Fractures - Outline

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Fractures

� What is a fracture?

� A fracture is a break in the continuity of a bone.

� Other structures may be involved.

� There might be soft tissue edema, hemorrhage into muscles and joints, joint dislocations,

ruptured tendons , severed nerves, damaged blood vessels and injury to body organs.

� Classifications of Fractures

� Complete - fracture involving the entire cross section of the bone; usually displaced.

� Incomplete fracture involving only a portion of the cross section of bone; usually undisplaced.

� Open break in the skin and underlying soft tissue leading directly into fracture or its

hematoma.

� Closed Fracture does not communicated with outside area.

� Specific Types of Fractures

� Greenstick one side of a bone is broken, and the other side is bent.

� Transverse fracture straight across the bone.

� Oblique fracture occurring at an angle across the bone.

� Comminuted bone has splintered into several fragments.

� Clinical Manifestations

� Pain

� Loss of function; inability to use the part

� Localized swelling and discoloration of the skin

� Deformity (visible or palplable)

� False motion; abdominal mobility at fracture site

� Crepitation (grating sensation)

� Bone might be visible through skin

� Fracture



TYPES OF FRACTURE

� 1. Complete fracture

� Involves a break across the entire cross-section

� 2. Incomplete fracture

� The break occurs through only a part of the cross-section

� Fracture

TYPES OF FRACTURE

� 1. Closed fracture

� The fracture that does not cause a break in the skin

� 2. Open fracture

� The fracture that involves a break in the skin

� Fracture

TYPES OF FRACTURE

� 1. Comminuted fracture

� A fracture that involves production of several bone fragments

� 2. Simple fracture

� A fracture that involves break of bone into two parts or one

� Fracture

ASSESSMENT FINDINGS

� 1. Pain or tenderness over the involved area

� 2. Loss of function

� 3. Deformity

� 4. Shortening

� 5. Crepitus

� 6. Swelling and discoloration



� Fracture

ASSESSMENT FINDINGS

1. Pain

� Continuous and increases in severity

� Muscles spasm accompanies the fracture is a reaction of the body to immobilize the fractured

bone

� Fracture

ASSESSMENT FINDINGS

2. Loss of function

� Abnormal movement and pain can result to this manifestation

� Fracture

ASSESSMENT FINDINGS

3. Deformity

� Displacement, angulations or rotation of the fragments Causes deformity

� Fracture

ASSESSMENT FINDINGS

4. Crepitus

� A grating sensation produced when the bone fragments rub each other

� Fracture

� DIAGNOSTIC TEST

� X-ray

� Fracture

EMERGENCYMANAGEMENT OF FRACTURE

� 1. Immobilize any suspected fracture

� 2. Support the extremity above and below when moving the affected part from a vehicle

� 3. Suggested temporary splints- hard board, stick, rolled sheets



� 4. Apply sling if forearm fracture is suspected or the suspected fractured arm maybe bandaged

to the chest

� Fracture

EMERGENCYMANAGEMENT OF FRACTURE

� 5. Open fracture is managed by covering a clean/sterile gauze to prevent contamination

� 6. DO NOT attempt to reduce the facture

� Fracture

MEDICAL MANAGEMENT

� 1. Reduction of fracture either open or closed, Immobilization and Restoration of function

� 2. Antibiotics, Muscle relaxants such as METHOCARBAMOLand Pain medications

� Fracture

General Nursing MANAGEMENT

For CLOSED FRACTURE

� 1. Assist in reduction and immobilization

� 2. Administer pain medication and muscle relaxants

� 3. teach patient to care for the cast

� 4. Teach patient about potential complication of fracture and to report infection, poor

alignment and continuous pain

� Fracture

General Nursing MANAGEMENT

For OPEN FRACTURE

� 1. Prevent wound and bone infection

� Administer prescribed antibiotics

� Administer tetanus prophylaxis

� Assist in serial wound debridement

� 2. Elevate the extremity to prevent edema formation



� 3. Administer care of traction and cast

� Fracture

� FRACTURE COMPLICATIONS

� Early

� 1. Shock

� 2. F at embolism

� 3. Compartment syndrome

� 4. Infection

� 5. DVT

� Fracture

� FRACTURE COMPLICATIONS

� Late

� 1. Delayed union

� 2. Avascular necrosis

� 3. Delayed reaction to fixation devices

� 4. Complex regional syndrome

� Fracture

� FRACTURE COMPLICATIONS: F at E mbolism

� Occurs usually in fractures of the long bones

� Fat globules may move into the blood stream because the marrow pressure is greater than

capillary pressure

� Fat globules occlude the small blood vessels of the lungs, brain kidneys and other organs

� Fracture

� FRACTURE COMPLICATIONS: Fat Embolism

� Onset is rapid, within 24-72 hours

� ASSESSMENT FINDINGS



� 1. Sudden dyspnea and respiratory distress

� 2. tachycardia

� 3. Chest pain

� 4. Crackles, wheezes and cough

� 5. Petechial rashes over the chest, axilla and hard palate

� Fracture


� Nursing Management

� 1. Support the respiratory function

� Respiratory failure is the most common cause of death

� Administer O2 in high concentration

� Prepare for possible intubation and ventilator support

� Fracture



� 2. Administer drugs

� Corticosteroids

� Dopamine

� Morphine

� Fracture



� 3. Institute preventive measures

� Immediate immobilization of f racture

� Minimal f racture manipulation



� Adequate support for f ractured bone during turning and positioning

� Maintain adequate hydration and electrolyte balance

� Fracture

� Early complication: Compartment syndrome

� This results from fractures of arms or legs where closed compartment are present.

� Compartment contains blood vessels, nerves, muscles which are enclosed by fascia.

� A complication that develops when tissue perfusion in the muscles is less than required for

tissue viability

� Fracture

� Fracture



1. P ain- Deep, throbbing and UN RELI EVE D pain by opiods

� Pain is due to reduction in the size of the muscle compartment by tight cast

� Pain is due to increased mass in the compartment by edema, swelling or hemorrhage

� Fracture



� 2. Paresthesia- burning or tingling sensation

� 3. Numbness

� 4. Motor weakness

� 5. P ulselessness, impaired capillary refill time and cyanotic skin

� Fracture


� Medical and Nursing management

� 1. Assess frequently the neurovascular status of the casted extremity



� 2. E levate the extremity above the level of the heart

� 3. Assist in cast removal and FASCIOTOMY

� Open Reduction Internal Fixation (ORIF)

- Surgical insertion of internal fixation devices like metal pins, wires or screws to keep bone

fragment in position.

PRE-OPERATIVE CARE:

1. Immobilize the affected bone

2. Handle the affected bone gently

3. Cover open fractures with sterile gauze.

POST-OPERATIVE CARE

1. Monitor neuromascular status

2. Monitor for signs of nerve damage 5Ps

3. Monitor for complications: DVT (Homans sign), thromboplebitis, infection

� CARPAL TUNNEL SYNDROME:

Compression of the median nerve of the wrist.

Most common in women 30-50 years of age.

Usually associated with job-related tasks (typists, computer operators, assembly line workers, truck

drivers, carpenters)

Initial manif estations: paresthesia, clumsiness whwn using the hands

Other manif estations;

Numbness

Pain

Paresthesia

Pain radiating to forearm, shoulder and chest

Loss of f ine motor movement of the hand.

LABORATORY DATA:



(+) Tinels Sign tapping the median nerve at the wrist produces the symptoms

(+) Phalens test holding the wrist in acute flexion for 60 s produces the symptoms

Splint the wrist

Administered steroid as ordered

Prepare the client for surgical intervention: (decompression of the median nerve)

Prepare the client for occupation and job counselling

Post-operatively, elevate the hand and arm 24h

Encourage the client to handle normal activitiesof daily living, 2-3 days following surgery

� Strains

� Excessive stretching of a muscle or tendon

� Nursing management

� 1. Immobilize aff ected part

� 2. Apply cold packs initially, then heat packs

� 3. Limit joint activity

� 4. Administer NSAIDs and muscle relaxants

� Sprains

� Excessive stretching of the LIGAMENTS


� 1. Immobilize extremity and advise rest

� 2. Apply cold packs initially then heat packs

� 3. Compression bandage may be applied to relieve edema

� 4. Assist in cast application

� 5. AdministerNSAIDS

� Herniated disk

� Occurs when all or part of the nucleus pulposus forces through the weakened or torn outer

ring (annulus pulposus



� Herniated disk

� Impingement on the spinal nerves will result to BACK PAIN

� Treatment

� Reduction setting the bone; restoration of fracture fragments into anatomical position and

alignment.

� Methods

� Closed reduction

� Traction

� Open reduction

� Closed Reduction

� Bringing the bony fragments into apposition by manipulation and manual traction

� Usually done under anesthesia to relieve pain and relax muscles

� Cast is usually applied to immobilize extremity and maintain reduction

� Open Reduction

� Operative intervention to achieve fracture reduction

� Bone fragments are repositioned under direct visualization

� Internal fixation devices(metallic pins, wires, screws, plates, nails, rods) may be used to hold

bone fragments in position

� After closure of wound, cast may be applied

� C ast T ypes and Maintenance Instructions

� Musculoskeletal Modalities

� Traction

� Cast


Traction

� A method of fracture immobilization by applying equipments to align bone fragments



� Used for immobilization, bone alignment and relief of muscle spasm

� Traction

� Skin traction- Buck, Bryant

� Skeletal traction

� Traction

� Balanced Suspension traction

� Running/Straight traction

� Traction

� Pulling force exerted on bones to reduce or immobilize f ractures, reduce muscle spasm,

correct or prevent deformities

� Traction

� TO decrease muscle spasms

� TO reduce, align and immobilize f ractures

� To correct deformities


Traction: General principles

� 1. ALWAY S ensure that the weights hang freely and do not touch the floor

� 2. N EVER remove the weights

� 3. Maintain proper body alignment

� 4. Ensure that the pulleys and ropes are properly functioning and fastened by tying square knot



� 5. Observe and prevent foot drop

� Provide foot plate

� 6. Observe for DVT, skin irritation and breakdown

� 7. Provide pin care for clients in skeletal traction- use of hydrogen peroxide





8. Promote skin integrity

� Use special mattress if possible

� Provide frequent skin care

� Assess pin entrance and cleanse the pin with hydrogen peroxide solution

� Turn and reposition within the limits of traction

� Use the trapeze


CAST

� Immobilizing tool made of plaster of Paris or fiberglass

� Provides immobilization of the fracture


CAST: types

1. Long arm

2. Short arm

3. Short leg

4. Long leg

5. Spica

6. Body cast

� Casting Materials

� Plaster of Paris

� Drying takes 1-3 days

� If dry, it is SHINY, WHITE, hard and resistant

� Fiberglass



� Lightweight and dries in 20-30 minutes

� Water resistant

� Cast application

1. TO immobilize a body part in a specif ic position

2. TO exert uniform compression to the tissue

3. TO provide early mobilization of UNAFFECTED body part

4. TO correct deformities

5. TO stabilize and support unstable joints


CAST: General Nursing Care

� 1. Allow the cast to air dry (usually 24-72 hours)

� 2. H andle a wet cast with the P ALMS not the f ingertips



� 3. Keep the casted extremity ELEVATED using a pillow

� 4. Turn the extremity for equal drying. DO N OT USE DRYER for plaster cast

� Encourage mobility and range of motion exercises



� 5. Petal the edges of the cast to prevent crumbling of the edges

� 6. Examine the skin for pressure areas and Regularly check the pulses and skin



� 7. Instruct the patient not to place sticks or small ob jects inside the cast

� 8. Monitor for the following: pain, swelling, discoloration, coolness, tingling or lack of

sensation and diminished pulses





� Hot spots occurring along the cast may indicate inf ection under the cast

� Common Musculoskeletal conditions


� What is a cast?

� A cast holds a broken bone in place as it heals. Casts also help to prevent or decrease muscle

contractions, and are effective at providing immobilization, especially after surgery.

� Casts immobilize the joint above and the joint below the area that is to be kept straight and

without motion. For example, a child with a forearm fracture will have a long arm cast to

immobilize the wrist and elbow joints.

� What are casts made of ?

� The outside, or hard part of the cast, is made from two different kinds of casting materials.

plaster - white in color.

f iberglass - comes in a variety of colors, patterns, and designs.

� Cotton and other synthetic materials are used to line the inside of the cast to make it soft and to

provide padding around bony areas, such as the wrist or elbow.

� Special waterproof cast liners may be used under a fiberglass cast, allowing the child to get the

cast wet. Consult your child's physician for special cast care instructions for this type of cast.

� What are the diff erent types of casts?

� Short arm cast: Applied below the elbow to the hand.

Use: Forearm or wrist fractures. Also used to hold the forearm or wrist muscles

and tendons in place after surgery.

� Long arm cast: Applied from the upper arm to the hand.

Use: Upper arm, elbow, or forearm fractures.Also used to hold the arm or elbow

muscles and tendons in place after surgery.

� Arm cylinder cast: Applied from the upper arm to the wrist.



Use: To hold the elbow muscles and tendons in place after a dislocation or

surgery.

� Shoulder spica cast: Applied around the trunk of the body to the shoulder, arm, and hand.

Use: Shoulder dislocations or after surgery on the shoulder area

� Minerva cast: Applied around the neck and trunk of the body.

Use: After surgery on the neck or upper back area.

� Short leg cast: Applied to the area below the knee to the foot.

Use: Lower leg fractures, severe ankle sprains/strains, or fractures.Also used to

hold the leg or foot muscles and tendons in place after surgery to allow healing.

� Leg cylinder cast: Applied from the upper thigh to the ankle.

Use: Knee, or lower leg fractures, knee dislocations, or after surgery on the leg or knee area.

� Unilateral hip spica cast: Applied from the chest to the foot on one leg.

Use: Thigh fractures. Also used to hold the hip or thigh muscles and tendons in place after

surgery to allow healing.

� One and one-half hip spica cast: Applied from the chest to the foot on one leg to the knee of

the other leg. A bar is placed between both legs to keep the hips and legs immobilized.

Use: Thigh fracture. Also used to hold the hip or thigh muscles and tendons in place after

surgery to allow healing.

� Bilateral long leg hip spica cast: Applied from the chest to the feet. A bar is placed

between both legs to keep the hips and legs immobilized.

Use: Pelvis, hip, or thigh fractures. Also used to hold the hip or thigh muscles and tendons in

place after surgery to allow healing.

� Short leg hip spica cast: Applied from the chest to the thighs or knees.

Use: To hold the hip muscles and tendons in place after surgery to allow healing.

� Abduction boot cast: Applied from the upper thighs to the feet. A bar is placed between both

legs to keep the hips and legs immobilized.

Use: To hold the hip muscles and tendons in place after surgery to allow healing.

� How can my child move around while in a cast?

� Assistive devices for children with casts include:



crutches

walkers

wagons

wheelchairs

reclining wheelchairs

� Cast care instructions:

� Keep the cast clean and dry.

� Check for cracks or breaks in the cast.

� Rough edges can be padded to protect the skin from scratches.

� Do not scratch the skin under the cast by inserting objects inside the cast.

� Can use a hairdryer placed on a cool setting to blow air under the cast and cool down the hot,

itchy skin. Never blow warm or hot air into the cast.

� Do not put powders or lotion inside the cast.

� Cover the cast while your child is eating to prevent food spills and crumbs from entering the

cast.

� Prevent small toys or objects from being put inside the cast.

� Elevate the cast above the level of the heart to decrease swelling.

� Encourage your child to move his/her fingers or toes to promote circulation.

� Do not use the abduction bar on the cast to lift or carry the child.

� Older children with body casts may need to use a bedpan or urinal in order to go to the

bathroom. Tips to keep body casts clean and dry and prevent skin irritation around the genital

area include the following:

Use a diaper or sanitary napkin around the genital area to prevent leakage or

splashing of urine.

Place toilet paper inside the bedpan to prevent urine from splashing onto the

cast or bed.

Keep the genital area as clean and dry as possible to prevent skin irritation.

� When to call your child's physician:



� Contact your child's physician or healthcare provider if your child develops one or more of the

following symptoms:

fever greater than 101° F

increased pain

increased swelling above or below the cast

complaints of numbness or tingling

drainage or foul odor from the cast

cool or cold fingers or toes

� METABOLIC BONE DISORDERS

Osteoporosis

� A disease of the bone characterized by a decrease in the bone mass and density with a change in

bone structure


Osteoporosis: Pathophysiology

� Normal homeostatic bone turnover is altered rate of bone RESORPTION is greater than bone

FORMATION reduction in total bone mass reduction in bone mineral density prone to

FRACTURE


Osteoporosis: TYPES

� 1. Primary Osteoporosis- advanced age, post-menopausal

� 2. Secondary osteoporosis- Steroid overuse, Renal failure


RISK factors for the development of Osteoporosis

� 1. Sedentary lifestyle

� 2. Age

� 3. Diet- caffeine, alcohol, low Ca and Vit D

� 4. Post-menopausal



� 5. Genetics- caucasian and asian

� 6. Immobility

� METABOLIC DISORDER

ASSESSMENT FINDINGS

� 1. Low stature

� 2. F racture

� F emur

� 3. Bone pain


LABORATORY FINDINGS

� 1. DEXA-scan

� Provides information about bone mineral density

� T-score is at least 2.5 SD below the young adult mean value

� 2. X-ray studies


Medical management of Osteoporosis

� 1. Diet therapy with calcium and Vitamin D

� 2. Hormone replacement therapy

� 3. Biphosphonates-Alendronate, risedronate produce increased bone mass by inhibiting the

OSTEOCLAST

� 4. Moderate weight bearing exercises

� 5. Management of fractures


OsteoporosisNursing Interventions

1. Promote understanding of osteoporosis and the treatment regimen

� Provide adequate dietary supplement of calcium and vitaminD



� Instruct to employ a regular program of moderate exercises and physical activity

� Manage the constipating side-effect of calcium supplements



� Take calcium supplements with meals

� Take alendronate with an EMPTY stomach with water

� Instruct on intake of Hormonal replacement



2. Relieve the pain

� Instruct the patient to rest on a firm mattress

� Suggest that knee flexion will cause relaxation of back muscles

� Heat application may provide comfort

� Encourage good posture and body mechanics

� Instruct to avoid twisting and heavy lifting



� 3. Improve bowel elimination

� Constipation is a problem of calcium supplements and immobility

� Advise intake of HIGH fiber diet and increased fluids



� 4. Prevent injury

� Instruct to use isometric exercise to strengthen the trunk muscles

� AVOID sudden jarring, bending and strenuous lifting



� Provide a safe environment

� Juvenile rheumatoidArthritis

� Definition:

� AUTO-IMMUNE inflammatory joint disorder of UNKNOWN cause

� SYSTEMIC chronic disorder of connective tissue

� Diagnosed BEFORE age 16 years old

� Juvenile rheumatoidArthritis

� PATHOPHYSIOLOGY : unknown

� Affected by stress, climate and genetics

� Common in girls 2-5 and 9-12 y.o.

� JRA

� Symptoms may decrease as child enters adulthood

� With periods of remissions and exacerbations

� JRA

Medical Management

1. ASPIRIN and NSAIDs- mainstay treatment

2. Slow-acting anti-rheumatic drugs

3. Corticosteroids

� JRA

Nursing Management

1. Encourage normal performance of daily activities

2. Assist child in ROM exercises

3. Administer medications

4. Encourage social and emotional development

� JRA



NursingManagement

During acute attack:

� SPLINT the joints

� NEUTRAL positioning

� Warm or cold packs

� DEGENERATIVE JOINT DISEASE

OSTEOARTHRITIS

� The most common form of degenerative joint disorder


OSTEOARTHRITIS

� Chronic, N ON-systemic disorder of joints


OSTEOARTHRITIS: Pathophysiology

� In jury, genetic, Previous joint damage, Obesity , Advanced age

� Stimulate the chondrocytes to release chemicals

� chemicals will cause cartilage degeneration, reactive inflammation of the synovial lining and

bone stiffening


OSTEOARTHRITIS: Risk factors

� 1. Increased age

� 2. Obesity

� 3. Repetitive use of joints with previous joint damage

� 4. Anatomical deformity

� 5. genetic susceptibility

OSTEOARTHRITIS: Assessment findings

� 1. Joint pain



� 2. Joint stiffness

� 3. F unctional joint impairment limitation

� The joint involvement is ASYMMETRI CAL

� This is not systemic, there is no F EVER , no severe swelling

� Atrophy of unused muscles

� Usual joint are the WE IGHT bearing joints



1. Joint pain

� Caused by

� Inflamed cartilage and synovium

� Stretching of the joint capsule

� Irritation of nerve endings



2. Stiff ness

commonly occurs in the morning after awakening

Lasts only for less than 30 minutes

DECREASE S with movement, but worsens after increased weight bearing activitry

C repitation may be elicited


OSTEOARTHRITIS: Diagnostic findings

1. X-ray

� Narrowing of joint space

� Loss of cartilage



� Osteophytes

2. Blood tests will show no evidence of systemic inflammation and are not useful


OSTEOARTHRITIS: Medical management

� 1. Weight reduction

� 2. Use of splinting devices to support joints

� 3. Occupational and physical therapy

� 4. Pharmacologic management

� Use of P ARACETAMOL , NS AIDS

� Use of Glucosamine and chondroitin

� Topical analgesics

� Intra-articular steroids to decrease inflam


OSTEOARTHRITIS: Nursing Interventions

1. Provide relief of PAIN

� Administer prescribed analgesics

� Application of heat modalities. I CE P ACK S may be used in the early acute stage!!!

� P lan daily activities when pain is less severe

� P ain meds before exercising



2. Advise patient to reduce weight

� Aerobic exercise

� Walking

3. Administer prescribed medications



� NSAIDS



4. Position the client to prevent flexion deformity

� Use of foot board, splints, wedges and pillows

� Rheumatoid arthritis

� A type of chronic systemic inflammatory arthritis and connective tissue disorder affecting more

women (ages 35-45) than men


FACTORS:

Genetic

Auto-immune connective tissue disorders

Fatigue, emotional stress, cold, infection


Pathophysiology

� Immune reaction in the synovium attracts neutrophils releases enzymes breakdown of

collagen irritates the synovial liningcausing synovial inflammation edema and pannus

formation and joint erosions and swelling


ASSESSMENT FINDINGS

� 1. PAIN

� 2. Joint swelling and stiffness-SYMMETRI CAL , Bilateral

� 3. W armth, erythema and lack of function

� 4. F ever , weight loss, anemia, fatigue

� 5. Palpation of join reveals spongy tissue

� 6. Hesitancy in joint movement




ASSESSMENT FINDINGS

� Joint involvement is SYMMETRICAL and BILATERAL

� Characteristically beginning in the hands, wrist and feet

� Joint STIFFNESS occurs early morning, lasts MORE than 30 minutes, not relieved by movement,

diminishes as the day progresses


ASSESSMENT FINDINGS

� Joints are swollen and warm

� Painful when moved

� Deformities are common in the hands and feet causing misalignment

� Rheumatoid nodules may be found in the subcutaneous tissues


Diagnostic test

� 1. X-ray

� Shows bony erosion

� 2. Blood studies reveal (+ ) rheumatoid factor, elevated E SR and CRP and AN T I-nuclear

antibody

� 3. Arthrocentesis shows synovial fluid that is cloudy, milky or dark yellow containing numerous

WBC and inflammatory proteins


MEDICAL MANAGEMENT

� 1. T herapeutic dose of NS AIDS and Aspirin to reduce inflammation

� 2. Chemotherapy with methotrexate, antimalarials, gold therapy and steroid

� 3. For advanced cases- arthroplasty, synovectomy

� 4. Nutritional therapy


MEDICAL MANAGEMENT



GOLD THERAPY:

� IM or Oral preparation

� Takes several months (3-6) before effects can be seen

� Can damage the kidney and causes bone marrow depression

� May NOT work for all individuals


Nursing MANAGEMENT

1. Relieve pain and discomfort

� USE splints to immobilize the affected extremity during acute stage of the disease and

inflammation to RE DU CE DE F ORMI TY

� Administer prescribed medications

� Suggest application of COLD packs during the acute phase of pain, thenHEAT application as

the inflammation subsides


Nursing MANAGEMENT

2. Decrease patient fatigue

� Schedule activity when pain is less severe

� Provide adequate periods of rests

3. Promote restorative sleep


Nursing Management

4. Increase patient mobility

� Advise proper posture and body mechanics

� Support joint in functional position

� Advise ACTIVE ROME

� Avoid direct pressure over the joint




Nursing Management

5. Provide Diet therapy

� Patients experience anorexia, nausea and weight loss

� Regular diet with caloric restrictions because steroids may increase appetite

� Supplements of vitamins, iron and P ROTE IN


6. Increase Mobility and prevent deformity:

� Lie F LAT on a firm mattress

� Lie P RON E several times to prevent H I P F LEX I ON contracture

� Use one pillow under the head because of risk of dorsal kyphosis

� N O P illow under the joints because this promotes flexion contractures


� C apsaicin

� Unknown mechanism, probably Inhibits substance P

� Reduces pain

� A pplied over the affected area

� Do N OT bandage the area

� Side effect: burning sensation

� W ash hands after application

� Hot versus Cold

� OA versus RA

� OA versus RA

� Gouty arthritis

� A systemic disease caused by deposition of uric acid crystals in the joint and body tissues



� CAUSES:

� 1. Primary gout- disorder of P urine metabolism

� 2. Secondary gout- excessive uric acid in the blood like leukemia

� Gouty arthritis


� 1. Severe pain in the involved joints, initially the big toe

� 2. Swelling and inflammation of the joint

� 3. TOP H I- yellowish-whitish, irregular deposits in the skin that break open and reveal a gritty

appearance

� 4. PODAGRA-big toe

� Gouty arthritis

ASSESSMENT FINDINGS

� 5. Fever, malaise

� 6. Body weakness and headache

� 7. Renal stones

� Gouty arthritis

DIAGNOSTIC TEST

� Elevated levels of uric acid in the blood

� Uric acid stones in the kidney

� (+ ) urate crystals in the synovial fluid

� Gouty arthritis

� Medical management

� 1. Allupurinol- take it WITH FOOD

� Rash signif ies allergic reaction

� 2. Colchicine

� For acute attack



� 3. Probenecid

� For uric acid excretion

in the kidney

� Gouty arthritis

Nursing Intervention

1. Provide a diet with LOW purine

� Avoid Organ meats, aged and processed foods

� STRI CT dietary restriction is N OT necessary

2. Encourage an increased fluid intake (2-3L/ day ) to prevent stone formation

3. Instruct the patient to avoid alcohol

4. P rovide alkaline ash diet to increase urinary pH

5. Provide bed rest during early attack of gout

� Gouty arthritis

Nursing Intervention

6. Position the affected extremity in mild flexion

7. Administer anti-gout medication and analgesics

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Fractures - Outline

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