Fractures - FRACTURES A fracture is a discontinuity or...

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FRACTURES A fracture is a discontinuity or break in a bone. There are more than 150 fracture classifications. Five major ones are 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. CARE SETTING Most fractures are managed at the community level. Although a number of the interventions listed here are appropriate for this population, this plan of care addresses more complicated injuries encountered on an inpatient acute medical- surgical unit. RELATED CONCERNS Craniocerebral trauma (acute rehabilitative phase) Pneumonia: microbial Psychosocial aspects of care Renal failure: acute Spinal cord injury (acute rehabilitative phase) Surgical intervention Thrombophlebitis: deep vein thrombosis Patient Assessment Database Symptoms of fracture depend on the site, severity, type, and amount of damage to other structures. ACTIVITY/REST May report: Weakness, fatigue Gait and/or mobility problems May exhibit: Restricted/loss of function of affected part (may be immediate, because of the fracture, or develop secondarily from tissue swelling, pain) Weakness (e.g., affected extremity or generalized) CIRCULATION May exhibit: Hypertension (occasionally seen as a response to acute pain/anxiety) or hypotension (severe blood loss) Tachycardia (stress response, hypovolemia) Pulse diminished/absent distal to injury in extremity Delayed capillary refill, pallor of affected part Tissue swelling, bruising, or hematoma mass at site of injury ELIMINATION May exhibit: Hematuria, sediment in urine, changes in output, acute renal failure (ARF) (with major skeletal muscle damage) NEUROSENSORY May report: Loss of/impaired motion or sensation Muscle spasms, worsening over time
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Numbness/tingling (paresthesias) May exhibit: Local musculoskeletal deformities, e.g., abnormal angulation, posture changes, shortening of limbs, rotation, crepitation (grating sound with movement or touch), muscle spasms, visible weakness/loss of function Giving way/collapse or locking of joints; dislocations Agitation (may be related to pain/anxiety or other trauma) Range-of-motion (ROM) deficits PAIN/DISCOMFORT May report: Sudden severe pain at the time of injury (may be localized to the area of tissue/skeletal damage and then become more diffuse; can diminish on immobilization); absence of pain suggests nerve damage Muscle aching pain, spasms/cramping (after immobilization) May exhibit: Guarding/distraction behaviors, restlessness Self-focus SAFETY May report:
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