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Fracture and dislocations-nursing management, nursing assessment, nursing diagnosis, nursing interventions

NURSING MANAGEMENT

NURSING ASSESSMENT

A brief history of the accident, mechanism of injury and the position in which the victim was found can be obtained from the patient or witnesses. As soon as possible the patient should be transported to an emergency department where a thorough assessment and treatment can be initiated. Subjective and objective data should be obtained

Subjective data

  • Important health information
  • Past Health History, use of medications and surgery or other treatments
  • Functional health patterns:
  • Health perception, activity exercise, and cognition level

Objective data

  • General: apprehension, guarding of injured site
  • Integumentary: skin lacerations, pallor, cool skin or bluish and warm skin; ecchymosis
  • Cardiovascular: reduced or absent pulse distal to injury, decreased skin temperature, delayed capillary refill
  • Neurologic: paresthesias, decreased or absent sensation, hypersensation
  • Musculoskeletal: restricted or lost function of affected part, local bony deformities, shortening

NURSING DIAGNOSIS

  • Risk for peripheral dysfunction related to nerve compression
  • Acute pain related to edema, movement of bone fragments and muscle spasms
  • Risk of hypovolemia and shock related to trauma and bleeding
  • Risk for infection related to disruption of skin integrity and presence of environmental pathogens secondary to open fracture, external fixator pins, and surgical incision
  • Risk for impaired skin integrity related to improper handling of the site and impaired mobility
  • Impaired physical mobility related to ineffective use of crutches as manifested by instability to move about independently
  • Risk for infection related to disruption of skin integrity and presence of environmental pathogens secondary to open fracture, external fixator pins, and surgical incision
  • Anxiety related to immobility and fear of unknown
  • Ineffective therapeutic regimen management related to lack of knowledge regarding muscle atrophy, exercise program and cast

NURSING INTERVENTIONS

  1. Risk for peripheral dysfunction related to nerve compression

  • Assess for signs and symptoms of peripheral neurovascular dysfunction such as pain in affected extremity that is relieved by drugs, paresthesias, pain on passive movement, weakness, cool temperature, pallor, and diminished pulses
  • Elevate extremity above heart level to reduce edema by promoting venous return
  • Apply ice compresses as ordered to reduce pain and provide comfort
  • Notify physician immediately if patient complains of increasing pain that is unrelieved by drugs because this may indicate neurovascular impairment, which can result in significant injury if unrelieved
  • Teach patient signs of peripheral neurovascular dysfunction to enable her or his participation in care
  1. Acute pain related to edema, movement of bone fragments and muscle spasms

  • Gently and correctly position fractured extremity to minimize pain and prevent bone displacement
  • Use a pain scale to assess pain and effectiveness of interventions
  • Elevate, apply ice and support affected extremity to reduce edema and promote comfort
  • Give patient analgesics and/or muscle relaxant as indicated to relieve pain and promote muscle relaxation
  • Be alert for pain that is not diminished after analgesic is administered because this may indicate an impending compartment syndrome
  1. Risk of hypovolemia and shock related to trauma and bleeding

  • Assess general condition of the patient
  • Monitor electrolyte balance
  • Weigh daily
  • Administer intravenous fluids as recommended
  • Monitor intake output record
  • Check for blood transfusion if required
  • Assess early sign of dehydration
  1. Risk for infection related to disruption of skin integrity and presence of environmental pathogens secondary to open fracture, external fixator pins, and surgical incision

  • Assess fracture or pin insertion points for blistering, discoloration and drainage as indicators of infection
  • Use aseptic techniques when providing wound or pin care to prevent cross contamination and possible introduction of infection
  • Obtain culture of wound if infection is suspected to identify infective organisms
  • Administer antibiotics as ordered
  • Monitor temperature 2 hourly
  • Monitor WBC count
  1. Risk for impaired skin integrity related to immobility and presence of cast

  • Examine potential pressure areas 4 hourly
  • Petal cast edges to prevent skin abrasion
  • Provide appropriate skin care to prevent pressure sores
  • Encourage fluid intake and high-protein, high-vitamin, high-calcium diet
  • Assess exposed skin areas of traction sites for signs of infection or irritation
  • Instruct patient not to insert items into cast to scratch
  • Instruct patient to report areas of warmth, pain, burning or moisture beneath the cast; foul odor from cast ends
  1. Impaired physical mobility related to ineffective use of crutches as manifested by instability to move about independently

  • Teach gait training principles to patient; sit with feet over edge of bed, stand with no weight on affected extremity, measure and adjust crutches to promote mobility according to patient’s capabilities
  • Ensure gait is compatible with weight-bearing status to prevent misalignment
  • Work with physical therapist regarding exercise and gait training to reinforce plan and to provide unified approach to patient
  1. Anxiety related to immobility and fear of unknown

  • Assess the knowledge of the patient about the condition, prognosis and treatment
  • Explain the necessary information
  • Use simple language
  • Instruct in calm and relaxed environment
  • Involve the family members
  • Clarify doubts and queries as asked
  • Provide written instructions as per requirement
  1. Ineffective therapeutic regimen management related to lack of knowledge regarding muscle atrophy, exercise program and cast

  • Assess the previous knowledge of the patient
  • Instruct in simple language using short sentences
  • Instruct patient on home care measures related to exercise, cast care, and prevention of complications so that patient can carry out prescribed discharge plan
  • Explain factors that contribute to atrophy; emphasize relationship of inactivity to muscle atrophy
  • Provide written instructions of prescribed exercise plan

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