At the end of this session, you will be able to :

State the definition of fracture. List the etiology of fracture. Identify the pathophysiology of

fracture. State the sign & symptom of

fracture.

LEARNING OBJECTIVES cont.

Identify the complication of fracture.

Understand regarding treatment of fracture.

Identify the nursing intervention & appreciate the nursing care for fracture patient.

PATIENT’S PROFILE

MRS. T

FEMALE

54 YEARS OLD

HOUSEWIFE

PATIENT’S PROFILE TROLLEY

ANXIOUS

ALLERGICS - NIL

D.O.A 21/3/14 @ 2300 Hr

Mrs T was admitted to 5XX-4 with complaint

of fall at home tonight and swelling

left thigh.

Doctor = Dr J

Diagnosis 1.# Lower 1/3 Left Femur2.Hypertension

PATIENT’S PROFILE MEDICAL HISTORY HPT

SURGICAL HISTORY NIL

FAMILY MED HISTORY NIL

CURRENT MEDICATION

Nil

VITAL SIGN TEMPERATURE : 37.2˚C BLOOD PRESSURE : 160/110mmHg PULSE : 70 bpm RESPIRATION : 21 bpm PAIN SCORE : 6 Weight : Unfit

ACTIVITY DAILY LIVING

Anxious and asking many questions.

Need assistance in ADL and personal hygeine

On pampers

PHYSICAL EXAMINATION

S/B Dr J in A&E

POP left leg CRIB PCM 2 QID IM Pethidine 50mg PRN Monitor BP 2 hourly Dr AB to see in ward

206

BONES

MECHANISM OF INJURY Compression Tension Bending Unloaded Shear Torsion Combined loading Pathological diseases

TRAUMATIC #

• Due to sustained trauma.

PATHOLOGICAL #

• A fracture through a bone which has been made weak by some underlying diseases e.g. osteoporosis, bone cancer or osteogenesis imperfecta.

CLOSED (SIMPLE) #

• Those in which the skin is intact.

OPEN (COMPOUND) #

• Involved wound that communicate with the fracture, or where fracture haematoma is exposed.

COMPLETE #

• A fracture in which the bone fragment separate completely.

INCOMPLETE #• A fracture in which the bone

fragments are still partially joined. There is crack in the osseous tissue that does not completely transverse the width of the bone.

Caused by breaking in continuity of periosteum which contains multiple nociceptor.

Due to muscle spasm that act as natural splinting to minimize movement of fragments.

Edema of nearby soft tissues caused by bleeding of torn periosteal blood vessels and injured muscles evokes pressure pain.

Due to muscle spasms because muscles try to hold bone fragments in place.

Extremities cannot function properly because normal function of muscles depends on the integrity of bone which they’re attached.

Resulted from displacement, angulation, rotation or from soft tissue swelling.

Visible or palpatable.

Due to contraction of the muscles that are attached above & below the # site.

A grating sensation can be felt on hand’s examination.

• Age

• Female (drop of estrogen)

• Bone disease

• Smoking

• Malnutrition

• Lack of exercise or physical activity

• Steroid user

RISK FACTORS

Insufficient blood supply to muscles and nerves due to increase pressure within one of body’s compartment.

COMPARTMENT SYNDROME

Fat globules (emboli) move into blood because bone marrow pressure is greater than capillary pressure & occlude small blood vessel to other organs.

Hypoxia, tachypnea, tachycardia & pyrexia.

FAT EMBOLISM SYNDROME

(in long bone)

The fractured bone fail to heal.

NON UNION

The fractured bone heals in deformed manner.

MAL UNION

• Neutropil- 83.1% (40 – 75%)

• Lymphocyte- 12.7% (20-45%)

• Glucose- 7.4 (3.9 – 6.1mmol/L)

• Potassium- 2.9 (3.5 – 5.5mmol/L)

SURGICAL PROFILE

• Comminuted spiral fracture distal third of left femur

X-RAY LEFT FEMUR

DRUGSIN WARD

DATEORDERED

DATE OFF

PCM 2 QID 21/3/14 /3/14

IM Pethidine 50mg PRN 21/3/14 /3/14

Tab Covasc 5mg Daily 21/3/14 /3/14

IV Rocephin 1gm Daily 22/3/14 /3/14

Alteration in comfort : pain related to fracture 1/3 left femur.

NURSING DIAGNOSIS

Knowledge deficit related to management of blood pressure control.

NURSING DIAGNOSIS

SUPPORTING DATA Patient will verbalize understand

regarding the management of blood pressure.

Patient will maintain optimal normal blood pressure.

NURSING INTERVENTION

Reinforce about doctor’s explanation.

Monitor blood pressure 4 hourly.

NURSING INTERVENTION Explain the sign and symptom of

high blood pressure : Headache Blurring vision Numbness

NURSING INTERVENTION

Advise patient on dietary plan and provide :

Low salt diet Low fat diet

NURSING INTERVENTION

Advise patient to do regular follow up.

NURSING INTERVENTION

Advise patient to maintain healthy lifestyle :

Avoid stress Consume healthy diet and avoid

salty and high fat food

NURSING INTERVENTION

Advise patient to do regular exercise.

Encourage family members support.

NURSING INTERVENTION

Explain the complication of high blood pressure :

Influences of cardiovascular Cerebral Renal system

Alteration in emotional status anxiety related to symptoms of stroke and treatment.

NURSING DIAGNOSIS

Alteration in ADL related to right sided weakness and numbness of right hand.

NURSING DIAGNOSIS

Potential fall related to right sided body weakness.

NURSING DIAGNOSIS

Potential infection related to intravenous cannulation.

NURSING DIAGNOSIS

Alteration in comfort : pain related to surgical intervention.

NURSING DIAGNOSIS

Potential bleeding related to surgical intervention.

NURSING DIAGNOSIS

Potential infection related to surgical intervention.

NURSING DIAGNOSIS