1-48

[Previous] [Next]

1-48. NURSING MANAGEMENT OF A PATIENT WITH A FRACTURE

a. Nursing care of a patient with a fracture, whether casted or in traction, is based upon prevention of complications while healing. By performing an accurate nursing assessment on a regular basis, the nursing staff can manage the patient's pain and prevent complications.

b. When assessing a patient with a fracture, check the "5 P's"--pain, pulse, pallor, paresthesia, and paralysis.

(1) Pain. Determine where the pain is located and if it is worse or better? Worsening pain may indicate increased edema, lack of adequate blood supply, or tissue damage.

 

(2) Pulse. Check the peripheral pulses, especially those distal to the fracture site. Compare all pulses with those on the unaffected side. Pulses should be strong and equal.

 

(3) Pallor. Observe the color and temperature of the skin, especially around the fracture site. Perform the capillary refill (blanching) test.

 

(4) Paresthesia. Examine the injured area for increase or decrease in sensation. Can the patient detect tactile stimulation such as a blunt touch or a sharp pinprick? Does the patient complain of numbness or tingling?

 

(5) Paralysis. Check the patient's mobility. Can he wiggle his toes and fingers? Can he move his extremities?

c. All nursing assessment findings should be documented in the patient's chart so that comparison can be made with notes made at both earlier and later dates. In this way, the patient's progress can be followed and

changes in status are easily recognized. In addition to the five P's mentioned above, the patient's level of consciousness and temperature should be checked regularly. Mental status changes and temperature elevation could indicate the presence of infection. Reposition the patient as necessary to relieve pressure areas. Check all dressings, bandages, casts, splints, and traction equipment to ensure that nothing is causing constriction or pressure. Frequent and thorough checking and observation on the part of the nursing staff will promote healing and prevent complications.