, for a new fracture.

Assess the five Ps. Determine the mechanism of injury. Immobilize the part. Move injured parts as little as possible. Cover any open wounds with a sterile, or clean dressing. Reassess the five Ps. Apply traction if circulatory compromise is present. Elevate the injured limb, if possible. Apply cold to the injured area. Call emergency medical services.

2. Assess for circulatory impairment (cyanosis, coldness, mottling, decreased peripheral pulses, positive blanch sign, edema not relieved by elevation, pain or cramping). 3. Assess for neurologic impairment (lack of sensation or movement, pain, or tenderness, or numbness and tingling). 4. Administer analgesic medications. 5. Explain fracture management to the child and family. Depending on the type of break and its location, repair (by realignment or reduction) may be made by closed or open reduction followed by immobilization with a splint, traction or a cast. 6. Maintain skin integrity and prevent breakdown. Institute appropriate measures for cast and appliance care. 7. Prevent Complications

Prevent circulatory impairment by assessing pulses, color and temperature, and by reporting changes immediately. Prevent nerve compression syndromes by testing sensation and motor function, including subjective symptoms of pain, muscular weakness, burning sensation, limited ROM, and altered sensation. Correct alignment to alleviate pressure if appropriate, and notify the health care provider. Prevent compartment syndrome by assessing for muscle weakness and pain out of proportion to injury. Early detection is critical to prevent tissue damage. o Causes of compartment syndrome include tight dressings or casts, hemorrhage. trauma, burns and surgery. o Treatment entails pressure relief, which sometimes require performing a fasciotomy.

8. Prevent infection, including osteomyelitits, bys using infection control measures. 9. Prevent renal calculi by encouraging fluids, monitoring I&O, and mobilizing the child as much as possible.

10. Prevent pulmonary emboli by carefully monitoring adolescents and children with multiple fractures. Emboli generally occur within the first 24 hours. http://nursingcrib.com/nursing-notes-reviewer/fractures/