ORTHOPEDIC

NURSING
Ma. Criselda C. Ultado MAN,RN
PHILIPPINE ORTHOPEDIC CENTER
 Musculo- Skeletal Assessment
Nursing History
➢ Determine involvement in competitive sports
➢ Alcohol or caffeine use, cigarette smoking, constant
dieting
➢ Menopause before age 45, estrogen deficiency
( operation )
➢ Family Hx osteoporosis
➢ Chronic diseases
 Typical Complaints (Symptoms)
 
Pain Weakness
 
Stiffness Instability
 
Swelling Change in
❏ Deformity sensibility

Loss of function
 Musculo- Skeletal Assessment

➢ History of problems in bone, muscle or joint

function
➢ Reason for consultation (complaints of the
patient)
➢ Nature and extent of pain
➢ Normal activity pattern
➢ Height loss in women over age 50
Equipment Requirements

1. A tape measure (preferably of the type used by

tailors) for measuring a limb length and girth;
2. A goniometer, for measuring the range of
movements in a joint;
3. A disposable sharp point.
 Questions to
Joint pain
ask

Does the pain change during the course of the day?

Has the pain been there for a short or long time?

Where is the maximal site of pain?

Does the pain get better or worse as you move about?
 Inspection

Deformity and Shortening

Swelling and Wasting

Scars and wounds

Presence or absence of limbs (part of the limb)

Skin color

Position (active, passive)

Posture and gait
 Osteoarthritis of the Hip
Characteristic habitus and gait
Cerebral palsy Osteoporosis
Hemiplegia on right side. Progressive thoracic kyphosis, or
Hip and knee contractures
dowager’s hump, with loss of height
and talipes equinus.
and abdominal protrusion
 Deformity

Deformity results either from misalignment of the
bones forming the joint or from alteration of the
relationship between the articular surfaces.

If misalignment exists, a deviation of the part
distal to the joint away from the midline is
called a valgus deformity and a deviation
towards the midline a varus deformity.
Upper Extremity Deformities b

b c

(a) Normal axis of upper extremity;

(b) Cubitus valgus;
a c
(c) Cubitus varus.
Lower Extremity
Deformities
b

(a) Normal axis of lower extremity;

(b) Genu valgum;
a (c) Genu varum. c
Deformities of the back

b c d
a

The spine: (a) the successive lordosis and kyphosis of the cervical,
thoracic, lumbar and sacral regions; (b) exaggerated lordosis; (c)
rounded kyphosis; (d) a knuckle kyphosis with gibbus.
 Deformities
of the back

Scoliosis can be seen with the

patient standing but is more
marked when the patient leans
forward.
Swelling of joints

Causes of joint swelling include effusion, thickening of the
synovial tissues and of the bony margins of the joint.

Differentiation of these causes is achieved by palpation..
Swelling and Wasting

Residual left calf atrophy Ruptured biceps tendon

Swelling and Wasting
Swelling over the mid
clavicle. Non union of
a fracture

Olecranon bursitis often may be

due to occupation (miners).
Clinical forms: acute, chronic
 Swelling and Wasting

Osteoarthritis of the knee. Rheumatoid arthritis of the hands

Bony swelling associated
with quadriceps wasting
 Swelling and Wasting

This was an osteogenic sarcoma in

Osteomyelitis of the forearm a 10 year old girl in Uganda
Scars and Wounds

Burn of the upper extremity. Oedema

Wound of the forearm Open fracture of the both leg bones

Scars and Wounds
Chronic infection of
the olecranon.

Scars are a map of the past.

Chronic osteomyelitis with
the scars of sinuses,one of
them still draining.
Congenital Deformities
Reduplication
of great toes

Reduplicated thumb

Patient with ‘lobster claw’ congenital

Amniotic constriction and club feet
deformities of both hands and feet
 Proximal Femoral
Congenital absence Focal Deficiency
of extremities
 Palpation
► Local temperature
► Crepitus in the joints and soft tissues
► 1Swelling
► 2Painful areas, tenderness
► Tonus
 Palpation
Note any local heat any tenderness,
whether localized or diffuse

Note any joint crepitus

Auscultation and Percussion
Are needed in the chest and abdomen
damages to determinate:
 the blood level in the cavities;
 presence of pneumothorax;
 changes of breathing;
 function of intestines
 Movement
► Determination of the range of motion in
the joints
► Movements in an abnormal range or plane
► The cause of abnormal range of motion (pain,
contraction, deformity)
► Movement of a joint is either active (i.e.
inducted by the patient) or passive (i.e.
inducted by the examiner).
Measuring of the range of motion in the joints

Use of the goniometer to measure

the different joint motion.
Neutral position:
the limbs extended
with the feet dorsi-flexed
to 90o, the upper limbs
midway between
pronation and supination
with the arms flexed to
90o at the elbow.
The neutral position from
which joint
measurement is
performed
Hip and Knee Rangeof Motion
Zero starting position is
the thigh in line with the
trunk. In measuring hip
extension, the
contralateral limb should
be held in flexion to
eliminate lumbar spine
motion. Hip flexion is
typically measured by
bringing both thighs into
flexion.
Hip and Knee Range of
Motion Knee motion is primarily
flexion and extension. The
zero starting position is
with the knee straight.
Normal knee flexion is 135°
to 145°. Extension beyond
the zero starting position is
more often seen in young
children.
Adults commonly have a
5° knee flexion
contracture.
Shoulder Range of Motion
Slight internal rotation
and abduction
Flexion and 180 160
o- o
required 180o Abduction
extension

90o

60o

Extension Flexion
(elevation) Abduction

o
Shoulder Range of Motion
External rotation
May be tested with
arm held at side or
abducted to 90°

Maximal internal
rotation is highest
midline spinous
process reached by
Arm abducted 90° Arm held at side (T 7 in young
extended thumb
from side adults)
Hand and Fingers.
Range of Motion
 Normal
Gait
In normal walking,
Heel Foot Midstance Opposite
heel each leg goes
Strike Flat
strike through a stance
phase and a
swing phase
alternately.
The rhythmic
repetition of such
Pre-swing Initial swing Terminal Heel
swing Strike cycles provides
 Gait
Watch how the patient stands and
observe his gait on walking. Note
that a patient with an unstable or
painful hip prefers to use a stick in
the opposite hand, and tends to
shorten the period of weight-bearing
on the affected limb.
 The common pathological gaits noticed in patients with
orthopedic disorders.
► Antalgic gait: occurs in painful condition of lower limb
► Trendelenburg gait: occurs in an unstable hip due to
CDH, gluteus medius weakness etc.
► Stiff hip gait: occurs in ankylosis of the hip
► Duck waddling (sailor's) gait: occurs in bilateral CDH
► Scissoring gait: occurs in CP
► High stepping gait: occurs in foot drop
► Circumduction gait: occurs in hemiplegia
► Charlie-Chaplin gait: occurs in tibial torsion
 High stepping gait
or Foot drop gait
Due to drop of the foot, the leg is
lifted more. The first to touch the
ground is the forefoot, and not
the heel.

Normal gait Trendelenburg gait

A child with unilateral dislocation exhibits a typical gait in
which the body lurches to the affected side as the child
bears weight on it (Trendelenburg's gait). In a child with
bilateral dislocation, there is alternate lurching on both
sides (waddling gait).
 Short leg limb

Hand-knee gait
Scissoring gait The The person walks with hand
legs are crossed in front on the knee to prevent the
of each other while knee from buckling in a
walking due to spasm of quadriceps deficient knee
the adductors of the hip
 Special Tests

Straight leg raise

Lasegue’s sign

If this maneuver reproduces the patient’s radicular symptoms shooting

down the leg, the patient may have a pathological process (most
commonly a disc protrusion) compressing and inflaming the nerve root.
Special Tests

Positive Thomas test indicates a hip flexion contracture,

id est, the affected hip cannot be extended to the neutral
position.
Limitation of Movements

Loss of internal rotation

with hip flexed is a
sensitive and easy test
of hip arthritis.
Hypermobility in the Joints

a b

(a) Thumb to forearm. (b) Index finger metacarpophalangeal

joint hyperextension. (c) Elbow hyperextension. (d) Knee
hyperextension.
 Special Tests
“Springing” the pelvis. Pressure
on the pelvis produces pain if
there is a pelvic fracture

“Springing” the ribs.

Compression of the chest
induces pain if there is a
rib fracture
 Special Tests
Pressure along the extremity produces
pain in the bone fracture site.
Note: no placing your hands on the painful
area.
 Comparison of the
Opposite Extremities
Where there is significant true shortening
the heels will not be level (the discrepancy is
a guide to the amount of shortening) and the
pelvis will not be tilted. The site and amount
of shortening must now be further
investigated.
Comparison of the opposite
extremities
 Variants of measuring:
1. Anatomical: distance between
the most remote bony
prominences of the
extremity (segment), which is
measured;
2. Relative: distance between the
adjacent bone prominence
(proximally) and remote
prominence of the extremity
(distally);
 Variants of measuring
3. Seeming: distance
between the proximal and
distal prominence of the
same extremity in case of
its angulation;
4. Functional: using the small
boards a doctor augment
the support height under
short leg until a patient
feels balance in his pelvis
Measuring the distance from
bony points

a b

(a) On the upper extremity;

(b) On the lower extremity.
 Additional
Methods.
X-Ray

Conventional radiology: X-rays that have passed through

the human body strike radiographic film creating an image.
 X-Ray
Standard radiographic
examination: the radiographic
representation of various tissues
depends upon their relative
densities, which determines the
amount of radiation they will
absorb. Bone tissue, which has a
high density, appears white,
while soft-tissues are reproduced
in tones of gray and gas in black.
Scoliometer. The inclination
angle measured by scoliometer
will help determine which
patients may need radiography.
 Computed
Tomography
(CT)
The patient is placed inside
a ring-like structure, around which

the radiogenic tube and the radiation

detectors rotate. The CT scan creates
several high- resolution images that
are a cross-section of the scanned
portion of the body. Together these
images provide accurate information
about the patient's anatomy and
 Ultrasound Examination of Joints
An ultrasound examination
involves high frequency sound
waves which are transmitted
through the skin and reflected by
the internal organs and structures.
These "echoes " form a picture on
a screen which can be examined
for any abnormalities.
USI gives the possibility to diagnose lesions of tendons,
ligaments, muscles and joint capsules.
Diseases, associated with affection of
juxta-articular and cartilaginous tissues, may be
quickly and painful diagnosed by means of USI

Normal hip of a Dysplasia of the Subluxation of the Congenital

1-year-old hip in a baby hip in a baby dislocation of the
infant hip
 Angiography (Vasography)

Biplanar X-Ray Angiography

Angiography is the x-ray study of the blood vessels. An angiogram uses a

radiopaque substance, or dye, to make the blood vessels visible under x- ray.
Angiography is used to detect abnormalities or blockages in the blood vessels
(occlusions) throughout the circulatory system and in some organs.
 Arthroscopy
Arthroscopy is primarily
used to help diagnose joint
problems. This procedure,
most commonly associated
with knee and shoulder
problems, allows accurate
examination and diagnosis
of damaged joint ligaments,
surfaces, and other related
joint structures.
 Magnetic Resonance Imaging
Magnetic Resonance Imaging, or MRI, is a painless and safe
diagnostic procedure that uses a powerful magnet and radio
waves to produce detailed images of the body's organs and
structures, without the use of X-rays or other radiation.
Magnetic Resonance Imaging
The patient is placed on a
moveable bed that is inserted into
the magnet. The magnet creates
a strong magnetic field that aligns
the protons of hydrogen atoms,
which are then exposed to a
beam of radio waves. This spins
the various protons of the body,
and they produce a faint signal
that is detected by the receiver
portion of the MRI scanner. The
receiver information is processed
by a computer, and an image is
produced.
Magnetic Resonance Imaging
The magnetic field forces hydrogen
atoms in the body to line up in a certain
way (similar to how the needle on a
compass moves when you hold it near
a magnet). When radio waves are sent
toward the lined-up hydrogen atoms,
they bounce back, and a computer
records the signal.
Different types of tissues send back different signals. For
example, tissues that contain little or no hydrogen (such as
bone) appear black. Those that contain large amounts of
hydrogen (such as the brain) produce a bright image
Range of motion
 Includes both active & passive ROM
 Put each major joint through
active and passive full ROM
 Demonstrate and instruct the
client
Muscle tone and strength
 Check for hypertonicity &
hypotonicity
 In case of pain: support the
extremity
 Slight resistance can be there
 Compare symmetrical muscle pairs
 Maneuvers to assess muscle
strength
 Neck (sternocleidomastoid muscle)
Place hand firmly against client’s
upper jaw & ask the client to turn
the head laterally against resistance
Cont.
. Shoulder (trapezius)
Place hand over midline of client’s
shoulder exerting firm pressure. Have
the client to raise shoulder against
resistance
 Muscle strength
Muscle function Grade % Normal Lovett scale level

No evidence of 0 0 0(zero) contractility

Slight contractility, no 1 10 T(trace) movement

Full range of motion, 2 25 P(poor)

gravity eliminated

Full range of motion 3 50 F(fair)

with gravity

Full range of motion 4 75 G(good) against gravity, some

resistance
Full range of motion 5 10 N(normal)
against gravity, 0
full resistance
FRACTURE

• Bone fracture is a medical condition in which there is a damage in the continuity of the bone –
broken bone.

• This can the be the result of high force impact or stress - physical force exerted on the bone is
stronger than the bone itself.

• Pathologic fracture – fracture as a result of medical conditions that weaken the bone such as
• Osteoporosis
• Bone cancer
• Osteogenesis imperfecta
CLASSIFICATION OF FRACTURE

SOFT TISSUE DISPLACEMENT FRACTURE FRAGMENTS

INVOLVEMENT 1. Non- PATTERN 1. Incomplete

1. Closed 1. Linear
displace 2. Transverse 2. Complete
fracture
2. Open fracture/
d 3. Oblique 3. Comminute
2. Displace 4. Spiral d
compound 5. Impacted
fracture d 6. Avulsion
 SOFT TISSUE
CLOSED FRACTURE/
INVOLVEMENT
SIMPLE
FRACTURE

• Broken bone do not

break the skin

OPEN FRACTURE/
COMPOUND FRACTURE
The ends of
the broken bone tear
the skin
They are at the
risk of infection
 DISPLACEMENT
NON - DISPLACED
FRACTURE

The bone cracks either part

or all the way through, but
does not move and Tibial fracture
maintains proper alignment
DISPLACED
FRACTURE

The bone snaps into two or

more parts and moves so
that the two ends are not Mid radius fracture
lined up straight
 FRACTURE PATTERN
LINEAR
FRACTURE
Break in a bone
cranial
resembling a thin line,
without splintering,

depression, or distortion of Right parietal skull fracture

bone
TRANSVERSE FRACTURE

The broken piece of bone is at

a right angle to the bone’s
axis
Ulna fracture
 FRACTURE PATTERN
OBLIQUE FRACTURE Tibia fracture

The bone break

has a curved or
sloped pattern

SPIRAL FRACTURE Humerus fracture

Cause by twisting force

which result in
spiral-shaped fracture
line about the bone, like a
staircase.
 FRACTURE PATTERN
AVULSION FRACTURE
Bone fracture which occurs
when a fragment of bone
tears away from the main
mass of bone as a result of
physical trauma Calcaneus fracture

IMPACTED
FRACTURE

Bone breaks fragments

are driven to other bone
Humerus
fragments
 FRAGMENTS
INCOMPLETE FRACTURE

The bone cracked but does

not completely break into
pieces

COMPLETE Radius fracture

FRACTURE

The bone breaks into two

or more pieces.
 FRAGMENT
COMMINUTED
FRACTURE S
Break of splinter of the
bone into more than two
fragments. Tibia-fibula fracture
Compression Fracture
A fracture caused by compression, the act of
pressing together. Compression fractures of the
vertebrae are especially common with osteoporosis.
MANAGEMENT OF FRACTURES:

➢ BANDAGING
BANDAGING
 A bandage can be used to:
• Hold a dressing in place over an open wound
• Apply direct pressure over a dressing to control
bleeding
• Prevent or reduce swelling
• Provide support and stability for an extremity
or joint
* A bandage should be clean not sterile
 Types of Bandages
• Roller bandages
• Self-adhering, conforming bandages
• Gauze rollers
• Elastic roller bandages
• Triangular bandages
ROLLER BANDAGES
Different Width Sizes
• 1-inch width for fingers
• 2-inch width for
wrist,
hands, feet
• 3-inch width for ankles,
elbows, arms
• 4-inch width for knees.
legs
SELF-ADHERING, CONFORMING
BANDAGES
GAUZE ROLLERS
ELASTIC ROLLER BANDAGES
TRIANGULAR BANDAGES
BANDAGING
How to do the basics...
• Bandaging the Head

• Bandaging the Ears

THE FOLLOWING TERMS ARE USED IN
ROLLER BANDAGING
FIGURE OF EIGHT (CRISS-CROSS)
SIMPLE SPIRAL
A bandage with successive laps
• A roller bandage applied crossing over and around each other
spirally around the limb. to resemble the numeric figure
eight.
SPIRAL REVERSE SPICA
• A spiral bandage that is • A kind of figure eight
turned and folded back on bandage which is applied
itself as necessary to make to a joint or trunk.
it fit the contour of the
body more securely
BANDAGING
 SPLINTING
EXTREMITIES
Reasons for Splinting to stabilize an
injured area are to:
• Reduce pain
• Prevent damage to muscle, nerves and
blood vessels
• Prevent a closed fracture from becoming an
open fracture
• Reduce bleeding and swelling
 TYPES OF SPLINTING
• Air Splint
• Pillow Splint
• Buddy taping or a self splint
 AIR SPLINT

Device for temporarily immobilizing fractured or otherwise

injured e
xtremities. It consists of an inflatable cylinder that can
be closed at either end and becomes rigid when filled with air
 PILLOW SPLINT

Provides exceptional comfort and maximum pain relief

during rest and sleep.
BUDDY TAPING OR SELF SPLINT
 SLINGS
• Sling support and protect the upper
extremities.
• Sling is not a bandage, it used as a support
for any injury to the shoulder or arm.
 ARM SLINGS
• The purpose of an arm sling is to immobilize and protect an
injured arm so that it can heal. Though broken arms are a
common reason for wearing a sling, you don't necessarily
have to have a broken bone to wear one - contusions, sprains,
and dislocations can also require a sling.

• Sling can be vital to your healing process because, in

addition to supporting your arm as it heals, it provides a
sign to others to treat your arm gently.
ARM SLING
 Splinting Specific Areas
1. Shoulder
it involve the clavicle (collarbone), the scapula (shoulder
blade), or the head humerus (upper arm)
2. Elbow
UPPER EXTREMITIES
• Forearm
• Wrist, hand and fingers
• Pelvis and hips
• Femur (Thigh)
3. Knee
• Knee in bent position
• Knee in straight position

LOWER EXTREMITIES
• Lower leg (Tibia/Fibula)
• Thigh (Femur)
• Lower leg
• Ankle and foot
 MEDICAL /SURGICAL
MANAGEMENT OF FRACTURES:
1. Reduction - Reduction of a fracture (“setting” the
bone) refers to restoration of the fracture fragments to
anatomic alignment and rotation.

It’s a surgical approach, the fracture fragments are reduced.

External/Internal fixation devices (metallic pins, wires, screws,

plates, nails, or rods) may be used to hold the bone fragments
in position until solid bone healing occurs.
Internal fixation
External
fixation
Difference between internal or
external fixation
 Closed reduction
• closed reduction is accomplished by bringing the bone
fragments into apposition (ie, placing the ends in contact)
through manipulation and manual traction.

• Extremity is held in the desired position while the

physician applies a cast, splint, or other device.

• X - rays are obtained to verify that the bone

fragments are correctly aligned.

• Traction (skin or skeletal) may be used to effect

fracture reduction and immobilization.
 2.Immobilization
• Immobilization may be accomplished by external or
internal fixation.
• Methods of external fixation include bandages,
casts, splints, continuous traction, and external
fixators.
• Metal implants used for internal fixation serve as
internal splints to immobilize the fracture.
Traction
Traction is the use of weights, ropes and pulleys to
apply force to tissues surrounding a broken bone.
Traction
1. Skin traction-
• Bucks traction used for knee,hip bone
fracture
• Weight usually 5-7 pounds attach to skin
2. Skeletal traction –
• Needs invasive procedure
• Weight is upto 10 kg attached to bone
 Splinting
• Splinting is the most common procedure
for immobilizing an injury.
 Why Do We Splint?
• To stabilize the extremity

• To decrease pain
• Actually treat the injury
Possible items for Splinting
• Soft materials. Towels, blankets, or pillows,
tied with bandaging materials or soft cloths.

• Rigid materials. A board, metal strip, folded

magazine or newspaper, or other rigid item.
 Soft Splints
• Splinting Using a Towel
• Splinting using a towel, in which the
towel is rolledup and wrapped around
the limb, then tied in place.
 Guidelines for Splinting
1. Support the injured area.
2. Splint injury in the position
that you find it.
3. Don’t try to realign bones.
4. Check for color, warmth, and
sensation.
5. Immobilize above and below the
injury.
The splint should go beyond the joints above
and below the fractured or dislocated bone to
prevent these from moving
 3. Maintaining and restoring
function
• Restlessness, anxiety, and discomfort are controlled with
a variety of approaches, such as reassurance, position
changes, and pain relief strategies, including use of
analgesics.
• exercises are encouraged to minimize disuse atrophy
and to promote circulation.
• Participation in activities of daily living (ADLs) is
encouraged to promote independent functioning and
self-esteem.
 Treating an Open Fracture
• Do not draw exposed bones back into tissue.
Treating an Open Fracture
DO:
• Cover wound.
• Splint fracture without disturbing wound.
• Place a moist 4" x 4" dressing over bone end
to prevent drying.
• Assist the surgeon in debridement of wound
Complication of fracture
Early complications
• Shock
• fat embolism
• compartment syndrome
• deep vein thrombosis
• disseminated intravascular coagulopathy
• infection
 Compartment syndrome
• develops when tissue perfusion in the
muscles is less than that required for tissue
viability.
• patient complains of deep, severe pain,
which is not controlled by opioids.
 Compartment syndrome
• Reduction in size of muscle compartment
• It increase pressure in the
muscle compartment
• Reduce microcirculation ,leads to
muscle and nerve anoxia and necrosis
Delayed complications
• delayed union and nonunion
• avascular necrosis of bone
• reaction to internal fixation devices
 NURSING MANAGEMENT
Patients with closed fractures:
• Encourage patient not to mobilize fracture
site.

• exercises to maintain the health of

unaffected muscles for using assistive
devices (eg, crutches, walker).
• teach patients how to use assistive devices
safely.

• Patient teaching includes self-care,

medication information, monitoring for
potential complications, and the need for
continuing health care supervision.
 Patients with open fractures:

• administers tetanus prophylaxis if indicated.

• wound irrigation and debridement in the
operating room are necessary.
• Intravenous antibiotics are prescribed to prevent
or treat infection.
• wound is cultured.
• fracture is carefully reduced and stabilized by
external fixation or intramedullary nails.

• Any damage to blood vessels, soft tissue, muscles,

nerves, and tendons is treated.

• Heavily contaminated wounds are left unsutured

and dressed with sterile gauze to permit swelling
and wound drainage.
 Care of client with cast
Before application of a cast preparation of the client
includes:

• Detailed explanation of the procedure

• Skin preparation involves through cleansing of the skin

• Presence of unremovable particle or dust should be

reported to the physician

• Roll the cast material are individually submerged in clean

water and excess water is squeezed from the roll ,apply
bandage is applied to encircle the injured the body parts
• As the water evaporates the cast will dry
• plaster cast generates while drying so instruct
patient for heat sensation
• Do not cover the cast
• Windowing or bivalving a cast means cutting a cast
along both sides then splitting it to decrease
pressure on underlying tissue.
• Window may also be cut into cast to allow the
physician or nurse to visualize wounds under the
cast or removes drains.
Windowing
• Neurovascular assessment: It should be performed
every 30 minutes for 4 hours.
• Assess the cast extremity for color, warmth, pulse
distal to the cast, capillary refill.
• Movement of the distal fingers or toes, awareness of
light touch distal to the cast, change in the sensation.
• Assessment of the pain: Assess the degree of pain
• Assessment of the cast: The skin around the
cast edges should be observed for damage or
swelling.
“Hot spots” areas of the cast that feel warmer than
other section may indicate tissue necrosis or
infection under the cast.
“Wet spots” may indicate drainage under the
cast
Care of external fixation
• Assessment- pain, nerve supply,infection,pin
site etc.
• Small bleeding from pin site is normal
• Critical, If extend more than 24 hours
• Administer antibiotics, analgesic medicine
Care of traction
• Assessment – skin breakdown, pain,
neurovascular ,constipation
• Stool softener
• Plenty of fluids
• Provide bedpan and urinals for elimination
• Encourage clients activity
 NURSING
DIAGNOSIS:
 Acute pain related breakdown of continuity of the
bone as evidenced by facial expressions and
verbalization of patient.
• Goals: Patient will not feel pain
• Assess the onset, duration, location, severity and intensity of pain
• Intervention:
• Administer the analgesic according to physician order.
• Provide comfort devices like sand bags for immobilization
of affected parts.
• Provide diversion therapy
 Impaired physical mobility related to
application of traction or cast as evidenced by
assessment

• Goal: Patient will able to move unaffected area.

• Intervention:
• Provide range of motion exercises to the patient.
• Assist the patient in ambulation after recovery of
fracture.
• Provide assistance while using walker or crutches if
required.
•

• Prevent from complication which usually occurs due to

immobility.
Self care deficit related to fracture as evidenced by
poor personal hygiene.

• Goal: Patient will maintain the personal hygiene

• Intervention:
• Assess the need of self care
• Encourage the patient or relatives to do self care activity
• Head to foot care to be provided to the patient.
• Educate about importance of maintaining personal
hygiene.
 Imbalanced nutrition less than body requirement
relate to increase demand of nutrient for bone
healing as evidenced by observation.
• Goal: Maintain the nutritional status of the patient
• Intervention:
• Assess the nutritional status by intake/output chart,
biochemical measures, body mass.
• Maintain intake output chart daily.
• Encourages the patient to take protein rich diet.
• Plenty of fluids and frequent intake of meal is necessary.
• Try to assess the daily weight of the client
 References
• Joyce M. Black Jane tfokanson, medical
surgical nursing,7th edition, Elsevier
publication, volume 1,page no. 619-651
• Suddarth’s & burnner, text book of medical
surgical nursing, eleventh edition,Wolters
publication, Page no. 2079 -2104
• www.authorstream.com
• www.slideshare.com