MUSCULOSKELETAL1. CHILDHOOD FRACTURESA.Children’s bones heal faster than adults due to thicker periosteum and good blood supply.B.Epiphyseal plate injuries are common in children and need to monitored for any alterations in bone growth.C.Immobilization in children was once thought of as restorative. i.Most difficult aspects of an injuryii.Physical activity helps children communicate and explore. iii.Immobilization:1.Disrupt family functions2.Decreases muscle strength3.Leads to atrophy4.Increases risk of DVT5.Decreases respiratory function6.Constipation7.Altered skin integrity.D.Common fractures in childreni.Incomplete- Bone fractures are still attached.ii.Closed or simple- without break to skiniii.Open or compound- open wound with bone protrudingiv.Complicated-The fracture results in injury to other organs or tissues.v.Plastic deformation(bend)- The bone is bent no more than 45 degreesvi.Buckle(torus)- Compression of the bone resulting in a raised area at the site.vii.Greenstick- Incomplete fracture of the bone.viii.Transverse-Break is straight across the boneix.Spiral- break spirals around the bonex.Growth plate- Injury to the end of the long bone.xi.Complete- Bone fragments are separated.
2. RICEA.Treatment- Rest, ice, compression & elevation!B. Traction C.External fixationD.Open reduction and Internal Fixation- i.Align bones by steady pullingi.Metal screws are placed above and below the fracture site to stabilize while the bones heal.i.Bone fragments are first repositioned to the normal alignment then held together with screws by attaching metal plates to the outer surface of the bone. 3. FRACTURE NURSING INTERVENTIONSA.Emergency care at the time of injury- Maintain ABC’s, VS, Pain, and neurological status.B.Assess the neurovascular status of the injured extremityC.Stabilize injured area, elevate, ice, analgesics, keep client war.D. Assessment:i.6 Ps: Pain, Pulse, Pallor, Paresthesia, Paralysis & Poikiolthermia1.Poikiolthermia (chills – inability to regulate core body temperature)E.What is Compartment syndrome?i.Serious complication resulting from compression of nerves, blood vessels, and muscle inside a closed spaceii.May result in tissue deathiii.6 P’s: 1.Pain – not relieved by analgesics or elevation of the limb, movement increases pain2.Pulselessness – inability to palpate a pulse distal to the fracture or compartment3.Pallor – pale appearing skin, poor perfusion, cap refill > 3 seconds4.Paresthesia – tingling or burning sensation5.Paralysis – inability to move extremity or digits6.Pressure – involved limbs or digits may feel tense and warm; skin istight, shiny; pressure within the compartment is elevated
4. OVERUSE INJURIESA.Overuse injuries- repetitive microtrauma.
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