1-48. NURSING MANAGEMENT OF A PATIENT WITH A FRACTURE
a. Nursing care of a patient with a fracture, whether casted or in traction, is
based upon prevention of complications while healing. By performing an accurate
nursing assessment on a regular basis, the nursing staff can manage the patient's pain
and prevent complications.
b. When assessing a patient with a fracture, check the "5 P's"--pain, pulse,
pallor, paresthesia, and paralysis.
(1) Pain. Determine where the pain is located and if it is worse or better?
Worsening pain may indicate increased edema, lack of adequate blood supply, or tissue
(2) Pulse. Check the peripheral pulses, especially those distal to the
fracture site. Compare all pulses with those on the unaffected side. Pulses should be
strong and equal.
(3) Pallor. Observe the color and temperature of the skin, especially around
the fracture site. Perform the capillary refill (blanching) test.
(4) Paresthesia. Examine the injured area for increase or decrease in
sensation. Can the patient detect tactile stimulation such as a blunt touch or a sharp
pinprick? Does the patient complain of numbness or tingling?
(5) Paralysis. Check the patient's mobility. Can he wiggle his toes and
fingers? Can he move his extremities?
c. All nursing assessment findings should be documented in the patient's chart
so that comparison can be made with notes made at both earlier and later dates. In this
way, the patient's progress can be followed and changes in status are easily
recognized. In addition to the five P's mentioned above, the patient's level of
consciousness and temperature should be checked regularly. Mental status changes
and temperature elevation could indicate the presence of infection. Reposition the
patient as necessary to relieve pressure areas. Check all dressings, bandages, casts,
splints, and traction equipment to ensure that nothing is causing constriction or
pressure. Frequent and thorough checking and observation on the part of the nursing
staff will promote healing and prevent complications.
1-49. LIFE THREATENING COMPLICATIONS
a. Pulmonary Embolism. Pulmonary embolism is the occlusion of the
pulmonary arteries by a thrombus originating in the venous system. Patients with lower
extremity fractures are most susceptible to pulmonary embolism due to their relative