FRACTURE NURSING MANAGEMENT

Is a complete or incomplete disruption in the continuity of Close fracture

bone structure and is defined according to its type and extent.
 Health teaching
TYPES OF FRACTURE  Promote safe environment
 Document and monitor closely if the pain is
1. Close fracture (simple fracture) – does not cause a break relieved
in the skin, the skin is still intact but the bone is broke.
2. Open fracture (complex fracture)– Open fracture
Open fractures are graded according to these criteria:
• Type I – clean wound less than 1 cm long  Prevent infection of the wound
• Type II – larger wound without extensive soft tissue  Promote healing of the bone and soft tissue
• Type III (A, B, C) – highly contaminated and has extensive  Wound irrigation
soft tissue damage. May be accompanied by traumatic  Elevate extremity to minimize edema
amputation and is the most severe.  Assess Neuromuscular status frequently
 Monitor VS and sign of infection
3. Intra-articular fracture – a fracture that extends into the
joint surface (nearby joint) of a bone. Open reduction open fixation

 w/ the use of titanium to fix the fracture. It is

4. Complete fracture – the fracture completely separates the
most suitable, lessen the possibility for the body
bone into two
to reject this material
5. Incomplete fracture- does not break all through out
> common in pedia pt.  healing process of bone is more than 6 months
>green stick fracture- periosteum in pedia is more Closed reduction
flexible and stronger
 They manually manipulate the fracture.
SPECIFIC TYPE OF FRACTURE Ex. Hilot
1. Avulsion-  Commonly happen on our ball joints
 Tendon- corrective tissue that connect muscle to  Dislocation cases
bone Mal-union- a fractured bone that healed wrongly
2. Comminuted-
 Common in vehicular accidents External fixator-
3. Compression
Internal fixator-
 Common in the vertebrae
4. Depressed- Fasciotomy- surgical management to decompress the area.
 On the head part Pupunitin yung fascia
5. Epiphyseal
 End part of the long bone Fracture healing and complications
6. Green stick- only part of the bone is damage.
 Depend on the client
common in pediatric pt.
 3-12 weeks
7. Impacted-
 Child tend to heal faster because of the
8. Oblique- Slant yung crack
periosteum
9. Transverse- horizontal crack
10. Open- compound fracture EARLY COMPLICATIONS
11. Pathologic- osteoporosis
12. Simple- only the bone is damage  Hypovolemic shock
13. Spiral-  - hypo-tachy-tachy
14. Stress- overuse bone. Ex. Weightlifting  Fat embolism
 - usually occurs in long bone fractures
CLINICAL MANIFESTATION  Rapid onset- 12-72 hours
 B.R.O.K.E.N  Common in male

EMERGENCY MANAGEMENT CLINICAL TRIAD

MEDICAL MANAGEMENT  Hypoxemia- b

 Neurologic compromise
 Closed reduction- manual manipulation/  Petechial rush
reduction
 Open reduction- Surgical approach
 - Common site- toe
- Cause: too much intake of high purine intake. Ex.
 COMPARTMENT SYNDROME
Internal organs, beer, red meats
 a condition in which there is increased pressure
- By product of purine is uric acid
within a closed osteofascial compartment,
- Alipurinol-
resulting in impaired local circulation.
- Colchicine- common meds for gout. Most common
 Nagkakaroon sa compartment (fascia) and it will
side effect is diarrhea, stop the meds
cause pressure, and pain
- Diet- low purine diet
 6P’s (Cardinal sign) - Increased fluid intake
 Pain- deep throbbing unrelenting pain - Worst complication is renal impairment- acute/
unrelieved by pain meds chronic kidney failure
 Paresthesia- pins and needles -
 Pallor- poor blood supply
 Paralysis-
 Poikilothermia-  Systemic
 Pulselessness (late sign)- severe case  accumulation of metabolic ash
 Result of abnormal amount of uric acid
DELAYED COMPLICATION
 Uric acid-
 Delayed union- healing is delayed Risk factor
 Nonunion- bones don’t unite
 Malunion- bone is misaligned - Family history
- Age & sex- Common in men; 30-50 yrs. old
MEDICAL MANAGEMENT- Nonsurgical - Recent surgery / trauma
1. Ultrasound stimulation - Diet- diet rich in red meat
2. Electrical bone stimulation - Weight
- Medical condition- high blood pressure, diabetes
Surgical - Certain medication
1. Autograph- galling sa mismong body nila Gout tophi- accumulation of uric acid on the
2. Allograph- galling sa iba
DIAGNOSIS

AVASCULAR NECROSIS - Joint fluid test

 Bone loses its blood supply and dies - Blood test
- X-ray imaging
COMPLEX REGIONAL PAIN SYNDROME
 Chronic pain in a limb after an injury MEDICATION

- NSAIDs
- Colchicine- Diarrhea
- Ulasimang bato- herbal meds for gout

COMPLICATIONS

 Recurrent gout
 Advanced gout
 Kidney stones

OSTEOARTHRITIS

 Degenerative joint disease

 Pagtanda ng tao
 Localized disease
 Starts at 40 yrs. Old
GOUT, OSTEOARTHRITIS & RHEUMATIOD ARTHRITIS  Women; African American
GOUT- Cause by disposition of uric acid in the bones  Cartilage begin to breakdown
(metatarsals). Can be develop when the disease is chronic  Decrease joints movements
  Wear and tear

Rheumatoid Arthritis

 Systemic disease
 Auto immune problem of pt.
 Symmetric joint pain
 Deformities of hands

Early RA

- Methotrexate
- NSAID’s- ibuprofen
- Aspirin toxicity- bilateral hearing loss
- COX-2- risk for cardiovascular disease
- Analgesics-

 Common complain to arthritis is pain- immobilize the

area
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 Carpal tunnel syndrome
 Low back pain
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