Fractures Fundamentals Unit 12 Fractures l Fracture a

Fractures Fundamentals Unit 12

Fractures l Fracture- a break or interruption in the continuity of bone l At the fracture site there will be… ¡Some degree of tissue destruction ¡Some degree of interference in muscle activity

Fractures l Fracture types are… ¡ Complete – broken into two parts with complete separation of the two parts ¡ Comminuted – broken and shattered into more than two pieces ¡ Closed(simple) – no break in the skin ¡ Open(compound) – break in the skin ¡ Greenstick – partially broken and bent, common in children

Fractures l Two reduction methods ¡Closed ¡Open l Two types of casts ¡Plaster of Paris ¡Fiberglass l Patient preparation ¡Wash area ¡Prepare emotionally

Fractures l Care of the fresh cast ¡Plaster of Paris = 48 hours ¡Fiberglass = 1 hour ¡Speed of drying is affected by… l. Humidity l. Air circulation ¡Wet cast vs. dry cast

Fractures ¡Cast care l. Handle with extreme care! l. Support cast on pillows l. Do not allow heels to rest on bed l. Get help l. Handle with palms of hands ¡Complications l. Listen to your patient! l. Neurovascular checks

Fractures l. Complications ¡Gangrene ¡Paralysis ¡Impaired circulation ¡Pressure sores ¡Infection

Fractures l Circulation/neurovascular checks l Daily nursing care and interventions include… ¡Bathing ¡Fracture pans ¡Massage skin ¡Itching ¡Activity ¡Diet

Fractures l Cast removal ¡Cast cutter ¡Cast saw ¡Expect atrophy and dry skin l Remember, a cast is a mold of a body part used to immobilize a body part.

Fractures l Let’s review care at the bedside… ¡Leave cast uncovered to dry ¡If wet handle only with palms of hands ¡Assess neurovascular checks distally and compare with the unaffected limb ¡Provide care instruction ¡Assess for infection ¡Don’t forget to document

Fractures l. Traction ¡Purposes l. Relieve muscle spasms l. Reduce dislocations/relieve contractures l. Immobilization

Fractures l 2 General Types ¡Skin l. Buck’s l. Bryant’s l. Russell’s traction ¡Skeletal l. Crutchfield tongs l. Halo vest l. Steinmann’s pins

Fractures ¡Nursing care of your patient in traction • • • Weights and ropes Never remove weights! Patient position Keep patient covered Good skin care is essential! Turning? ROM? Pin sites Neurovascular checks Diversional activities Safety Pain medication Elimination

Fractures l Charting ¡Type of traction ¡Amount of weight used ¡Site of traction and pin sites ¡Pin site care ¡Distal neurovascular checks ¡Skin assessments ¡Patient tolerance ¡Any specific complaints l Review

Ostomy l Colostomy-surgical formation of an artificial anus from colon to abdomen l Purpose-allow for drainage of feces through a stoma ¡Permanent-removal of rectum or part of colon l. One stoma l. Left side of abdomen ¡Temporary l. May have two stomas l. Once intestine heals is reversed (anastomosis)

Ostomy l Ileostomy-an opening from small intestine to abdomen o Colon and rectum are removed o Stoma is on the right side of the abdomen and it is smaller o Cannot be irrigated o Permanent l Emotional adjustment

Ostomy l Types of stool coming from different ostomy sites will be… l Nursing care for your colostomy or ileostomy patient… l Assess the stoma l Observe for prolapse l Skin care l Meal time l Report absence of effluent l No rectal temps! l Keep incision clean l No laxatives l Spend time with the patient l Monitor flatus

Ostomy l Charting is important. l How do I change the colostomy appliance? l Controlling odors l How do I irrigate the colostomy? You are done with unit 12!