Nursing Management: Fractures

Nursing Management: Fractures

Neurovascular assessment

  • Peripheral vascular
    • Color and temperature
    • Capillary refill
    • Pulses
    • Edema
    • Motor function
    • Sensory function
    • Paresthesia

Nursing diagnoses

  • Impaired physical mobility related to loss of integrity of bone structures, movement of bone fragments, and prescribed movement restrictions
  • Risk for peripheral neurovascular dysfunction related to vascular insufficiency and nerve compression secondary to edema and/or mechanical compression by traction, splints, or casts
  • Acute pain related to edema, movement of bone fragments, and muscle spasms
  • Readiness for enhanced self–health management

Nursing implementation

  • Health Promotion
    • Teach safety precautions
    • Advocate  to decrease injuries
    • Encourage moderate exercise
    • Safe environment to reduce falls
    • Calcium and vitamin D intake
  • Traction
    • Inspect exposed skin
    • Monitor pin sites for infection
    • Pin site care per policy
    • Proper positioning
    • Exercise as permitted
    • Psychosocial needs
  • Ambulatory care
    • Do
      • Frequent neurovascular assessments
      • Apply ice for first 24 hours
      • Elevate  above  heart for first 48 hours
      • Exercise joints above and below
      • Use hair dryer on cool setting for itching
      • Check with health care provider before getting wet
      • Dry thoroughly after getting wet
      • Report increasing pain despite elevation, ice, and analgesia
      • Report swelling associated  with pain and discoloration OR movement
      • Report burning or tingling under cast
      • Report sores or foul odor under cast
    • Do not
      • Elevate if compartment syndrome
      • Get plaster cast wet
      • Remove  padding
      • Insert objects inside cast
      • Bear weight for 48 hours
      • Cover cast with plastic for prolonged period

Evaluation

  • Report satisfactory pain management
  • Demonstrate appropriate care of cast or immobilizer
  • Experience no peripheral neurovascular dysfunction
  • Experience uncomplicated bone healing

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