Fracture Types, Causes, Symptoms

Fractures: Introduction

• A fracture is a break or crack in a bone

Fractures: Causes

• Trauma
• Excessive pressure
• Osteoporosis or other underlying conditions

Fractures: Types

• Closed (Simple): Bone breaks but does not pierce the skin
• Open (Compound): Bone pierces the skin, increasing infection risk
• Transverse: Fracture line is perpendicular to the bone's long axis
• Oblique: Fracture occurs at an angle across the bone
• Spiral: Fracture twists around the bone, typically from a twisting motion
• Comminuted: Bone is shattered into multiple pieces
• Greenstick: Bone bends and cracks; is common in children
• Stress: Small crack or fracture from repetitive stress or overuse

Fractures: Signs and Symptoms

• Symptoms vary based on severity, location, and type of fracture
• Key indicators include pain, swelling, deformity, limited mobility, and crepitus

Fractures: Pain

• Acute and Severe: Sharp, intense pain at the injury site, worsens with movement or pressure

Fractures: Swelling and Bruising

• Swelling: Fluids sent to the injury area cause swelling
• Bruising: Bleeding from broken vessels causes immediate or delayed bruising

Fractures: Deformity and Abnormal Positioning

• Visible Deformity: Bone visibly out of place; limb appears bent, misaligned, or oddly shaped
• Angulation: Bone bent at an unnatural angle indicating displacement

Fractures: Limited Mobility or Inability to Move

• Loss of Function: Difficulty or inability to move the affected limb, especially in joints
• Inability to Bear Weight: Inability to stand or walk due to pain and instability

Fractures: Crepitus

• Grinding or Cracking Sound: Crunching or grinding sound as bone fragments rub together

Fractures: Numbness or Tingling

• Nerve Damage: Numbness, tingling, or loss of sensation due to nerve damage, especially in spine, wrist, or pelvis fractures

Fractures: Shock

• Physical Symptoms of Shock: Severe fractures can cause shock due to insufficient blood flow
• Symptoms include rapid pulse, pale/cool/clammy skin, shallow breathing, weakness/dizziness, confusion, and nausea

Fractures: Open Fractures

• Bone Piercing Through the Skin: Bone breaks and creates an open wound, increasing infection risk

Fractures: Red Flags

• Severe pain not improving with rest/medications
• Swelling not decreasing or worsening
• Visible deformity or misalignment
• Inability to bear weight (especially in leg fractures)
• Numbness/tingling indicating nerve involvement
• Signs of infection in open fractures (fever, redness, pus)

Fractures: Diagnostic Tests

• Used to confirm diagnosis, assess severity, and plan treatment

Fractures: X-Ray (Radiography)

• Description: primary imaging, radiation reveals fractures and their extent
• Purpose: identifies fracture type, displacement, and involvement of surrounding structures
• Procedure: images captured from different angles

Fractures: CT Scan (Computed Tomography)

• Description: Advanced imaging giving detailed cross-sections of bones and tissues
• Purpose: Useful for complex fractures in areas hard to view on X-rays
• Fractures with bone fragments
• Suspicion in complex anatomy areas (face, spine, pelvis)
• Procedure: Images taken from multiple angles and create 3D images

Fractures: MRI (Magnetic Resonance Imaging)

• Description: Uses fields and radio waves, it shows bones, muscles, tendons, ligaments, and other soft tissues
• Purpose: Detects soft tissue injuries, assesses stress fractures, identifies bone bruises or fractures not visible on X-rays
• Procedure: Patient lies still in a cylindrical machine, painless but noisy.

Fractures: Bone Scintigraphy (Bone Scan)

• Description: Nuclear test using radioactive material injected into bloodstream, detected by a special camera
• Purpose: Detects stress fractures, identifies bone infection/inflammation, diagnoses tumors/metastasis
• Procedure: Camera detects areas of increased bone activity

Fractures: Ultrasound

• Description: Sound waves create images of body structures
• Purpose: Diagnoses injuries to soft tissue; detects fractures near the skin surface
• Detecting fractures such as the clavicle or forearm
• Assessing associated soft tissue injuries such as tendon/ligament damage
• Guiding physician in fracture reduction or joint injections

Fractures: Lab Tests

• Description: Not directly diagnostic but assess overall condition and influence bone healing
• Purpose: Assess bone health, check for deficiencies, signs of infection, and assess inflammation
• Calcium levels
• Vitamin D levels
• Complete blood count (CBC)
• C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR)

Fracture Management: Types

• Restore normal function, prevent complications, relieve pain

Fracture Management: Conservative (Non-Surgical)

• Most common treatment, includes immobilization, traction and pain management
• Immobilization: Splints casts or braces keep the bone in place
• Casting: Hard plaster or fiberglass encases the injured limb
• Splints: Stabilizes less severe fractures or those with soft tissue involvement
• Traction: Pulling force aligns bone fragments
• Pain Management: Use of medications such as NSAIDs, opioids, or muscle relaxants

Fracture Management: Surgical (Operative)

• Internal Fixation: Plates, screws, rods, or nails stabilize bones internally
• External Fixation: Pins/screws connect to an external frame for complex fractures where soft tissue involvement is significant
• Open Reduction Internal Fixation (ORIF): Surgical procedure with direct visualization and internal devices (plates and screws) which stabilize the fracture

Fractures: Role of Nurses

• Critical, duties extend from initial assessment to long-term rehab and emotional support

Fractures: Nursing Assessment

• Initial Assessment: Evaluate patient’s pain level, fracture location/type, and complications
• Monitoring for Complications: Monitor compartment syndrome, infection, DVT, or pulmonary embolism
• Neurovascular Checks: Assess circulation, sensation, and movement in the affected limb

Fractures: Nursing Pain Management

• Administering Medications: Prescribed pain relievers and assess effectiveness
• Non-Pharmacological Pain Relief: Positioning, ice, and relaxation techniques
• Patient Education: Educate patients on adhering to pain management to avoid complications

Fractures: Nursing Mobility and Positioning

• Positioning: Prevent further injury, alleviate pain, and promote healing
• Encouraging Mobility: Assist in early mobilization and rehab

Fractures: Nursing Wound Care

• Cleaning and Dressing: For open fractures, clean the wound, apply sterile dressings, monitor for infection
• Observation for Infection: Redness, swelling, warmth, or discharge needing prompt reporting

Fractures: Nursing Psychosocial Support

• Providing Emotional Support: Psychological support and reassurance
• Patient and Family Education: Fracture care, recovery timelines, and post-discharge instructions

Fractures: Nursing Rehabilitation and Follow-Up Care

• Promoting Rehabilitation:Physical therapy to regain full functionality
• Diet and Nutrition: Diet rich in calcium, vitamin D, and protein
• Monitoring for Complications: Follow-appointments and report complications like non-union or malunion

Burns: Introduction

• Tissue injury caused by heat, chemicals, electricity, or radiation
• Can affect skin, muscles, bones, and organs

Burns: Degrees

• Classified into four main degrees

Burns: First-Degree Burns

• Description: Affects only epidermis (outer layer of skin)
• Symptoms: Redness, pain, swelling and dry skin
• Example: Mild sunburn
• Healing: Heals in 3-5 days without scarring

Burns: Second-Degree Burns

• Description: Affects epidermis and dermis (second layer)
• Symptoms: Intense redness, blisters, swelling and pain
• Example: Scalds from hot liquids or flash burns
• Healing: May take 2-3 weeks, scarring possible

Burns: Third-Degree Burns

• Description: Damages all skin layers, potential extending to deeper tissues
• Symptoms: White, charred, leathery appearance and loss of sensation and swelling
• Example: Prolonged exposure to flames, electrical or chemical burns
• Healing: Requires medical intervention, often skin grafts

Burns: Fourth-Degree Burns

• Description: Extends beyond skin to deeper tissues
• Symptoms: Charred completely destroyed skin, no pain due to nerve destruction and tissue necrosis
• Example: Electrical burns and may require amputation or reconstructive surgery
• Healing: Reconstruction surgery and long-term rehab.

Burns: Symptoms

• Symptoms depend on the burn’s degree and extent
• Include pain varying with depth, redness/paleness, swelling/blistering, charred skin, skin peeling, fever, shock and breathing difficulty

Burns: Burn Management

• Managing burns includes immediate first aid assessment and care
• First Aid for Burns (Initial Care): Stop, cool and cover the burn

Burns: Stop The Burn

• Remove: Remove the heat source of the thermal burns
• Flush: Chemical exposure flush area with water

Burns: Cooling the Burn

• Apply: Cool water on the area
• Avoid: Ice and cold water

Burns: Wound Coverage

• Use: Non-stick Clean Dressing
• Prevent: Infection

Burns: Pain Relief

• Over the counter meds if not contraindicated

Burns: Wound Cleaning

• Clean site to prevent infection

Burns: Topical

• Use: Ointments and creams to promote healing
• Silver sulfadiazine

Burns: Fluid

• Provide: fluid resuscitation prevent shock

Burns: Debridement

• Removal: Skin debridement

Burns: Tetanus

• Provide: Tetanus shots

Burns: Roles of nurses

• Important: Focus on emotional physical and support
• Initial Assessment / Triage

Burns: Initial Assessment

• Severity: Assess size, degree, location
• Vitally Monitor: Airway ,breathing and circulation

Burns: Body Surface Area

• Percentage: Surface area TBSA estimates

Burns: Nursing Wound Care

• Cleans wounds, dress topical meds and cover sterile
• Monitoring For Infection Assess the wound drainage and warmth and redness
• Assist removal dead tissue during debridement or skin

Burns: Fluid and electrolyte management

• IV - fluids :Help maintain hydration to electrolyte fluid
• Output carefully track fluid ,intake to maintain imbalance or overload

Burns: Pain Managment

• Help reduce acute ongoing admin and non Pharmacological methods that help relaxation

Burns: Support,

• Assess and provide emotional support that causes referrals

Burns: Role of Nines

• Quick useful determines area of TBSA helps need for medication and fluid and care with advanced help.

Crisis: Introduction

• A crisis disrupts a person’s usual capacity of functioning, is disturbing and unstable. Healthcare has mental breakdowns, medical emergencies, mass casualty and societal crises.
• It is when a person can no longer cope using usual habits.

Crisis: Levels

• Severity is categorized in level form that depend on the impact.
• Minor: Level 1 that is a discomfort and manages emotions
• Ex: minor accidents
• Support: limited and able to return to normal function with support.
• Moderate : Level 2 is the higher disruption
• Ex: Illness diagnosis
• Support: Need and may withdraw from the professional advice
• Severe: crisis overwhelms and immediate intervention is crucial
• Ex: Disasters and trauma or health crisis
• Support: Un able and needs immediate
• Disaster : Large group of trauma involving mass trauma events.
• Support: Agencies are required to help cope with the management

Responsibilities of nurses of crisis

• Immediate and support

Nurses: Initial Assessment

• Rapid to provide severity of incident
• Emergency: Triage to provide patients conditions of injuries patients safety monitor safe measures
• Psychological:
• Emotional calmly reassure and provide coping skills
• Coping : help emotional through support
• Referral : refer support that’ is needed
• Patient care: nurses provide physical care such as wound
• Assistance assist in any procedure or disaster with first aid
• Team: To provide team care coordination and collaboration
• Collaboration coordination where the resources provide effectively
• Communication role and communication and provide feedback
• Communication. Communicate family and other support
• Advocacy:
• Support individuals safety for safety and needs of physical and social rights
• Support larger advocacy to support the efforts
• Reporting:
• Provide accurate reporting documentation that is relevant to support. documentations and safety of critical support

What is resilience?

• Resilience refers to the ability to bounce back from adversity, trauma, stress and recover and respond.

Steps of Increasing resilience

• Focus on self care and stress management
• Cultivate and strong support
• Regulation of emotions

Model steps of improving development

• Being flexible model support team
• Promote work environment.
• Give long term focus goals.

Long Term: Quality Resilent Leaders

• Resilient: Focuses on organization goals
• Optimism: Maintain positive outlook that will succeed with adversity team
• Emotional : Able managing of stress of others.