ASUHAN KEPERAWATAN PADA PASIEN FRAKTUROLEH JOHANSEN HUTAJULU*

*

*

FracturesDefinition: Interruption in normal bone continuity, which is accompanied by soft tissue injuryClassification:- Simple or closed- Open or compound

*

Fracture PatternsOblique Line of Fx. AngledTransverse Across the boneLongitudinal Length of boneSpiral Twisting or rotation of boneComminuted broken in > 2 placesImpacted Fragments driven into each otherDisplaced or Avulsed torn away by a ligament or tendon*

*

*

Upper Extremity FracturesFractures include those of the:ClavicleScapulaHumerusOlecranonRadius and ulnaWrist and hand*

Lower Extremity FracturesFractures include those of the:FemurPatellaTibia and fibulaAnkle and foot*

*

*

*

*

Stages of Bone HealingHematomaGranulationCallus FormationOsteoblastic ProliferationBone RemodelingComplete Healing*

Bone Healing ProblemsDelayed Union - > 6 months to a year

Nonunion - < of bone fragments joined together

Malunion Bone healed in state of deformity*

*

Asuhan keperawatanPengkajian Anamnesa (Data Subyektif): riwayat sakit/fraktur, riwayat pengobatan, riwayat penyakit penyerta, riwayat diet/nutrisi.

*

Mengeluh nyeri saat pergerakanKehilangan sensasiTidak bisa menggerakkan bagian yang sakit/fraktur. Penurunan ROMCemasTakut

*

Pemeriksaan fisik (Data Obyektif):Inspeksi/look: perubahan bentuk tlg, luka, warna, edema, hematom, ecchymosis, kelainan gaya jalanPalpasi/feel: krepitasi, perfusi; ..Move: ekstensi, fleksi, rotasi, abduksi, adduksi, kerusakan neurovaskuler.

*

Pemeriksaan penunjangX-rayLaboratorium: Hb, Ht, Tr, LkPemeriksaan lain sesuai dengan etiologinya.*

Special Assessment Considerations For fractures of the shoulder and upper arm, assess client in sitting or standing position.

Support the affected arm to promote comfort.*

For distal areas of the arm, assess client in a supine position.

For fracture of lower extremities and pelvis, client is in supine position.

*

Nursing DiagnosesAcute PainRisk for Neurovascular DysfunctionRisk for InfectionAltered Mobility Activity Intolerance*

Complications of FracturesShockNeurovascular CompromiseDVT & Pulmonary EmboliAseptic NecrosisAcute Compartment SyndromeFat Embolism SyndromeOsteomyelitis

*

Kompartemen sindrom: peningkatan tekanan interstitial jaringan, penurunan lairan darah kapiler, hipoksia dan nekrosis jaringan lokal*

*

ShockEtiology: Hemorrhage into damaged tissues, especially thorax, pelvis, & extremities

Treatment: Control bleeding and restore blood volume

*

Neurovascular CompromiseEtiology: Damage to nerves from fragments of bone, pressure from casts, splints, & traction

Treatment: 6 Ps Pain, Pulslessness, Paresthesia, Pallor, Paralysis, Poikothermia *

Risk for Peripheral Neurovascular DysfunctionInterventions include:Emergency care: assess for respiratory distress, bleeding and head injuryNonsurgical management: closed reduction and immobilization with a bandage, splint, cast, or traction*

Fat Embolism SyndromeEtiology: Release of particles of fat into the blood stream from the yellow marrow at site of injury

Risk Factors: Fr. of long bones, multiple fr., high serum glucose or cholesterol level*

DVT & Pulmonary EmboliEtiology: Immobility, trauma, surgery

Risk Factors: Incidence in fractures of the lower extremities; Smoking, obesity, Heart Disease

Treatment: Anticoagulants*

Vascular NecrosisEtiology: Loss of blood supply to bone

Risk Factors: Hip fractures or any fracture where this bone displacement

Treatment: Surgical joint replacement *

*

Compartment SyndromeEtiology: Massive compromise in circulation from external (Tight, bulky dressings, casts) & internal (blood & fluid)

Treatment: Immediately loosen any tight dressings & MD can bivalve cast;Surgery Decompression fasciotomy for edema and bleeding*

*

Medical Management of FracturesClosed Reduction & immobilization Manual traction to align the bone

External Fixation Percutaneous placement of pins implanted into bone

- Kronner 4-Barr Compression Frame- Hex-Fix External device for tibial fractures- Halo Traction Cervical spinal fractures

*

*

*

Nursing Care External FixationTeach patient to grasp frame when moving, rather than limbFrequent observation & neurovascular assessmentsPin Care Note symptoms of infectionAssess for loosening or shifting of devices*

CastsPurpose: Immobilze, correct deformity, allow early mobility, & provide support & protection

Types: Plaster of Paris & Fiberglass*

Plaster Cast CareInstruct that cast will feel warmHandle cast with palms of handsTurn client q 1-2 hours for dryingElevate on pillow than heartPedal rough edges with moleskinInspect q 4-8 hours drainage, cracking, odor, alignment & fit*

*

Cast ComplicationsCirculatory impairment Peripheral nerve damageImpaired skin integrityPneumonia, DVT, ConstipationCompartment SyndromeCast Syndrome Body castFracture blisters*

TractionDefinition: Pulling force that is applied to part of an extremity while a counter traction pulls in the opposite direction

Purpose: Reduce Fracture, immobilize, decrease pain & muscle spasm, correct deformities, stretch tight muscles*

*

*

*

Types of TractionContinuous or Running Bucks, RussellCircumferential PelvicCervicalSuspension or Balanced Thomas RingSkeletal Steinmann pins, Kirschner wires, Crutchfield tongs *

Nursing Assessment Equipment weights, pulleys, ropes, Balkan frameMobilitySkin integrity NeurovascularGastrointestinalUrinary*

*

*

*