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ASUHAN KEPERAWATAN PADA PASIEN FRAKTUROLEH JOHANSEN HUTAJULU*
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FracturesDefinition: Interruption in normal bone continuity, which is accompanied by soft tissue injuryClassification:- Simple or closed- Open or compound
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Fracture PatternsOblique Line of Fx. AngledTransverse Across the boneLongitudinal Length of boneSpiral Twisting or rotation of boneComminuted broken in > 2 placesImpacted Fragments driven into each otherDisplaced or Avulsed torn away by a ligament or tendon*
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Upper Extremity FracturesFractures include those of the:ClavicleScapulaHumerusOlecranonRadius and ulnaWrist and hand*
Lower Extremity FracturesFractures include those of the:FemurPatellaTibia and fibulaAnkle and foot*
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Stages of Bone HealingHematomaGranulationCallus FormationOsteoblastic ProliferationBone RemodelingComplete Healing*
Bone Healing ProblemsDelayed Union - > 6 months to a year
Nonunion - < of bone fragments joined together
Malunion Bone healed in state of deformity*
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Asuhan keperawatanPengkajian Anamnesa (Data Subyektif): riwayat sakit/fraktur, riwayat pengobatan, riwayat penyakit penyerta, riwayat diet/nutrisi.
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Mengeluh nyeri saat pergerakanKehilangan sensasiTidak bisa menggerakkan bagian yang sakit/fraktur. Penurunan ROMCemasTakut
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Pemeriksaan fisik (Data Obyektif):Inspeksi/look: perubahan bentuk tlg, luka, warna, edema, hematom, ecchymosis, kelainan gaya jalanPalpasi/feel: krepitasi, perfusi; ..Move: ekstensi, fleksi, rotasi, abduksi, adduksi, kerusakan neurovaskuler.
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Pemeriksaan penunjangX-rayLaboratorium: Hb, Ht, Tr, LkPemeriksaan lain sesuai dengan etiologinya.*
Special Assessment Considerations For fractures of the shoulder and upper arm, assess client in sitting or standing position.
Support the affected arm to promote comfort.*
For distal areas of the arm, assess client in a supine position.
For fracture of lower extremities and pelvis, client is in supine position.
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Nursing DiagnosesAcute PainRisk for Neurovascular DysfunctionRisk for InfectionAltered Mobility Activity Intolerance*
Complications of FracturesShockNeurovascular CompromiseDVT & Pulmonary EmboliAseptic NecrosisAcute Compartment SyndromeFat Embolism SyndromeOsteomyelitis
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Kompartemen sindrom: peningkatan tekanan interstitial jaringan, penurunan lairan darah kapiler, hipoksia dan nekrosis jaringan lokal*
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ShockEtiology: Hemorrhage into damaged tissues, especially thorax, pelvis, & extremities
Treatment: Control bleeding and restore blood volume
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Neurovascular CompromiseEtiology: Damage to nerves from fragments of bone, pressure from casts, splints, & traction
Treatment: 6 Ps Pain, Pulslessness, Paresthesia, Pallor, Paralysis, Poikothermia *
Risk for Peripheral Neurovascular DysfunctionInterventions include:Emergency care: assess for respiratory distress, bleeding and head injuryNonsurgical management: closed reduction and immobilization with a bandage, splint, cast, or traction*
Fat Embolism SyndromeEtiology: Release of particles of fat into the blood stream from the yellow marrow at site of injury
Risk Factors: Fr. of long bones, multiple fr., high serum glucose or cholesterol level*
DVT & Pulmonary EmboliEtiology: Immobility, trauma, surgery
Risk Factors: Incidence in fractures of the lower extremities; Smoking, obesity, Heart Disease
Treatment: Anticoagulants*
Vascular NecrosisEtiology: Loss of blood supply to bone
Risk Factors: Hip fractures or any fracture where this bone displacement
Treatment: Surgical joint replacement *
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Compartment SyndromeEtiology: Massive compromise in circulation from external (Tight, bulky dressings, casts) & internal (blood & fluid)
Treatment: Immediately loosen any tight dressings & MD can bivalve cast;Surgery Decompression fasciotomy for edema and bleeding*
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Medical Management of FracturesClosed Reduction & immobilization Manual traction to align the bone
External Fixation Percutaneous placement of pins implanted into bone
- Kronner 4-Barr Compression Frame- Hex-Fix External device for tibial fractures- Halo Traction Cervical spinal fractures
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Nursing Care External FixationTeach patient to grasp frame when moving, rather than limbFrequent observation & neurovascular assessmentsPin Care Note symptoms of infectionAssess for loosening or shifting of devices*
CastsPurpose: Immobilze, correct deformity, allow early mobility, & provide support & protection
Types: Plaster of Paris & Fiberglass*
Plaster Cast CareInstruct that cast will feel warmHandle cast with palms of handsTurn client q 1-2 hours for dryingElevate on pillow than heartPedal rough edges with moleskinInspect q 4-8 hours drainage, cracking, odor, alignment & fit*
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Cast ComplicationsCirculatory impairment Peripheral nerve damageImpaired skin integrityPneumonia, DVT, ConstipationCompartment SyndromeCast Syndrome Body castFracture blisters*
TractionDefinition: Pulling force that is applied to part of an extremity while a counter traction pulls in the opposite direction
Purpose: Reduce Fracture, immobilize, decrease pain & muscle spasm, correct deformities, stretch tight muscles*
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Types of TractionContinuous or Running Bucks, RussellCircumferential PelvicCervicalSuspension or Balanced Thomas RingSkeletal Steinmann pins, Kirschner wires, Crutchfield tongs *
Nursing Assessment Equipment weights, pulleys, ropes, Balkan frameMobilitySkin integrity NeurovascularGastrointestinalUrinary*
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