NURSING CARE:

Fracture

Jay Villasoto
Trochanter roll
Infected wound
NURSING CARE
Nursing Interventions (Risk for fall)
Maintain bed rest or limb rest as indicated.
Provide support of joints above and below
fracture site, especially when moving and
turning.
Secure a bed board under the mattress or
place patient on the orthopedic bed.
Support fracture site with pillows or folded
blankets. Maintain a neutral position of
affected part with sandbags, splints,
trochanter roll, footboard.
Use sufficient personnel for turning. Avoid
using abduction bar for turning patient with
a spica cast.
Rationale
Provides stability, reducing the possibility of
disturbing alignment and muscle spasms,
which enhances healing.
A soft or sagging mattress may deform a wet
(green) plaster cast, crack a dry cast, or
interfere with the pull of traction.
Prevents unnecessary movement and
disruption of alignment. Proper placement
of pillows also can prevent pressure
deformities in the drying cast.
Hip, body or multiple casts can be extremely
heavy and cumbersome. Failure to properly
support limbs in casts may cause the cast to
break.
NURSING CARE
Nursing Interventions (Impaired physical
mobility)
Assess the degree of immobility produced by
injury or treatment and note patient’s
perception of immobility.
Monitor blood pressure (BP) with the
resumption of activity. Note reports of
dizziness.
Reposition periodically and encourage
coughing and deep-breathing exercises.
Consult with a physical, occupational
therapist or rehabilitation specialist.
Rationale
Patient may be restricted by self-view or self-
perception out of proportion with actual
physical limitations, requiring information or
interventions to promote progress toward
wellness.
ostural hypotension is a common problem
following prolonged bed rest and may
require specific interventions (tilt table with
gradual elevation to upright position).
Prevents or reduces the incidence of skin
and respiratory complications (decubitus,
atelectasis, pneumonia).
Useful in creating individualized activity and
exercise program. Patient may require long-
term assistance with movement,
strengthening, and weight-bearing activities,
as well as the use of adjuncts (walkers,
crutches, canes); elevated toilet seats;
pickup sticks or reachers; special eating
utensils.
NURSING CARE
Nursing Interventions (Risk for injury
Assess pulses in casted above or below the
extremity, edema, coolness, inability to
move digits, paleness or cyanosis, numbness
of areas distal to the cast every 2 hours.
Observe paleness, numbness, or changes in
movement of the body part; weakness or
contractures of uninvolved muscles and
joints: Assess pulses and monitor
neurovascular status every 2 to 4 hours.
Assess the reason for and type of traction,  Provides detail regarding the use of  traction to
extremity or body part affected.
Rationale
Reveals about the neurovascular status of
an extremity after the application of a cast as
swelling persists causing the cast to become
tight and impairs circulation; a bivalved cast
manages severe swelling to prevent tissue
damage.
Reveals circulation changes brought about
by traction and muscular changes resulting
from immobilization.
realign bone ends, immobilized a part, correct a
deformity, decrease muscle spasms, provide rest
for an extremity; traction may be manual
as in cast application, skin in which the pull is
attached to the skin with bandages or straps, or
skeletal in which the pull is
attached to a pin, wire, or tongs inserted into the
bone at a distal position to the fracture.