Comprehensive Guide to Fractures and Ostomies Care

1. Fractures Fundamentals Unit 12

2. Fractures • Fracture- a break or interruption in the continuity of bone • At the fracture site there will be… • Some degree of tissue destruction • Some degree of interference in muscle activity

3. Fractures • Fracture types are… • Complete – broken into two parts with complete separation of the two parts • Comminuted – broken and shattered into more than two pieces • Closed(simple) – no break in the skin • Open(compound) – break in the skin • Greenstick – partially broken and bent, common in children

4. Fractures • Two reduction methods • Closed • Open • Two types of casts • Plaster of Paris • Fiberglass • Patient preparation • Wash area • Prepare emotionally

5. Fractures • Care of the fresh cast • Plaster of Paris = 48 hours • Fiberglass = 1 hour • Speed of drying is affected by… • Humidity • Air circulation • Wet cast vs. dry cast

6. Fractures • Cast care • Handle with extreme care! • Support cast on pillows • Do not allow heels to rest on bed • Get help • Handle with palms of hands • Complications • Listen to your patient! • Neurovascular checks

7. Fractures • Complications • Gangrene • Paralysis • Impaired circulation • Pressure sores • Infection

8. Fractures • Circulation/neurovascular checks • Daily nursing care and interventions include… • Bathing • Fracture pans • Massage skin • Itching • Activity • Diet

9. Fractures • Cast removal • Cast cutter • Cast saw • Expect atrophy and dry skin • Remember, a cast is a mold of a body part used to immobilize a body part.

10. Fractures • Let’s review care at the bedside… • Leave cast uncovered to dry • If wet handle only with palms of hands • Assess neurovascular checks distally and compare with the unaffected limb • Provide care instruction • Assess for infection • Don’t forget to document

11. Fractures • Traction • Purposes • Relieve muscle spasms • Reduce dislocations/relieve contractures • Immobilization

12. Fractures • 2 General Types • Skin • Buck’s • Bryant’s • Russell’s traction • Skeletal • Crutchfield tongs • Halo vest • Steinmann’s pins

13. Fractures • Nursing care of your patient in traction • Weights and ropes • Never remove weights! • Patient position • Keep patient covered • Good skin care is essential! • Turning? ROM? • Pin sites • Neurovascular checks • Diversional activities • Safety • Pain medication • Elimination

14. Fractures • Charting • Type of traction • Amount of weight used • Site of traction and pin sites • Pin site care • Distal neurovascular checks • Skin assessments • Patient tolerance • Any specific complaints • Review

15. Ostomy • Colostomy-surgical formation of an artificial anus from colon to abdomen • Purpose-allow for drainage of feces through a stoma • Permanent-removal of rectum or part of colon • One stoma • Left side of abdomen • Temporary • May have two stomas • Once intestine heals is reversed (anastomosis)

16. Ostomy • Ileostomy-an opening from small intestine to abdomen • Colon and rectum are removed • Stoma is on the right side of the abdomen and it is smaller • Cannot be irrigated • Permanent • Emotional adjustment

17. Ostomy • Types of stool coming from different ostomy sites will be… • Nursing care for your colostomy or ileostomy patient… • Assess the stoma • Observe for prolapse • Skin care • Meal time • Report absence of effluent • No rectal temps! • Keep incision clean • No laxatives • Spend time with the patient • Monitor for flatus

18. Ostomy • Charting is important. • How do I change the colostomy appliance? • Controlling odors • How do I irrigate the colostomy? You are done with unit 12!