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Questions and Answers
Which of the following is considered a risk factor for fractures in children?
Epiphyseal plate injuries in children can lead to altered growth.
True
What is a common type of fracture that involves an incomplete break of the bone?
Greenstick fracture
The ______ is used to confirm a fracture diagnosis and determine the positioning of the bone.
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Match the following types of fractures with their descriptions:
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What is the primary purpose of traction in nursing care?
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Patients in traction do not need frequent monitoring of skin integrity.
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Name one type of traction used in nursing care.
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The __________ is a type of traction that uses a halo-type bar encircling the head.
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Match the following nursing actions with their descriptions:
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What is the primary action to take if a fracture is suspected?
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Capillary refill time should be less than 5 seconds.
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What should be done to manage pain according to the guidelines?
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The affected extremity should be kept ______ to decrease swelling after casting.
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Match the following pain management actions with their purpose:
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When performing a neurovascular assessment, which of the following is NOT assessed?
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It is acceptable to use heating pads on a plaster cast to promote drying.
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What position should the client be placed in for injuries to the lower extremities?
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After injury, the first step in nursing care is to provide ______.
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Which type of cast is primarily used for the arm?
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Which of the following are symptoms of compartment syndrome? (Select all that apply)
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Surgical intervention is required for all types of fractures.
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What should parents be educated on regarding compartment syndrome?
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Compartment syndrome is caused by __________ compression of nerves and blood vessels.
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Match the following nursing actions with their corresponding descriptions:
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What is the primary cause of osteomyelitis?
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Pain from osteomyelitis may decrease with movement.
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Name one nursing action that should be taken for a child with osteomyelitis.
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Osteomyelitis is an infection within the _____ secondary to bacterial invasion.
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Which of the following should be included in client education about osteomyelitis treatment?
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Which manifestation is NOT typical of a fracture?
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Match the following nursing actions with osteomyelitis management:
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Children need a longer time to heal from fractures compared to adults.
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What should the nurse assess in a child with a fracture?
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Skeletal traction requires ensuring that the weights are _____ freely.
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Study Notes
Fractures in Children
- A fracture is a disruption of the bone's integrity, caused by stress exceeding bone resistance.
- Children's bone healing and remodeling differ from adults due to a thicker periosteum and better blood supply.
- Epiphyseal plate injuries can affect bone growth.
- Radiographic evidence of healed fractures in children can suggest past trauma or conditions like osteogenesis imperfecta.
Risk Factors for Fractures in Children
- Obesity
- Poor nutrition
- Developmental characteristics
- Common play activities
- Activities like climbing, running, or playing sports that increase risk of injury.
Expected Findings
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Physical Assessment:
- Pain
- Pallor
- Edema
- Ecchymosis
- Warmth or redness
- Decreased use of the affected area
Common Fracture Types in Children
- Plastic Deformation (Bend): Bone bends up to 45 degrees without breaking.
- Buckle (Torus): Compression causes a bulge at the fracture site.
- Greenstick: Incomplete fracture with one side broken, the other bent.
- Transverse: Fracture straight across the bone.
- Oblique: Fracture diagonal across the bone.
- Spiral: Fracture spirals around the bone.
- Physeal (Growth Plate): Injury at the end of a long bone, affecting the growth plate.
- Stress: Tiny fractures caused by repetitive muscle contractions.
Diagnostic Procedures
- Radiograph: Used to confirm diagnosis and assess bone positioning.
Nursing Actions for Radiographs
- Instruct and assist the client to remain still during the procedure.
Client Education for Radiographs
- Explain what to expect during the procedure.
- Provide emotional support.
Nursing Care for Fractures
- Provide emergency care at the time of injury.
- Obtain a history of the injury's cause.
- Monitor vital signs, pain, and neurological status.
- Assess circulation, sensation, and movement in extremities.
- Position the client in a sitting position for lower extremity injuries.
- Avoid any positions that may cause constriction.
- Stabilize the injured area.
- Assess above and below the injured area.
- Monitor for blood flow if a fracture is suspected.
- Elevate the injured limb and apply ice packs (20 minutes maximum).
- Administer pain medication as prescribed.
- Keep the client warm.
General Nursing Interventions
- Assess pain level using an age-appropriate scale.
- Provide pain management guidance.
- Monitor vital signs regularly.
- Report any changes in status.
- Maintain range of motion for unaffected extremities and fingers/toes.
- Instruct client and family on activity restrictions.
- Ensure caregiver and child safety.
- Increase calcium intake if not contraindicated.
Neurovascular Assessment
- Sensation: Check for numbness or tingling in extremities; loss indicates possible nerve damage.
- Skin Temperature: Assess temperature; should be warm, not cool.
- Skin Color: Check the color of the affected extremity, distal to the injury, for pigmentation changes.
- Capillary Refill: Apply pressure to nail beds until blanching occurs. Blood return should be within 3 seconds.
- Pulses: Pulses should be palpable, strong, and equal to those of the unaffected extremity.
- Movement: The client should be able to move joints distal to the injury (fingers or toes).
Medications
- Analgesics: Administer for pain.
- Opioid Analgesics: Monitor for respiratory depression.
Nursing Actions for Medications
- Monitor for adverse effects related to pain management.
Client Education for Medications
- Emphasize the importance of adequate pain relief.
Immunizations
- Administer tetanus for open fractures.
Antibiotics
- Administer for open fractures
Casting
- Cast Types: Long-leg, short-leg, bilateral long-leg, long-arm, short-arm, shoulder spica, 1½ spica, full leg.
Nursing Actions for Casting
- Instruct on cast application.
- Demonstrate the procedure using a doll or toy.
- Monitor and assess neurovascular status.
- Ensure limb elevation for the first 24 hours to reduce swelling.
- Turn and reposition the cast for 3-5 days.
- Avoid using heat sources or warm air for drying.
- Instruct on elevation and pillow use.
- Assess for increased warmth or hot spots on the cast.
- Monitor for drainage on the cast's exterior.
- Maintain skin integrity through routine skin care.
- For plaster casts, use palms of hands to avoid dents and expose to air for drying.
Education for Cast Care
- Provide written instructions to the client and parents.
- Educate on signs and symptoms to report.
- Explain proper crutch fitting and reinforce usage.
- Instruct parents and client on:
- Weekly skin checks
- Proper crutch care and use
- Discuss cast removal and care.
Traction Care
- Traction uses pulling force to reduce pain, maintain alignment, and provide muscle rest.
- The type of traction used depends on the specific indication.
Types of Traction
- Balanced Suspension Skeletal Traction: Continuous pulling force through ropes, weights, and a system applied to the extremity (e.g., Buck, Russell, Bryant traction).
- Halo Traction: Halo-type bar encircles the head, secured with screws inserted into the outer skull. Halo is attached to bed traction or rods secured to a vest worn by the client.
Nursing Actions for Traction
- Maintain body alignment.
- Provide pharmacological and nonpharmacological pain management interventions.
- Notify the provider if client experiences severe pain from muscle spasms not relieved by medications or repositioning.
- Assess and monitor neurovascular status.
- Monitor skin integrity routinely and document findings.
- Assess pin sites for redness, swelling, drainage, or odor.
- Provide pain care per facility protocol.
Additional Notes for Traction Care
- Assess for changes in elimination and maintain regular patterns.
- Verify all hardware is tight and the bed is level.
- Ensure comfort and safety during repositioning.
- Encourage mobility and exercise as tolerated.
- Promote regular deep breathing and coughing exercises.
- Reinstruct patient on changing restrictions as needed.
Complications
Compartment Syndrome
- Definition: Compression of nerves, blood vessels, and muscles.
-
Causes:
- Constricted compartment
- External pressure
- Forearm injuries
-
Symptoms:
- Pain
- Hardening of the extremity
- Numbness or tingling
- Possible contracture
-
Interventions:
- Remove dressing or cast
- Monitor for signs of compartment syndrome.
Parental Education for Compartment Syndrome
- Ensure adequate hydration and nutrition.
- Teach client and parents about symptoms of compartment syndrome.
- Report any symptoms immediately.
Surgical Interventions
- Surgery may be required depending on the type of fracture.
- Common fractures requiring surgery include supracondylar fractures and those affecting the humerus.
Nursing Actions for Surgical Interventions
- Monitor for signs of infection at the incision site.
- Encourage prescribed immobilization.
- Administer pain medication as needed.
- Provide crutch training for lower extremity fractures.
Interprofessional Care
- Orthopedic specialists are usually consulted for fracture care.
- Notify social services in cases of suspected abuse.
Client Education for Discharge
- Perform proper cast care and pin care (if applicable).
- Conduct neurovascular checks and know when to seek medical attention.
- Use prescribed antipyretics.
- Maintain prescribed physical restrictions.
- Report increasing pain, redness, inflammation, or fever.
- Follow up as instructed.
Osteomyelitis
- Definition: Infection within the bone caused by bacterial invasion from an outside source (open fracture) or bloodstream.
Assessments for Osteomyelitis
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General:
- Signs of infection (local and systemic)
- Tenderness, swelling, and warmth to touch
- Pain: May increase with movement
- Range of Motion: Assess ability to use the affected extremity.
Nursing Actions for Osteomyelitis
- Initiate diagnostic procedures (skin, blood, and bone cultures).
- Administer:
- IV antibiotics or oral therapy
- Pain management
- Supportive care (hydration, hematologic, and renal function)
- Maintain immobilization and elevation of the extremity.
- Teach parents about the treatment course.
- Collaborate with parents and provider regarding home care.
Client Education for Osteomyelitis
- Instruct the client and parents on the length of treatment.
- Provide information on:
- Need for long-term antibiotic therapy
- Monitoring the affected limb and avoiding weight-bearing
- Reporting activities inconsistent with therapy
- Ensuring proper nutrition.
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Description
Explore the unique aspects of fractures in children, including healing processes, risk factors, and common types of injuries. Understand the physical assessment findings that can indicate a fracture and how these injuries differ from those in adults.
