5. 1. 1. Casts—types:

         1. (a) Spica— applied to immobilize hip or shoulder joints.

         2. (b) Body cast—applied to trunk.

         3. (c) Arm or leg cast—joints above and below site included in cast.

      2. Splints, continuous traction.

      3. External fixation devices (Charnley)—multiple pins/rods through limb above and below fracture site, attached to external metal supports. Patient able to become ambulatory.

   2. Internal fixation— pins, wires, nails, rods. See Total hip replacement, p. 583, and Total knee replacement, p. 58

Assessment:

1. Subjective data:

   1. Pain, tenderness.

   2. Tingling, numbness.

   3. Nause

   4. History of traumatic event.

   5. Muscle spasm.

2. Objective data:

   1. Function: abnormal or lost.

   2. Deformities.

   3. Ecchymosis, increased heat over injured part.

   4. Localized edem

   5. Crepitation (grating sensations heard or felt as bone fragments rub against each other).

   6. Signs of shock.

   7. Indicators of anxiety.

   8. X-ray: fracture —positive interruption of bone; dislocation— abnormal position of bon

Analysis/nursing diagnosis:

1. Pain related to interruption in bon

2. Impaired physical mobility related to fracture/treatment modality.

3. 3. Risk for injury related to complications of fractures.

4. Knowledge deficit regarding cast care, crutch walking, traction.

5. Constipation related to immobilization.

6. Risk for impaired skin integrity related to immobility or friction from materials used to immobilize the fracture during healin

Nursing care plan/implementation:

1. Goal: promote healing and prevent complications of fractures (Table 7-36).

   1. Diet: high protein, iron, vitamins, to improve tissue repair; moderate carbohydrates to prevent weight gain; no increase in calcium, to prevent kidney stones (decalcification and demineralization occur when patient is immobilized).

      1. Encourage increased fluid intake, to prevent kidney stones.

      2. Prevent or correct constipation through increasing bulk foods, fruits, and fruit juices, or using prescribed stool softeners, laxatives, or cathartics as necessary.

   2. Provide activities to reduce perceptual deprivation—reading, handcrafts, music, special interests/hobbies that can be done while maintaining correct position for healin

2. Goal: prevent injury or trauma in relation to:

   1. ► Fracture care:

      1. Maintain affected part in optimum alignment.

      2. Maintain skin integrity; check all bony prominences for evidence of pressure q4h and prn, depending on amount of pressur

      3. Monitor: circulation in, sensation of, and motion of (CSM) affected part ql5min for first 4 hr; qlh until 24 hr; q4h and prn, depending on amount of edema (Table 7-37).

      4. Maintain mobility in unaffected limb and unaffected joints of affected limb by active and passive ROM; prevent footdrop by using ankle-top sneakers.

   2. ► Skin traction:

      1. Maintain correct alignment:

         1. (a) If tape or moleskin is used, shave extremity and apply benzoin to improve adherence of strip and reduce itchin

         2. (b) Check apparatus for slippage, bunching; replace prn.

      2. Prevent tissue injury:

         1. (a) Check all bony prominences for evidence of pressure: q!5min for first 4 hr; qlh until 24 hr, q4h and prn, depending on amount of edem

         2. (b) Nonadhesive traction may be removed q8h to check skin (, Bryant’s).

      3. Skeletal traction:

         1. Maintain affected part in optimum alignment:

            1. (a) Ropes on pulleys.

            2. (b) Weights hang fre

            3. (c) Elevate head of bed as prescribe

            4. (d) Check knots routinely.

         2. Maintain skin integrity:

            1. (a) Frequent skin car

            2. (b) Keep bed linens free of crumbs and wrinkles.

         3. Prevent infection: special skin care to pin insertion site ti Keep area around pins clean and dry. Use prescribed solution for cleansin