Terms in this set (35)
What emergency care does the nurse provide at the time of injury??
Monitor vital signs, pain, and neurologic status.
Assess the neurovascular status of the injured extremity.
Position the child in a supine position.
Stabilize the injured area, avoiding unnecessary movement.
Elevate the affected limb and apply ice packs.
Administer analgesics as prescribed.
Keep the child warm.
What are the general nursing interventions??
Assess pain frequently using an age-appropriate pain tool and use appropriate pain management, both pharmacological and nonpharmacological.
Monitor neurovascular status on a regular schedule. Report any change in status.
Maintain proper alignment.
Promote range of motion of fingers, toes, and unaffected extremities.
Instruct the child and family regarding activity restrictions.
What medication do you administer to a child with a fracture?? Why??
Analgesic for pain
When using an opiod analgesion what should the nurse monitor for??
Respiratory depression and consitpation.
What are the client education for analgesics??
Educate the child and parents about the need for adequate pain relief; educate about the need for proper nutrition and hydration.
What are the interdisciplinary care for fractures??
Orthopedic specialists are generally consulted for fracture care in children; Notify social services in situations in which abuse is suspected.
What is difference between plaster of paris cast and synthetic fiberglass cast?? How long do they take to dry??
Plaster of paris casts are heavy, are not water resistant, and can take 10 to 72 hr to dry. Synthetic fiberglass casts are light, are water resistant, and dry very quickly (in 5 to 30 min).
What should be done prior to casting??
The skin area should be observed for integrity, cleaned, and dried. Bony prominences should be padded to prevent skin breakdown.
How should a child with a cast be position??
Position the child on a firm mattress. Use an over-bed trapeze for older children.
What are the nursing interventions for pt with cast??
Position the child on a firm mattress. Use an over-bed trapeze for older children.
Elevate the cast above the level of the heart during the first 24 to 48 hr to prevent swelling.
Apply ice for the first 24 hr to decrease swelling.
Turn and position the child every 2 hr so that dry air circulates around and under the cast for faster drying. This will also prevent pressure from changing the shape of the cast. Do not use heat lamps or warm hair dryers.
Turn the child frequently while supporting all extremities and joints.
Instruct the child to keep the affected extremity supported (with a sling) or elevated when sitting.
Assess for increased warmth or hot spots on the cast surface, which could indicate infection.
If a wound is present, monitor the skin through the window that has been placed in an area of the cast to allow for skin inspection.
Monitor for drainage on the cast. Outline any drainage on the outside of the cast with a marker (and note date and time) so it can be monitored for any additional drainage.
Assess the general skin condition and the area around the cast edges.
Provide routine skin care and thorough perineal care to maintain skin integrity.
Use moleskin over any rough area of the cast that may rub against the child's skin.
Cover areas of the cast with plastic to avoid soiling from urine or feces.
Assist with proper crutch fitting and reinforce proper use.
What do you teach a pt with a cast??
Teach the child and parents that when the cast is applied it will feel warm, but it will not burn the child.
Teach the parents and child to report pain that is extremely severe or is not relieved 1 hr after the administration of pain medication.
Teach the parents and child how to perform neurovascular checks and when to contact the provider.
Give instructions for the proper use of crutches for lower extremity casts.
Reinforce skin and perineal care with a spica cast.
Instruct the child not to place any foreign objects under the cast to avoid trauma to the skin.
Reinforce use of proper restraints when transporting the child in any vehicle.
Teach the child and parents about cast removal and cast cutter.
Instruct the child to soak the extremity in warm water and then apply lotion after the cast has been removed
What is a traction used for??
Traction, countertraction, and friction are the three components used to align, immobilize, and reduce muscle spasms associated with certain fractures. Through the use of a forward-pulling force and a backward force, adding or removing weight controls the degree of force applied to maintain traction and alignment.
The type of traction used will vary depending on the fracture, age of the child, and associated injuries.
What are the different types of traction??
Skin, skeletal and halo
What is the skin traction??
Skin traction uses a pulling force that is applied by weights (may be used
intermittently). Using tape and straps applied to the skin along with boots and/
or cuffs, weights are attached by a rope to the extremity (Buck's traction, Russell's
What is the skeletal traction??
Skeletal traction uses a continuous pulling force that is applied directly to the skeletal structure and/or specific bone. A pin or rod is inserted through or
into the bone. Force is applied through the use of weights attached by rope. Skeletal traction (90°/90° traction) allows the child to change positions without
interfering with the pull of the traction and decreases complications associated with immobility and traction.
What is the halo traction??
Halo traction is another type of skeletal traction that uses a halo-type bar that encircles the head. Screws are inserted into the outer table of the skull. The halo is
attached to either bed traction or rods that are secured to a vest worn by the child.
What are the nursing actions for traction care??
Maintain body alignment and realign if the child seems uncomfortable or reports pain.
Provide pharmacological and nonpharmacological interventions for the management of pain and muscle spasms.
Notify the health care provider if the child experiences severe pain from muscle spasms that is unrelieved with medications and/or repositioning.
Assess and monitor neurovascular status
Routinely monitor the child's skin integrity and document findings.
Assess pin sites for pain, redness, swelling, drainage, or odor. Provide pin care per facility protocol.
Assess for changes in elimination and maintain usual patterns of elimination.
Assess that all the hardware is tight and that the bed is in the correct position.
Assess and maintain weights so that they hang freely and the ropes are free of knots. Do not lift or remove weights unless prescribed and supervised by the provider or physical therapist.
Assure that the wrench to release the rods is attached to the vest when using halo traction in the event that CPR is necessary.
Move the child in halo traction as a unit without applying pressure to the rods. This will prevent loosening of the pins and pain.
Consult with the provider for an over-bed trapeze to assist the child to move in bed.
Provide range of motion and encourage activity of non-immobilized extremities to maintain mobility and prevent contractures.
Promote frequent position changing within restrictions of traction.
Remove sheets from the head of the bed to the foot of the bed, and remake the bed in the same manner.
What is the client education for pt with traction??
Educate about the need to provide adequate hydration and nutrition while in traction.
Educate and reinforce about the use and need for stool softeners.
Teach the child and parents signs of infection.
Teach the child to report any signs of compartment syndrome immediately.
What is the most common fractures that require surgery??
Supracondylar fractures and fractures of the humerus and femur.
How is surgical reduction achieved??
By either a closed (no incision) or open (with incision)
reduction with or without pinning.
What are the nursing actions and client education for surgical interventions??
Monitor for signs of infection at the incision site. Encourage mobilization as soon as prescribed. Medicate for pain as needed.
Teach and reinforce to the child and parents what to expect before and after the procedure, including NPO status. Educate about the need for pain medication.
Care after discharge for surgical interventions
Teach and reinforce proper cast care, as well as pin care if indicated.
Teach and reinforce how to perform neurovascular checks and when to call or return to the provider.
Instruct the child and parents about the need for and use of antipruritic
medications if prescribed by the provider.
Instruct the parents to maintain physical restrictions as prescribed.
Instruct the parents in appropriate pain management.
Instruct the parents to report signs and symptoms of increasing pain, redness, inflammation and/or fever to the health care provider.
Instruct the parents regarding the importance of follow-up care as instructed by the provider.
What are the complications of fractures??
Compartment syndrome and osteomyelitis
When does compartment syndrome occur??
when pressure within one or more of the muscle
compartments of the extremity compromises circulation resulting in an ischemia-edema cycle with compromised neurovascular status.
What are the sources of pressure for compartment syndrome??
Pressure can result from external sources, such as a tight cast or a constrictive, bulky
dressing. Internal sources, such as an accumulation of blood or fluid within the muscle
compartment, can also cause pressure.
What happens if compartment syndrome is untreated??
Tissue necrosis can result. Neuromuscular damage occurs within 4 to 6 hr.
What are the signs/symptoms of compartment syndrome??
Increased pain that is unrelieved with elevation; intense pain when passively moved; paresthesia or numbeness; pallor
How can compartment syndrome be prevented??
Lossen the constrictive dressing or cut the bandage or tape. Elevate the extremity and apply ice. If compartment syndrome is suspected, to ensure adequate perfusion the arm should not be elevated above the level
of the heart. Notify the provider if cs is suspected so that cast can be cut.
Nursing Actions for cs
Assess the extremity at frequent intervals. Prepare child for fasciotomy.
Client Education for cs
Instruct the child to report pain that is not relieved by analgesics, pain that continues to increase in intensity, numbness or tingling, or a change in color of extremity.
What is osteomyelitis??
Infection within the bone secondary to a bacterial infection from an outside source, such as with an open fracture (endogenous) or from a bloodborne bacterial source (hematogenous)
What are the s/s of osteomyelitis??
The child will appear ill.
The child will not want to use the affected extremity.
The site of infection will be tender, and bone pain will worsen with movement.
Warmth, erythema, edema, and fever may occur.
What are the nursing actions for osteomyelitis??
Assist in diagnostic procedures, such as obtaining skin, blood, and bone cultures.
Assist with joint or bone biopsy.
Administer IV and oral antibiotic therapy.
Assist with proper positioning to promote comfort.
Administer pain medication as prescribed.
Consult with the parents and health care provider regarding home care needs.
What are the client education for osteomyelitis??
Educate the child and parents about the length of treatment that may be needed.
Remind the child and parents to avoid bearing any weight until cleared by the provider.
Advise the parents to provide for diversional activities consistent with the childfs level of development.
Educate the child about the need for proper nutrition.
What are the diagnostic procedure for osteomyelitis??
obtaining skin, blood, and bone cultures.