COMMON HEALTH PROBLEMS ACROSS THE LIFE-SPAN Prepared By: MS. ELIZABETH D. CRUZ E.N., M.A.N.

FRACTURES Is a disruption in the continuity of a bone, separating it into 2 or more fragments. ETIOLOGY 1. Direct force or crushing form = trauma/accident 2. Twisting force = ex. Skin traction 3. Powerful muscle contractions = highly developed muscles contract so violently that muscles tear from bone sometimes pulling a small piece of bone with it. 4. Prolonged stress = fatigue & stress bone break after repeated stress 5. Bone disease = bones weakened by disease or tumors & subject to pathological fractures 9.1 Pathophysiology

Cause Release of yellow marrow Affection of the surrounding tissue Breakage

Embolism Respiratory and Cardiac Arrest

Extravasatation Process

Hypovolemic shock Death

Hematoma formation

Inflammatory Process Irritation & damage to nerves Lose of Sensation

Damage to the blood vessels Bleeding

Pain

Decrease of blood supply to the bone Necrosis Death

TYPES OF FRACTURES 1 ACCORDING TO GENERAL CLASSIFICATION: 1.CLOSE/SIMPLE/UNCOMPLICATED FRACTURES = when the break in the b one has no communication to the outside = no open wound

2.OPEN/COMPOUND/ COMPLICATED FRACTURE = involve trauma to surrounding tissue & a break in the skin 3. INCOMPLETE FRACTURE = involves a portion of the cross section of the bone or may be longitudinal 4. COMPLETE FRACTURE = involves the entire cross section on the bone usually displaced(not normal position) 1 ACCORDING TO APPEARANCE 1. COMMINUTED FRACTURES = bone splintered into several fragments 2. IMPACTED FRACTURE = fragment of bone wedged into other bone fragment 3. COMPRESSION FRACTURE = bone collapses in on itself usually seen in vertebral fractures

4. DEPRESSED FRACTURE - usually occurs in the skull and facial with broken bone being driven inward. 5. GREENSTICK FRACTURE - one side of the bone is broken and the side is bent

ACCORDING TO PATTERN 1. TRANSVERSE FRACTURE = break runs across the bone = 90 degrees angle to longitudinal axis 2. OBLIQUE FRACTURE = fracture line occurs at approximately 45 degrees angle 3. SPIRAL FRACTURE = twists around the shaft of the bone

MANIFESTATIONS 1. Pain especially at the time of injury 2. Tenderness at the site 3. Swelling 4. Loss of function 5. Visible deformity 6. Crepitus = grating sensation either heard or felt as bone ends rub together 7. Dislocation 8. Bleeding from an open wound with protrusion of bone ends. DIAGNOSTIC PROCEDURE Radiographs & other imaging studies may identify the site & type of fracture

TREATMENT :Principle of Fracture Treatment 1. Reduction of fracture treatment a. closed manipulation in which a cast or sling is used. b. internal in surgery in which various type of holding devices are used. c. external fixation in which pins are inserted into bone above & below the fracture & held in place by clamping device 2. Maintenance of alignment by immobilization = is the most important phase in obtaining union of fracture fragments a. in closed reduction = is accomplished by application of plaster cast after fracture & have been aligned with or without the aid of anesthesia b. in open reduction = immobilization is done by nails, screws, pins, wires or rods which are inserted with or without plates. 3. Restoration of function = is an ongoing process actually begins with the maintenance of function of unaffected joints & extremities

STAGES OF BONE HEALING 1. HEMATOMA STAGE/ INFLAMMATORY STAGE When a bone is fractured, blood extravagates into the area between & around the fragments 7 the bone marrow. The clots begins 24 hours after the fractures occurs. This local clots serves as a febrin network for subsequent cellular invasion. 2. CELLULAR PROLIFERATION/ FIBROCARTILAGE FORMATION Occurs a few days after the fracture. The combination of periostal elevation & granulation tissue containing blood vessels, fibroblasts & osteoblasts produce a substance called osteoids forming a bridge across the fracture site. 3. CALLUS FORMATION

After the following weeks minerals are being deposited in the osteoids forming a large mass of differentiated tissue bridging the fracture called the CALLUS. 4. OSSIFICATION Final laying down of bone, is the state in which the fracture ends have knit together. 5. CONSOLIDATION/REMODELLING When consolidation is completed, the excess cells are absorbed, the primary cancellous is remodeled, compact bone being formed according to stress patterns. Remodeling continues as bone is formed in relation to its function

 COMPLICATIONS IN HEALING 1. Interruption in the sequence of bone healing are caused by: a. original injury b. debridement c. loss of bone substance d. soft tissue interpose between bone ends e. infection f. loss of circulation g. interrupted or improper immobilization h. inadequate fixation i. necrosis due to fixation devices j. metabolic disturbances 2. Complication to bone itself a. infection b. non-union c. mal-union d. delayed union AVERAGE DURATION OF BONE HEALING 1. Phalanges = 3 weeks 2. Clavicle = 3 - 4 weeks 3. Metacarpals = 4 weeks 4. Metatarsals = 5-6 weeks 5. Tarsals = 6-8 weeks 6. radius = 6 - 13 weeks 7. Tibia = 8 - 12 weeks 8. Humerus = 10 - 12 weeks 9. Fibula = 12-14 weeks 10. Spine = 6 - 12 months 11. femur = 12 weeks-12 months

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NURSING INTERVENTION 1. Prevent infection = cover any breaks in the skin with clean or sterile dressings 2. Provide care during transfer of the patient = immobilize a fractured extremity with splints in the position of the deformity before moving the client;avoid straightening the injured body part if joint is involved = support affected part when moving

3. Provide client & family teaching a. explain prescribed activity restrictions & necessary lifestyle modifications due to immobility b. teach proper use of assistive devices 4. Administer medications include narcotic or non narcotic analgesics & prophylactic antibiotics for open fracture

FRACTURES OF SPECIFIC SITES FRACTURES OF UPPER EXTREMITY Fracture of the CLAVICLE (Collar bone) FUNCTION: To hold the shoulder upward, outward, and backward from the thorax

MANAGEMENT: 1. Most fractures of the clavicle are treated by CLOSED REDUCTION and immobilization with a clavicle strap, figure of 8 bandage, or sling a. pad axilla to prevent nerve damage from pressure of the immobilizer. b. assess the neuromuscular status of the upper extremities 2. Open reduction & internal fixation may be done for marked displacement, severely comminuted fracture, & extensive soft tissue injury. a. arm is kept in a sling b. assess neurovascular status of the involved upper extremity NURSING INTERVENTION: 1. Exercise elbow, wrist, & fingers 2. Do shoulder exercise to obtain full shoulder motion as prescribed 1 FRACTURES OF NECK OF THE HUMERUS(FRACTURES OF THE PROXIMAL HUMERUS) ETIOLOGY: From falls in which the outstretched arm strikes the ground. MANAGEMENT: 1. Impacted fractures of neck of the humerus do not require reduction. The weight of the

arm helps to correct displacement. a. place a soft pad under the axilla to prevent skin maceration b. the arm is supported by a sling for comfort c. sleeping in a semi fowlers position 2. Displaced fractures are treated with reduction under x-ray control, open reduction NURSING INTERVENTION 1. Active motion of shoulder joint to prevent limitation of motion & stiffness of shoulder 2. Instruct to lean forward and allow affected arm to abduct & rotate.

1 FRACTURES ABOUT THE ELBOW & FOREARM ETIOLOGY: Usually occurs as a result of a fall on the elbow, on the outstretched hand, or from a direct blow MANAGEMENT: 1. Non operative(cast immobilization) 2. Operative( open reduction & internal fixation) 3. Elbow is immobilized in flexion to prevent extension contracture

NURSING INTERVENTION: 1. Observe hand swelling, skin color(blueness or blanching of nail beds), & temperature, comparing it with unaffected site 2. Evaluate radial pulse if weakness or disappears 3. Assess for paresthesia (pricking & burning sensations) in the hand, inability to move fingers, pain on passive movement of fingers--indicate nerve injury or impending ischemia 4. Elevate are to control edema 5. Encourage to move fingers and shoulder frequently. FRACTURES OF THE HIPS (PROXIMAL FEMUR) ETIOLOGY: Occur in older adults & frequently to women after insignificant injuries. MANIFESTATIONS: 1. Shortening & external rotation of affected leg

2. Pain in hip or in the knee 3. Unable to move leg, but is able to wiggle toes MANAGEMENT: 1. Surgical repair 2. Leg maybe immobilized by bucks extension traction until surgery NURSING INTERVENTION: 1. Use anticipatory nursing techniques to avoid complications like thrombophlebitis / thromboembolism 2. Monitor neurovascular status of the leg 3. Provide special skin care 4. Encourage to move by herself as much as possible to decrease complications 5. Prevent urinary tract infection a. avoid use of an indwelling catheter b. watch the color, & volume of urinary output. c. maintain fluid intake 6. Place pillow between legs--to keep affected leg in abduction 7. Position the client supine, placing a pillow under the affected leg from mid-thigh to ankle 8. Assist with turning by having her grasp the trapeze or bedrails 9. Encourage to take deep breaths while turning

FRACTURES OF THE LOWER EXTREMITIES 1 FRACTURES AT THE KNEE - Involves the distal shaft of the femur (supracondylar fracture), the articular surfaces(femoral condyles or tibial plateau fracture) or the patella MANAGEMENT: Traction, internal fixation and or immobilization.

NURSING INTERVENTIONS: 1. Elevate extremity, raise the gatch of the foot of the bed 2. Evaluate the effusion of the knee 3. Encourage quadriceps exercise to prevent atrophy of the thigh muscles 4. Progressive exercise like straight leg raising 1 FRACTURES OF TIBIA & FIBULA - requires prolonged immobilization due to tibia heals in 12 to 16 weeks MANAGEMENT: 1. Treatment approach depends on the specific characteristic of fracture 2. Closed fracture - maybe manage by simple manipulation & reduction maintained by application of plaster cast 3. Fracture may be treated by open reduction & fixation 4. External fixator used with open fracture

NURSING INTERVENTION 1. Elevate lower extremity to control edema 2. Assess neurovascular status of involved extremity

FRACTURES OF THE ANKLE - occur in the distal tibia & or fibula ETIOLOGY: result of forceful twisting of the ankle & associated with ligament disruption MANAGEMENT: - Immobilization with cast or splint and possible open reduction & internal fixation to reestablish the joint NURSING INTERVENTIONS: 1. Elevate lower extremity to control edema 2. Teach about weight-bearing

FRACTURES OF THE FOOT

ETIOLOGY: Fractures of the metatarsals and phalanges result from crush injuries of the foot MANAGEMENT: Immobilization with cast, splint or strapping NURSING INTERVENTION: 1. Teach patient to elevate foot to control edema 2. Partial weight-bearing is allowed 3. Exercise in warm water which supports the leg & relaxes muscles

1 FRACTURES OF THE SPINE (THORACIC & LUMBAR) -It results from an axial force that compress the involved vertebral body between those above and below it. - This compression force may result in the fracture of one or more vertebral bodies. - Neurologic deficit may occur depending on the type and severity of the injury. COMPRESSION FRACTURE BASED ON LOCATION 1. CERVICAL SPINE a. if there is no dislocation of the intervertebral disc, then they will remain stable until healed b. neurologic deficit is not common due to the longitudinal ligaments acts to restrain displacement of the fracture

2. THORACIC SPINE a. wedge compression fracture is most common. In this injury , one or more vertebral bodies colapse anteriorly become wedge shaped & create a prominence of the spinous process posteriorly b. vertical compression fracture is extended through the entire height of the vertebral body & lamina or spinous process. Thus, The vertebral body may shatter & the fragments maybe displaced.

3.MID LUMBAR SPINE a. excessive load secondary to muscle contraction alone may produce a compression fracture especially in osteoporosis bone b. midlumbar compression fracture may be considered stable and rarely associated with neurologic deficit

INCIDENCE: 1. All ages 2. Most common in MIDLUMBAR area 3. Most frequent compression fracture of the thoracic spine is the wedge compression fracture 4. High incidence of paraplegia with vertical fracture 5. Most compression fractures are stable 6. Most common cause of compression fracture is osteoporosis ETIOLOGY: 1. TRAUMATIC ORIGIN a. diving accident b. automobile accident c. falls or blows to the head d. falls in sitting position 2. NONTRAUMATIC ORIGIN a. osteoporosis

b. multiple myoma c. bone cancer, sarcomas and primary and metastatic lesions MEDICAL & SURGICAL MANAGEMENT A. CERVICAL COMPRESSION FRACTURE 1. Skeletal tractions such as halo or with skull tong 2. Head halter 3. Cervical range of motion exercises B. THORACOLUMBAR COMPRESSION FRACTURE 1. Bed rest on a firm mattress. Sitting is not permitted and only logroll. 2. As the symptoms subside, muscle strengthening exercise is done 3. If severe pain, body cast with spine in traction applied for 6 weeks 4. If severe deformity, a molder plaster jacket is applied to prevent progressive determity for 12-16 weeks NURSING INTERVENTIONS A. Monitor neurologic status of the trunk and extremities 1. Assess neurologic status of the trunk and extremities 2. Maintain proper positioning a. protect head & spine from excessive flexion & extension b. maintain immobilization of cervical spine w/sandbags 3. Utilize special beds/frames or logrolling for turning or positioning a. Promote comfort b. Discuss patients feelings & fears c. Provide mobility within prescribed restrictions d. Provide self-care within activity of restrictions e. Discuss changes in body image f. Discuss how lifestyle maybe altered due to injury g. Provide bowel & bladder rehabilitation program h. Provide diversionary activities appropriate for patients age and activity level i. Provide calm, restful environment j. Provide client education regarding progressive muscle strengthening exercise as indicated

1 FRACTURES OF THE PELVIS - Includes fracture of the sacrum, ilieum, pubis,ischium & coccyx TYPES OF PELVIC FRACTURES 1. STABLE FRACTURES - do not involve the pelvic ring or result in minimal displacement 2. UNSTABLE FRACTURES

- rotationally unstable

ETIOLOGY: 1. Auto accidents, crush injuries, & falls cause most pelvic fractures 2. Injury to internal organs and blood vessels frequently accompany these fractures 3. Bleeding from bone fragments also occurs MANIFESTATIONS: 1. Pain with movement & tenderness over fracture sites 2. Inability to bear weight because of pain 3. Back pain from fracture 4. Paralytic ileus TREATMENT: 1. STABLE FRACTURE = bedrest for 1 to 7 days then progress from partial to full weight bearing. 2.UNSTABLE FRACTURES = pelvic external fixation with half pins to recreate a stable pelvis. Early mobilization and ambulation. NURSING INTERVENTIONS: A. Promoting adequate tissue perfussion 1. Monitor vital signs & level of consciousness. 2. Support vital functions as needed and prescribed B. Ensuring abdominal-organ functioning 1. Monitor urine output for blood 2. Monitor bowel function 3. Assist the patient with therapeutic regimen C. Promoting Ambulation & activities of daily living 1. Turn the patient as a unit 2. Encourage exercises & activities to minimized development of immobility-related problems. 3. Assist the patient being treated with pelvic sling 4. Assist with gradual resumption of activity & ambulation

SPECIAL FRACTURES COLLES FRACTURE = is a fracture of the radius above the wrist with dorsal displacement of the lower fragment. SMITHS FRACTURE = Is a fracture of the proximal 3rd of the radius ulna

POTTS FRACTURE = is the fracture of the cervical thoracic, and lumbo sacral area

MONTEGGIA FRACTURE = is the fracture of the proximal 3rd of ulna with radial head dislocation.

BENNETTS FRACTURE = is the fracture of the base of the thumb dislocation of the metacarpal joint of the thumb.

PILONS FRACTURE = is the fracture of the ankle

GALEAZZIS FRACTURE = is the fracture of the distal 3rd of the radius with radius ulnar dislocation.

MALGAIGNE FRACTURE = is the fracture of the pelvic ring causing pelvic instability.

HANGMANS FRACTURE = is the cervical fracture of C1 & C2

1. 2. 3. 4.

GOALS FOR MANAGEMENT OF FRACTURE Restore function Prevent deformity Management of deformity if present Develop power for adaptation

CONTUSIONS CONTUSION

= Is an injury to the soft tissue produced by a blunt force like blow, kick, or fall.

MANIFESTATIONS OF CONTUSIONS 1. Hemorrhage into injured part(ecchymosis) from rupture of small blood vessels 2. Pain, swelling & discoloration

NURSING INTERVENTIONS OF CONTUSIONS 3. Elevate the affected part. 4. Apply cold compresses for 1st 24 hours to decrease edema. 5. Apply heat to affected area after 24 hours 4 times a day to promote circulation and absorption. 6. Apply pressure bandage to control bleeding and swelling. SPRAINS = Is a complete or incomplete tear in the supporting ligaments surrounding joints = common locations ankle, knee, wrist, thumb, shoulder, neck, lower back

ETIOLOGY: Commonly result from a wrenching or twisting motion that disrupts the stabilizing action of ligaments


1. 2. 3. 4.

MANIFESTATIONS OF SPRAINS: Rapid swelling due to extravasations of blood within tissues Pain on passive movement of joint Increasing pain during 1st few hours due to continued swelling X-ray reveals no bone injury

NURSING INTERVENTION OF SPRAIN 2. Elevate or immobilize the affected joint and supply ice packs for the 1st 24 hours 3. After swelling is controlled apply warm treatment such as warm compresses or a heating pad. 4. Provide care to patient with extremity with tape, splint, cast or bandage. 5. Prepare the client with a severe sprain for surgical repair or reattachment if indicated.

STRAINS = Is tearing of the muscle caused by excessive force, stretching, or overuse

ETIOLOGY: Result from excessively vigorous movement in under stretched or overstretched muscles & tendons. MANIFESTATIONS: 1. Hemorrhage into the muscle 2. Swelling 3. Tenderness 4. Pain NURSING INTERVENTION OF STRAIN 1. For acute, apply ice packs for the 1st 48 hours to control swelling. 2. Then, after swelling is controlled apply warm treatment such as warm compresses. 3. Rest the part for 4 to 6 weeks. 4. For both acute & chronic strain permit only minimal movement of the affected area.

DISLOCATION

= When the surfaces of the bones forming the joint are no longer in anatomical contactthis is an emergency due to associated disruption of surrounding blood & nerve supplies.

ETIOLOGY: 1. Trauma 2. Disease 3. Congenital condition MANIFESTATIONS: Burning pain & joint Deformity Stiffness & loss joint function Moderate to severe around joint X-ray confirmation of dislocation without associated fracture.

1. 2. 3. 4. 5.

NURSING INTERVENTIONS OF DISLOCATION 1. To lessen swelling, elevate the affected extremity. Keep its elevated until after dislocation is reduced because manipulation decreases swelling. 2. Assess affected extremity for signs of neurovascular problems such as pain, absent pulse, paresthesia, pallor and paralysis. 3. Because condition causes severe pain give pain medication per doctors order. 4. Provide appropriate care if patient is immobilized either in traction or in cast. 5. Encourage patient to do exercise.