Nursing Management of a Patient With Close Fracture

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NURSING MANAGEMENT OF A PATIENT WITH CLOSE FRACTURE

A CASE STUDY PRESENTED TO THE

OUR LADY OF FATIMA UNIVERSITY

COLLEGE OF NURSING

VALENZUEA CITY

BY:

YAP JOHN JOSHUA M.

MS.VILMA MIGUEL, RN, MAN

Clinical instructor



INTRODUCTION

PATIENT PROFILE

PATIENT NAME M.A.DC

AGE 8

SEX MALE

BED NUMBER 34

HOSPITAL NUMBER 713421

BLOOD TYPE O+

ADDRESS Sto.Nino Gov.Pascual Malabon

DATE OF BIRTH Dec,12,2003

OCCUPATION student

DATE OF ADMISSION FEB,12,2012

DIAGNOSIS Fractured closed complete



FAMILY MEDICAL HISTORY

PAST MEDICAL HISTORY: ACCORDING TO DOES NOT HAVE ANY PAST MEDICAL HISTORY

PRESENT MEDICAL HISTORY: PTA . FALL INJURE ABOUT 3Ft HIGh

C.C: SWELLING AND TENDERNESS AT RIGHT ELBOW

MOTHER FATHER

M.A.DC



Anatomy and Physiology

A bone fracture is a medical condition in which there is a break in the continuity of the bone. A

bone fracture can be the result of high force impact or stress, or trivial injury as a result of certain medical

conditions that weaken the bones, such as osteoporosis, bone cancer, or osteogenesis imperfecta, where

the fracture is then properly termed a pathologic fracture.

When outside forces are applied to bone it has the potential to fail. Fractures occur when bone

cannot withstand those outside forces. Fracture, break, or crack all mean the same thing. One term is not

better or worse than another. The integrity of the bone has been damaged and the bone structure fails and

a fracture occurs. (Wedro, 2012)

Broken bones hurt for a variety of reasons including: the nerve endings that surround bones contain

pain fiber. These fibers may become irritated when the bone is broken or bruised; broken bones bleed,

and the blood and associated swelling causes pain; and muscles that surround the injured area may go into

spasm when they try to hold the broken bone fragments in place, and these spasms may cause further

pain. (Wedro, 2012)



GENER AL SIGNS AND SYMPTOMS OF FR ACTURE

1. Pain at or near the seat of fracture.

2. Tenderness of discomfort on gentle pressure over the affected area.

3. Swelling about the seat of fracture. Swelling frequently render it difficult to perceive

other signs of fracture and care must be taken therefore not to treat the condition as a less

serious injury.

4. Loss or power; the injured part cannot be moved normally

5. Deformity of the limb; the limb may assume an unnatural position and be mis-shapen.

The contracting muscles may cause the broken ends of the bone to override, thereby

producing shortening of the limp.

6. Irregularity of the bone. If the fracture is near the skin the irregularity of the bone may

be felt.

7. Crepitus (bony grating) may be heard or felt.

8. Unnatural movement at the seat of the fracture.



TYPES OF FR ACTURES

y Open fracture: An open fracture is a fracture where the broken bone is exposed. That is

dangerous because of increased chances of infection. It is also called compound fracture.

y Closed fracture: Also known as simple fracture, a closed fracture is a fracture where the

bone is broken, but the skin is intact.

y Com pl ete fracture: The two pieces of the bone, resulting from the fracture, completely

separate from each other.

y I nc om pl ete fracture: In this, the two pieces of bone, resulting from the fracture do not

completely separate from each other; the bone pieces are still joined to some extent. This

happens when the crack (or fracture) does not traverse along the entire width of the bone.

y M ul ti-fragmentary fracture: In this the bone splits into multiple pieces.

y Com pre ssi on fracture: A compression fracture is a closed fracture that occurs when two or

more bones are forced against each other. It commonly occurs to the bones of the spine and

may be caused by falling into a standing or sitting position, or a result of advanced

osteoporosis.

y Av ulsi on fracture: An avulsion fracture is a closed fracture where a piece of bone is broken

off by a sudden, forceful contraction of a muscle. This type of fracture is common in athletes

and can occur when muscles are not properly stretched before activity. This fracture can also

because of an injury.

y I m pacted fracture: An impacted fracture is similar to a compression fracture, yet it occurs

within the same bone. It is a closed fracture which occurs when pressure is applied to both

ends of the bone, causing it to split into two fragments that jam into each other. This type of

fracture is common in car accidents and falls.



y S tre ss fracture: It is a common overuse injury. It is most often seen in athletes who run and

jump on hard surfaces such as runners, ballet dancers and basketball players.

y

Linear fracture

:

In this the fracture is parallel to the bone's long axis.

y T ran sv er se fracture: In this the fracture is at a right angle to the bone's long axis.

y Obl ique fracture: In this the fracture is diagonal to a bone's long axis.

y S piral fracture: In this at least one part of the bone has been twisted.

y Comminuted fracture: In this the fracture results in several fragments.

y Com pacted fracture: In this the fracture is caused when bone fragments are driven into

each other.



MEDICAL THER APY

Fractures are broken bones. Fractures cause pain and make it difficult or impossible to use the part of thebody that is injured. The treatment of a fracture depends upon the type and location of the fracture, if there are other injuries, and how serious those injuries are.

The goal of treatment is to have a completely healed well-aligned bone that functions well. The boneshould not be deformed and should look good when healed. The treatment should allow the person to goback to work as soon as possible. The broken pieces must be put back into the correct position and keptin proper alignment until healing is completed. The types of treatment include:

y closed reduction

y traction

y open reduction and internal fixation

y external fixation

y casts and splints and

y functional casts or braces

X-rays - help determine the proper diagnosis and type of treatment. Sometimes fractures do not affectbone alignment and only require protection of the bone with a splint or cast while it heals. However, if thefractured bone is not lined up correctly, it may need to be reduced. This means re-aligning the bone. Aclosed reduction re-aligns a bone by manipulation without surgery. Sometimes it is not possible for theprovider to get the bones in the right position with a closed reduction. If this happens, traction can be puton the bones to gently pull them into position. Traction is usually used for a short period of time andbefore other forms of treatment are used.



NO N MODIFIABLE

FACTORS

WITHIN 48 HOURS AFTER THE INJURY

, VASCULAR TISSUE INVADES THE

FRACTURE AREA FROM

SURROUNDING SOFT TISSUE AND THE

MARROW CAVITY , AND BLOOD

FLOW TO THE ENTIRE BONE IS

INCREASED. AS THE REPAIR PROCESS

CONTINUES REMODELING OCCURS

DURING WHICH UNNECESSARY

CALLUS IS RESORBED AND

TRABECULAE ARE FORMULATED A

LONG LINES OF STRESS

PATHOPHYSIOLOGY

Direct trauma to the bone and

tissue due to fall about 3FT high

When a bone is broken, the

periosteum and blood vessel in the

cortex, marrow, and

surroundingsoft tissue are

disrupted

>irregularity

of the bone

>unnatural

movement

of the site

BLEEDING OCCURS FROM THE

DAMAGE ENDS OF THE BONE FROM

THE NEIGBORING SOFT TISSUE.

A CLOT (HEMATOMA) FORMS WITHIN

THE MEDULLARY CANAL, BETWEEN

THE FRACTURE ENDS OF THE BONE

AND BENEATH THE PERIOSTEUM

BONE TISSUE IMMIDIATELY

ADJACENT TO FRACTURE DIES

NECROTIC TISSUE ALONG WITH ANY DEBRIS IN THE FRACTURE AREA STIMULATES AN INTENSE

INFLAMMATORY RESPONSE

PAIN NEAR THE SEAT OF THE

FRACTURE

TENDERNESS OF DISCOMFORT

ON GENTLE PRESSURE OVER

AFFECTED AREA

SWELLING ABOUT THE SEAT

OF FRACTURE



P-E-R -S-O-N Assessment

Psychosocial Feb. 16, 2012

ASSESSMENT INTER PRETATION

1. Significant Others Father Members of the family will help

the client to cope up easier and

better to his condition.

2. Coping mechanism

2.1 Problem- Focused

2.2 Emotional-Focused

Sublimation

Calm

Instead of minding the pain that

he is experiencing, he listens to

music to ease the pain.

The patient is in calm and

accepting mood.

3. Religion Roman Catholic God is the one who give him

strength and confidence to face

his trials.

4. Primary Language Tagalog Tagalog is the medium of

communication between the

client and the student nurse.

5. Occupation Student The client is a grade 3 level

6. Education elementary

7. General Apperance He have dirty nails has scars in

his elbow and feet and has a

splint in his right arm

8. Orientation Oriented in time, place and

person

He was able to recognize the day,

the hospital and himself. He is in

stable mental capability.

9. Memory Intact Short term and Long term

memory

He can still remember the recent

events and the past events

including the accident he dealt

with.

10. Speech

a. Volume Soft The patient is conserving his



b. Rate

c. Amount

Slowed

Answer when questioned only

energy and cannot talk much due

to mild pain on his right arm.

11. Non-Verbal Behavior In good eye contact when

questionedFacial grimace He seems to be uncomfortable

and in pain.

Elimination

1. Stool

a. Consistency and

Shape

b. Amountc. Color

Formed stool

UndeterminedBrownish-yellowish

According to the client, it has

been 1 week after the operation

before he defecates.

2. Urine

a. Quantity

b. Color

c. Odor

d. Clarity

FC

Yellowish

Aromatic

Clear

The yellowish color is due to the

medications rendered to theclient.

3. Toileting Ability The patient can go to the

Comfort room so whenever he

feels the urgency, he is just the

one to go in the comfort room

R est and Activity

1. Current Activity Level The patient can walk but can¶t

move his right arm he is

slightly active



2. ADL¶s Upon waking up, the client

usually takes his breakfast .He

also play in his cellphone

when he feels bores.

3. Sleep

a. Sleep history

Usual bedtime

Usual waking time

8pm

7 am

The patient has difficulty in

sleeping due to hot

environment that he is

experiencing.

4. Body Frame

5. Muscle

a. Strength

b. Tone

Normal

Flaccid

The muscle of the patient is in

fair condition except for the

right arm

6. Motor function

a. Gross

b. Fine

Capable of extension and

flexion of extremities¶ except

for right arm still limited.

He can do his ADL by his

own.

7. Range of Motion Active ROM He can do work by his own

8. Pain Relief Measures playing Listens to music in

cellphone when he is in pain.

He diverts his attention to

suppress pain.



Safe Environment

1. Allergies No known allergy

2. Eyes/Vision Pink palpable conjunctiva

(anicteric sclerae)

Normal sensory and motor

function

3. Hearing Can recognize voices

4. Skin Warm and moist Due to hot environment

5. Mucous Membrane Moist Mucous Membrane Patient is well hydrated

6. Temperature T: 36. 2°C at auxillary

temperature

The patient is afebrile.

Oxygenation

Activity Tolerance Limited activity in his right arm

only

Airway Clearance No secretion present in the

airway of the client

Respiration RR: 22 cycles/minute The patient has slightly increase

in respiration but does not show

any signs of hypoxemia or

difficulty in breathing.

Lung Sounds (-) abnormal lung sounds

Nails Dirty and long Normal in shape

Capillary Refill

Blood Pressure



Nutrition

Hospital diet On diet as Tolerated Eaten full meal well

Fluid intake Can drink fluid Drink almost 1500 ml/ day

IVF¶s No IVF

Skin Turgor Good skin Turgor Signs of good hydration

COUR SE IN THE WARD

FEB.15.2012 THUR SDAY

Assessment Diet IVF Laboratory

Exam

Medication Doctor¶s

Orders

Nursing

R esponsibilities

Awake Maintained on diet

astolerated

Noongoin

g IVF

Nomedication

where given

There is nodoctors order

Encouragedincreased fluid

intake to promotehydration.

Instructed to doDeep Breathing

Exercise toalleviate pain and

promote relaxation.

Advised to Playgames in cell phone

to relieved boredom.



FEB.16.2012 FR IDAY

Assessment Diet IVF Laboratory

Exam

Medication Doctor¶s

Orders

Nursing

R esponsibilities

Conscious Maintained on diet

astolerated

Noongoing

IVF

Nomedication

where given

There is nodoctor¶s

order.

Encouragedincreased fluid

intake to promotehydration.

Instructed to do

Deep BreathingExercise toalleviate pain and

promote relaxation.

Advised to playgames in cell phone

to relieved

boredom.

Encouraged to doROM to the

Unaffected side to prevent muscle

atrophy

Nursing Management of a Patient With Close Fracture

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