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منتدى طلاب جامعة الحديدة


    Fracture

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    عاشق فلسطين
    عضو نشط
    عضو نشط

    ذكر
    عدد الرسائل : 65
    العمر : 31
    البلد : فلسطين
    القسم والمستوى : بكالوريوس تمريض
    المزاج : عالي جدا
    أختر علم دولتك :
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    السٌّمعَة : 0
    نقاط : 236
    تاريخ التسجيل : 08/09/2009

    بطاقة الشخصية
    تخصصي: تمريض
    المحافظة: الحديدة

    Fracture

    مُساهمة من طرف عاشق فلسطين في الجمعة أبريل 15, 2011 11:33 pm

    Fracture
    Definition:
    Is a break in the continuity of bone, occurs when the stress placed on a bone us greater than the bone can absorbed.

    Types of fractures:
    1- Complete: involves the entire cross section of bone, usually displaced "not normal position".
    2- Incomplete: involves a portion of cross section of the bone or maybe longitudinal.
    3- Closed "simple": skin "mucous membranes" not broken.
    4- Open "compound": skin broken, leading to directly to fracture.
    a. Grade I : minimal soft tissue injury.
    b. Grade II : Laceration greater than 1cm without extensive soft tissue flaps.
    c. Grade III: extensive soft tissue injury, including skin, muscles, neurovascular structure.
    5- Pathologic: through an area of diseased bone " osteoporosis, bone cyst, bone tumor, bone metastasis".
    Pattern of fractures:
    1- Greenstick: one side of bone is broken and the other side is bent.
    2- Transverse: straight across the bone.
    3- Obligue: at angle across the bone.
    4- Spiral: twists around the shaft of the bone.
    5- Comminuted: bone splintered into more than three fragments.
    6- Depressed: driven inward "seen in skull and facial bones fractures".
    7- Compression: bone collapses in an itself " seen in vertebral fractures".
    8- Avulsion: fragments of bone pulled off by ligament or tendon attachment.
    9- Impacted: fragment of bone wedged into other bone fragment.
    10- Fracture – dislocation: fracture complicated by the bone being out of the joint.

    Clinical manifestation:
    1- Pain at site of injury.
    2- Swelling tenderness
    3- False motion and crepitus.
    4- Deformity.
    5- Loss of function
    6- Ecchymosis.
    7- Paresthesia.

    Diagnostic Evaluation:
    1- X – ray : to detect integrity of bone.
    2- Blood studies ( CBC, Electrolytes ): with blood loss and extensive muscle damage, may show decreased hemoglobin and hematocrine.
    3- Arthroscopy: to detect joint involvement.
    4- Angiography: associated with blood vessel injury.
    5- Nerve conduction and electrolmyogram studies: to detect nerve injury.
    Management:
    Principle of management
    1- Factors influencing choice of management include
    • Type, location, and severity of fracture.
    • Soft tissue damage.
    • Age and health status.

    2- Goals include:
    • To regain and maintain correct position and alignment.
    • To regain the function of injured part.
    • To return to usual activities.

    3- The management process is a three – steps process:
    • Reduction: setting the bone into the anatomic position and alignment.
    • Immobilization: maintains reduction until healing occurs.
    • Rehabilitation: regaining normal function of affected part.


    Cast
    Type of cast:
    1- Rigid external immobilization (Plaster of Paris " P.O.P").
    • Consist of Anhydrous calcium sulfate.

    2- Water activated polyurethane.
    • Consist of fiberglass.
    • It ventilate the organ.
    • It doesn't absorbed water.
    • Have a color.

    Purpose of casts:
    1- Reduce pain.
    2- Immobilization of fracture.
    3- Correct the deformity of fracture.
    4- Sipport weak joint.
    5- Permit early mobilization

    Pattern of casts:
    1- Short arm cast:
    • From below the elbow to palmercreas
    2- Long arm cast:
    • From below the axillary to palmercreas.
    3- Gauntlet cast:
    • From below the elbow to palmercreas with thumb.
    4- Short leg cast:
    • From below the knee to base of toes .
    5- Long leg cast:
    • From mid of thigh the knee to base of toes.
    6- Shoulder spice cast:
    • Trunk with one or two hands.
    7- Hip spice cast: The hip with
    • One leg >> single.
    • Two legs >> double.
    • One and half leg.

    Care for pt with spice "body cast" :
    1- Avoiding sleep on normal mattress, but on firm mattress or putting a board of wood under him or mattress to prevent sores.
    2- Put pillow under crave back to support it.
    3- Place foot on board.
    4- Teach pt how to use trapeze.
    5- Turning pt frequency.
    6- Provide hygiene care.
    7- Provide skin care under the cast.
    8- Psychological support for pt to prevent depression

    Complication of cast:
    1- Pressure ulcers . "sores"
    2- Compartment syndrome.
    • Nerve >> parenthesis >> paralysis.
    • Blood vessels >> ischemia >> necrosis of tissue.
    3- Cast syndrome.
    • Physiology
    Pressure on mesenteric artery >> decrease blood supply >> necrosis of intestinal tissues >> intestinal obstruction.
    • Psychology
    Tachycardia – loss of sleep – sweaty – HTN.
    4- Problems of immobility.
    • UTI, DVT, renal stones, pneumonia , muscle weakness, impaired skim integrity,…etc.

    Pt Education:
    1. Neurovascular status:
    • Be aware if there is any problems at circulation
    • Assess for skin color.
    • Capillary refill.
    • Assess for parethesis and if there us no motor or no sensation.
    2. Cast care:
    • Instruct pt to avoid slick area.
    • Instruct pt to avoid plastic slipper.
    • Teach pt how to clean cast.

    3. Exercise:
    It is important to do activities to prevent disuse syndrome.
    Types of exercises:
    • Active >> pt do activity by himself.
    • Passive >> pt need help to do activity.
    • Isometric >> contraction of muscles without movement " fisting".

    Traction:
    Is application of a pulling force consist of ( rope – pully – weights ).
    Purpose of traction:
    1- To immobilized the fracture.
    2- To regain normal length of affected part.
    3- To eliminate muscles spasm.
    4- To prevent deformity.
    5- To reduce pain.

    Type of traction:
    1- Running or straight traction
    2- Balance traction.
    3- Skin traction.
    4- Skeletal traction.

    Nursing care for pt with traction:
    1- Maintain effective traction by:
    • Weight must hang free.
    • Ropes must be unobstructed.
    2- Minimize effects of immobility.
    • Turning pt every 2 hours to prevent bed sores.
    • Instruct pt to use trapeze and doing simple exercises to prevent muscle weakness.
    • Take high amount of fluid to prevent urine retention.
    • Instruct pt to take fibers to prevent constipation.
    • Hydrate the pt and give him small amount of coagulant as needed to prevent DVT.
    • Apply bed bath if pt can't do, to keep good general hygiene.
    • Encourage pt and give him psychological support to prevent depression.

    3- Avoiding infection of pin's sites:
    • Assess for manifestation of infection ( fever, tachycardia, redness, swelling, pain, pus ).
    • Maintain good hygiene.
    • Clean the site of pins with antiseptic agents.

    4- Promote tissue perfusion:
    • Peroneal nerve >>> Dorsal position of leg.
    • Tibial nerve >>> Planter position of leg.
    • Radial nerve >>> Sensation at web site.
    • Ulnar nerve >>> Thumb and medial finger opposition.

    Complication of traction:

    1- Bedsores
    2- DVT
    3- Renal stones
    4- Depression
    5- Pneumonia
    6- UTI
    7- Constipation.
    Internal fixation:
    A surgical procedure that stabilizes and joins the ends of fractured (broken) bones by mechanical devices such as metal plates, pins, rods, wires or screws.
    Wires
    Wires are often used as sutures or threads to "sew" the bones back together.
    • Can be used in conjunction with other forms of internal fixation to hold bones together.
    • Can be used alone to treat fractures of small bones, such as those found in the hand or foot.
    Pins
    • Pins hold pieces of bone together. They are usually used in pieces of bone that are too small to be fixed with screws.
    • These pins are usually removed after a certain amount of time, but may be left in permanently for some fractures.
    Plates
    Plates are like internal splints that hold the fractured ends of bone together.
    • Extend along the bone and are screwed in place. If two bones that run parallel to each other both break, such as in the lower leg, plating one bone may provide enough support for the other bone as well.
    • May be left in place or removed (in selected cases) after healing is complete.
    Nails or Rods
    In some fractures of the long bones, the best way to align the bone ends is by inserting a rod or nail through the hollow center of the bone that normally contains some marrow.
    • Held in place by screws until the fracture has healed.
    • May be left in the bone after healing is complete.
    Screws
    Bone screws are used for internal fixation more often than any other type of implant. Although the bone screw is a simple device, there are several designs based on how the screw will be used.
    • Can be used alone to hold a fracture, as well as with plates, rods, or nails.
    • May be designed for a specific type of fracture.
    • May be left in place, or removed after the bone heals.

    External fixation:
    Is a surgical treatment used to set bone fractures in which a cast would not allow proper alignment of the fracture. In this kind of reduction, holes are drilled into uninjured areas of bones around the fracture and special bolts or wires are screwed into the holes

    Ilizarov external fixator on a tibia.

    Used for:
    • Comminuted fractures.
    • Open fractures. "soft tissues injury".

    Nursing care for External fixation:
    1. Reassuring for pt and describe the aim of this technique.
    2. Assess neurovascular status.
    3. Avoiding infection.
    4. Provide wound care.
    5. Elevated lower limbs.
    6. Instruct pt t\not to adjust clamps.
    7. X – ray after wound healing:
    • If fracture still we provide cast instead of external fixation
    until bone healing occurs.
    • If the fracture healing occur, we can use crip bandage.

      الوقت/التاريخ الآن هو الإثنين أغسطس 20, 2018 7:53 am