Podcast
Questions and Answers
Which of the following is considered a risk factor for fractures in children?
Which of the following is considered a risk factor for fractures in children?
Epiphyseal plate injuries in children can lead to altered growth.
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?
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.
The ______ is used to confirm a fracture diagnosis and determine the positioning of the bone.
Signup and view all the answers
Match the following types of fractures with their descriptions:
Match the following types of fractures with their descriptions:
Signup and view all the answers
What is the primary purpose of traction in nursing care?
What is the primary purpose of traction in nursing care?
Signup and view all the answers
Patients in traction do not need frequent monitoring of skin integrity.
Patients in traction do not need frequent monitoring of skin integrity.
Signup and view all the answers
Name one type of traction used in nursing care.
Name one type of traction used in nursing care.
Signup and view all the answers
The __________ is a type of traction that uses a halo-type bar encircling the head.
The __________ is a type of traction that uses a halo-type bar encircling the head.
Signup and view all the answers
Match the following nursing actions with their descriptions:
Match the following nursing actions with their descriptions:
Signup and view all the answers
What is the primary action to take if a fracture is suspected?
What is the primary action to take if a fracture is suspected?
Signup and view all the answers
Capillary refill time should be less than 5 seconds.
Capillary refill time should be less than 5 seconds.
Signup and view all the answers
What should be done to manage pain according to the guidelines?
What should be done to manage pain according to the guidelines?
Signup and view all the answers
The affected extremity should be kept ______ to decrease swelling after casting.
The affected extremity should be kept ______ to decrease swelling after casting.
Signup and view all the answers
Match the following pain management actions with their purpose:
Match the following pain management actions with their purpose:
Signup and view all the answers
When performing a neurovascular assessment, which of the following is NOT assessed?
When performing a neurovascular assessment, which of the following is NOT assessed?
Signup and view all the answers
It is acceptable to use heating pads on a plaster cast to promote drying.
It is acceptable to use heating pads on a plaster cast to promote drying.
Signup and view all the answers
What position should the client be placed in for injuries to the lower extremities?
What position should the client be placed in for injuries to the lower extremities?
Signup and view all the answers
After injury, the first step in nursing care is to provide ______.
After injury, the first step in nursing care is to provide ______.
Signup and view all the answers
Which type of cast is primarily used for the arm?
Which type of cast is primarily used for the arm?
Signup and view all the answers
Which of the following are symptoms of compartment syndrome? (Select all that apply)
Which of the following are symptoms of compartment syndrome? (Select all that apply)
Signup and view all the answers
Surgical intervention is required for all types of fractures.
Surgical intervention is required for all types of fractures.
Signup and view all the answers
What should parents be educated on regarding compartment syndrome?
What should parents be educated on regarding compartment syndrome?
Signup and view all the answers
Compartment syndrome is caused by __________ compression of nerves and blood vessels.
Compartment syndrome is caused by __________ compression of nerves and blood vessels.
Signup and view all the answers
Match the following nursing actions with their corresponding descriptions:
Match the following nursing actions with their corresponding descriptions:
Signup and view all the answers
What is the primary cause of osteomyelitis?
What is the primary cause of osteomyelitis?
Signup and view all the answers
Pain from osteomyelitis may decrease with movement.
Pain from osteomyelitis may decrease with movement.
Signup and view all the answers
Name one nursing action that should be taken for a child with osteomyelitis.
Name one nursing action that should be taken for a child with osteomyelitis.
Signup and view all the answers
Osteomyelitis is an infection within the _____ secondary to bacterial invasion.
Osteomyelitis is an infection within the _____ secondary to bacterial invasion.
Signup and view all the answers
Which of the following should be included in client education about osteomyelitis treatment?
Which of the following should be included in client education about osteomyelitis treatment?
Signup and view all the answers
Which manifestation is NOT typical of a fracture?
Which manifestation is NOT typical of a fracture?
Signup and view all the answers
Match the following nursing actions with osteomyelitis management:
Match the following nursing actions with osteomyelitis management:
Signup and view all the answers
Children need a longer time to heal from fractures compared to adults.
Children need a longer time to heal from fractures compared to adults.
Signup and view all the answers
What should the nurse assess in a child with a fracture?
What should the nurse assess in a child with a fracture?
Signup and view all the answers
Skeletal traction requires ensuring that the weights are _____ freely.
Skeletal traction requires ensuring that the weights are _____ freely.
Signup and view all the answers
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
-
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
-
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.
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
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.
