Nursing Care of Physically Challenged

NURSING CARE OF PHYSICALLY CHALLENGED

FRACTURES

A fracture is a discontinuity or break in a bone. The five major fracture classifications as follow:

1.      Incomplete: Fracture involves only a portion of the cross-section of the bone. One side breaks; the other usually just bends (greenstick).

2.      Complete: Fracture line involves entire cross-section of the bone, and bone fragments are usually displaced.

3.      Closed: The fracture does not extend through the skin.

4.      Open: Bone fragments extend through the muscle and skin, which is potentially infected.

5.      Pathological: Fracture occurs in diseased bone (such as cancer, osteoporosis), with no or only minimal trauma.

Stable fractures are usually treated with casting. Unstable fractures that are unlikely to reduce may require surgical fixation.

NURSING CARE OF THE PATIENT WITH A PLASTER CAST

Although a patient with an arm or leg cast is much more self-reliant than a patient in a body or spice cast, it is a nursing responsibility to monitor all patients and assist as needed. Nursing management includes the following actions to assess the effectiveness of the cast.

• Check the edges of the cast and all skin areas where the cast edges may cause pressure. If there are signs of edema or circulatory impairment, notify the charge nurse or physician immediately.
• Slip your fingers under the cast edges to detect any plaster crumbs or other foreign material.
• Move the skin back and forth gently to stimulate circulation
• Lean down and smell the cast to detect odors indicating tissue damage. A musty or moldy odor at the surface of the cast may be the first indication that necrosis from pressure has developed underneath.
• Check the integrity of the cast by looking for cracks, breaks, and soft spots.
• The casted body part must be examined and assessed frequently in order to prevent complications.
• Assess the casted part by checking the following.
•  Assess circulation by performing the blanching test and comparing the skin temperature and blanching reaction of the affected limb to that of the unaffected limb.
• Assess the presence of sensation in the affected limb by touching exposed areas of skin and instructing the patient to describe what he felt.
• Assess the motor ability of the affected limb by having the patient wiggle his fingers or toes.
• Patient education will do much to prevent complications. Instruct the patient to do the following.
• Avoid resting cast on hard surfaces or sharp edges that may dent the cast and cause pressure areas.
• Never use a pen or other foreign object to "scratch" inside the cast. This may cause skin damage and infection.
• Report any danger signs like pale, cold fingers or toes, tingling, numbness, increased pain, pressure spots, odor, or feeling that the cast has become too tight to the nursing staff immediately
• Report any damage to the cast such as cracks, breaks, or soft spots.
• Never attempt to remove or alter the cast.
• After a leg cast is applied, prevent or alleviate swelling by elevating the extremity above the level of the heart.
• If the patient has an arm cast, instruct him to make and release a tight fist.
• Encourage the patient to wiggle his fingers and toes frequently

NURSING CARE OF PATIENT ON TRACTION

Traction permits pull on the long axis of the fractured bone and overcomes muscle tension/shortening to facilitate alignment and union.

• Maintain position/integrity of traction (e.g., Buck, Russell)
• Ascertain that all clamps are functional.
• Lubricate pulleys and check ropes for fraying. Secure and wrap knots with
  adhesive tape.
• Keep ropes unobstructed with weights hanging free; avoid lifting/releasing weights.
• Position patient so that appropriate pull is maintained on the long axis of the bone.
• Review restrictions imposed by therapy, e.g., not bending at waist/sitting up with Buck traction or not turning below the waist with Russell traction.
• Review follow-up/serial x-rays.
• Administer analgesics as per physician orders.