o Radiographic exams show healing at different stages – physical abuse All bones in pt body, various stages of healing = red flag o Fractures of epiphyseal plate – bone growth may be affected Signs/Symptoms Swelling Pain Deformity (may or may not be visible) Not using the extremity (refuses to walk/crawl) Bruising Crepitus Treatment Immobilization Casting Open reduction – severe fracture or crushed Traction – if pt is unstable Splinting – greenstick fracture
External pins/fixators – kids with halos Children in a Cast Joints above and below broken bone are immobilized Swelling post application – compartment syndrome o Cap refill & pulses Edges of cast need to be smooth skin breakdown/infection Avoid using finger tips when moving – whole hand Hot spots – make window for observation Good hiding spot for food and toys; itching/scratching – teaching! Cast care 24-48 hours to fully harden As soon as dry, weigh pt – don’t weigh wet Elevate above heart Circle any areas of drainage Keep dry Distal pulse check/ capillary refill Don’t place an object into the cast to scratch! Cast Care Compartment syndrome (6 Ps ) o 1 Pain o 2 Paresthesia o 3 Pressure o 4 Pallor o 5 Paralysis o 6 Pulselessness Traction o Traction until can get surgery o Wts on traction to ensure bones stay apart so don’t heal or cause more problems o Skin Attached to skin with adhesive or elastic bandage o Skeletal traction – halo Wire or pins into bone -skull cant turn head Pin care Nursing Considerations with traction o Routine skin observation and care
o Weights must be free hanging at all times & out of way – bump = pain! o Ensure position o Color o Movement – more harmful o Sensation – still feel limb Immobilization o Muscular – loss of strength & mass o Skeletal – bone demineralization & joint mobility decreased o Metabolism o Cardiovascular – clots & low exercise o Respiratory – cant move around, less deep breaths, pneumonias easier developed IS therapy o Gastrointestinal – constipation - hydration & softeners o Urinary – urinary stasis & dehydration – I&Os o Integumentary – skin breakdown o Delayed developmental milestones Broken legs, higher likelihood of regression Nursing Considerations o Feeding – sit up if possible o Want to feel more independent o Changes in electrolytes and metabolic rate – ensure enough nutrition o Change position frequently – roll Q2hrs o Monitor for depression Changing room or look can help o Provide stimulation Age appropriate toys, crayons, coors, pictures, art projects CHILDLIFE! o Discharge planning Wheelchair, getting up stairs, ADLs
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- Spring '17