ASUHAN KEPERAWATAN

PADA PASIEN FRAKTUR

OLEH
JOHANSEN HUTAJULU
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Fractures
Definition: Interruption in normal bone
continuity, which is accompanied by soft
tissue injury
Classification:
- Simple or closed
- Open or compound

Fracture Patterns

Oblique Line of Fx. Angled

Transverse Across the bone
Longitudinal Length of bone
Spiral Twisting or rotation of bone
Comminuted broken in > 2 places
Impacted Fragments driven into each other
Displaced or Avulsed torn away by a ligament or tendon

Upper Extremity Fractures

Fractures include those of the:

Clavicle
Scapula
Humerus
Olecranon
Radius and ulna
Wrist and hand

Lower Extremity Fractures

Fractures include those of the:

Femur
Patella
Tibia and fibula
Ankle and foot

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Stages of Bone Healing

Hematoma
Granulation
Callus Formation
Osteoblastic Proliferation
Bone Remodeling
Complete Healing
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Bone Healing Problems

Delayed Union - > 6 months to a year

Nonunion - < of bone fragments joined

together
Malunion Bone healed in state of deformity
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Asuhan keperawatan
1. Pengkajian
Anamnesa (Data Subyektif):
riwayat sakit/fraktur,
riwayat pengobatan,
riwayat penyakit penyerta,
riwayat diet/nutrisi.

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 Mengeluh nyeri saat pergerakan

Kehilangan sensasi
Tidak bisa menggerakkan bagian yang
sakit/fraktur.
Penurunan ROM
Cemas
Takut

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 Pemeriksaan fisik (Data Obyektif):

Inspeksi/look: perubahan bentuk tlg, luka,
warna, edema, hematom, ecchymosis,
kelainan gaya jalan
Palpasi/feel: krepitasi, perfusi; ..
Move: ekstensi, fleksi, rotasi, abduksi,
adduksi, kerusakan neurovaskuler.

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 Pemeriksaan penunjang
X-ray
Laboratorium: Hb, Ht, Tr, Lk
Pemeriksaan lain sesuai dengan
etiologinya.

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Special Assessment
Considerations
For fractures of the shoulder and upper
arm, assess client in sitting or standing
position.
Support the affected arm to promote
comfort.
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 For distal areas of the arm, assess client

in a supine position.
For fracture of lower extremities and
pelvis, client is in supine position.

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Nursing Diagnoses

Acute Pain
Risk for Neurovascular Dysfunction
Risk for Infection
Altered Mobility
Activity Intolerance

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Complications of Fractures

Shock
Neurovascular Compromise
DVT & Pulmonary Emboli
Aseptic Necrosis
Acute Compartment Syndrome
Fat Embolism Syndrome
Osteomyelitis

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 Kompartemen sindrom: peningkatan

tekanan interstitial jaringan, penurunan
lairan darah kapiler, hipoksia dan
nekrosis jaringan lokal

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Shock
Etiology: Hemorrhage into damaged
tissues, especially thorax, pelvis, &
extremities
Treatment: Control bleeding and restore
blood volume

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Neurovascular Compromise
Etiology: Damage to nerves from fragments
of bone, pressure from casts, splints, &
traction
Treatment: 6 Ps Pain, Pulslessness,
Paresthesia, Pallor, Paralysis, Poikothermia

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Risk for Peripheral

Neurovascular Dysfunction

Interventions include:

Emergency care: assess for respiratory distress,

bleeding and head injury
Nonsurgical management: closed reduction and
immobilization with a bandage, splint, cast, or
traction

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Fat Embolism Syndrome

Etiology: Release of particles of fat into the

blood stream from the yellow marrow at site of
injury
Risk Factors: Fr. of long bones, multiple fr.,
high serum glucose or cholesterol level

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DVT & Pulmonary Emboli

Etiology: Immobility, trauma, surgery
Risk Factors: Incidence in fractures of the lower
extremities; Smoking, obesity, Heart Disease
Treatment: Anticoagulants

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Vascular Necrosis
Etiology: Loss of blood supply to bone
Risk Factors: Hip fractures or any fracture
where this bone displacement
Treatment: Surgical joint replacement

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Compartment Syndrome
Etiology: Massive compromise in circulation from external
(Tight, bulky dressings, casts) & internal (blood & fluid)
Treatment: Immediately loosen any tight dressings & MD
can bivalve cast;
Surgery Decompression fasciotomy for edema and
bleeding

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Medical Management of
Fractures

Closed Reduction & immobilization Manual

traction to align the bone

External Fixation Percutaneous placement of pins

implanted into bone
- Kronner 4-Barr Compression Frame
- Hex-Fix External device for tibial fractures
- Halo Traction Cervical spinal fractures

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Nursing Care External Fixation

Teach patient to grasp frame when moving,
rather than limb
Frequent observation & neurovascular
assessments
Pin Care Note symptoms of infection
Assess for loosening or shifting of devices
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Casts
Purpose: Immobilze, correct deformity, allow
early mobility, & provide support & protection
Types: Plaster of Paris & Fiberglass

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Plaster Cast Care

Instruct that cast will feel warm

Handle cast with palms of hands
Turn client q 1-2 hours for drying
Elevate on pillow than heart
Pedal rough edges with moleskin
Inspect q 4-8 hours drainage, cracking, odor,
alignment & fit

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Cast Complications

Circulatory impairment
Peripheral nerve damage
Impaired skin integrity
Pneumonia, DVT, Constipation
Compartment Syndrome
Cast Syndrome Body cast
Fracture blisters

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Traction
Definition: Pulling force that is applied to part of an
extremity while a counter traction pulls in the
opposite direction
Purpose: Reduce Fracture, immobilize, decrease
pain & muscle spasm, correct deformities, stretch
tight muscles

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Types of Traction

Continuous or Running Bucks, Russell

Circumferential Pelvic
Cervical
Suspension or Balanced Thomas Ring
Skeletal Steinmann pins, Kirschner wires,
Crutchfield tongs

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Nursing
Assessment
Equipment weights, pulleys, ropes,
Balkan frame
Mobility
Skin integrity
Neurovascular
Gastrointestinal
Urinary

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