Nursing management/Consideration
What nutrition therapy should you consider with fractures?
protein, vitamins B C and D, calcium, phosphorus, magnesium, fluid and high fiber diet to prevent constipation
What are the complications associated with fractures?
Infection (need surgical debridment and ABX)
Compartment syndrome- DO NOT ELEVATE OR APPLY COLD THERAPY. CUT CAST. NOTIFY DR
Rhabdomyolysis (assess urine output)
VTE (heparin, lovenox, ROM on unaffected side)
Fat embolism
How do you get a Colles fractures, how does it present, how do you treat it and whats a complication?
Falling on an outstretched arm and hand and being older than 50. Presents with dorsal displacement and distal fragment (silver fork deformity).
a complication is vascular insufficiency from edema.
perform neurovas assessment and encourage movement of thumbs and fingers
What are some considerations for hip fractures?
If a posterior approach was used in surgery, you MUST prevent dislocation (things that cause: more than 90 degrees of flexion)
Patient should use raised toilet seat, shower chair, chair with arms and have pillow in between legs
Patient can't put on own socks or abduct over midline.
What should you do in your assessment when someone has a fracture?
IMMOBILIZE IN POSITION IT WAS FOUND AND PERFORM NEUROVASCULAR ASSESSMENT FREQUENTLY!
What are complication of tibial fractures and treatment?
Compartment syndrome, fat emboli, delayed union/nonunion, infection.
Do a neurovas assessment q2hr for first 2 days, non weight bearing for 6-12 weeks, ROM exercise
How does a humeral shaft fracture present? Complication? How to treat?
displacement of humeral shaft, shortened extremity.
complications are radial nerve injury and brachial artery injury
exercise motion of hand, fingers, shoulder
Prothesis dislocation
What can a pelvis fracture cause? How is it diagnosed? How do you treat it?
High mortality rate!
May cause intraabdominal injuries, acute pelvic compartment syndrome, and parylytic ileus (NPO, NGtube)
Diagnosed with x-ray or CT
Do a neurovas assessment DISTALLY
be careful with handling and moving pt
What is the considerations of stable vertebral fractures? Symptoms? Treatment?
If instability occurs they will need surgery (vertebroplasty and balloon kyphoplasty). Should keep the spine in good alignment until union achieved
SX are kyphotic deformity (dowagers hump)
Treated with halo vest, cervical coller, jewett or bahler vogt brace. Logrolling
More common in women, intracapsular fractures, extracapsular fractures.
Presents with external rotation, muscle spasm, shortening of the affected extremity
Affected extremity immobilized by bucks traction. then CRPP and partial hip replacement
Encourage them to use trapeze bar to reposition and avoid turning them to affected side
What is the priority with facial fractures? Considerations? Treatment?
Patent airway and adequate ventilation is PRIORITY! You should always assume they have ABC problem
immobilize, maintain airway and nutrition, and provide emotional support.
Treat pt as if spinal injury present until its ruled out. use CT scan for clarity. nutrition is important! (they can't eat normally). if they have a eye globe rupture place a protective shield over the eye
What is the etiology of femoral shaft fractures? Presentation? Complications? Treatment?
More common in young adults and considerable blood loss often occurs.
Presents with deformity, angulation, shortening of extremity, inability to move hip or knee
Complications are fat emboli, nerve injury, and soft tissue damage
Manage by immobilizing and limit weight bearing and strength exercise
What are considerations of mandibular fractures? Treatment?
Need immediate treatment and surgery to immobilize