Nursing College

1. Fracture

2.  A fracture is any break in a bone, including
chips, cracks, splintering, and complete breaks.
 Two Basic Types Of Fracture:
 Closed Fracture (Simple fracture):
 Open Fracture: (Compound fracture)

3.  Closed Fracture (Simple fracture):
 Occurs when a bone is broken but there is no
penetration extending from the fracture
through the skin.

4.  Open Fracture: (Compound fracture)
 Is a fracture in which there is a wound over the
fracture site, with or without bone protruding
through it.
 This type of fracture is more serious than closed
fractures because the risks of contamination and
infection are greater.

5. Fractures are further classified according to
their appearance on x-ray into:
 Green stick fracture
 Usually occurs in children whose bones are still pliable (like
green sticks)
 A break occurs straight across part of the width of the bone,
perpendicular to the long axis
 Transverse Fracture
 Cuts across the bone at right angles to its long axis
 often caused by direct injury

6.  Oblique Fracture
 The fracture line crosses the bone at an oblique angle
 Comminuted Fracture:
 The bone is fragmented into more than two pieces
 Impacted Fracture:
 The broken ends of the bone are jammed together
 Spiral Fracture:
 Usually results from twisting injuries
 The fracture line has the appearance of a spring

7. Causes Of Fractures
 Direct Force: The bone breaks at the spot of application
of the force e.g., direct hit over a bone, bullet injury.
 Indirect Force: The bone breaks away from the
application of force somewhere else, e.g. after falling on
outside stretched hands.
 Force of Powerful Muscle Actions: For example, violent
cough may cause rib fracture.

8.  Aging and bone disease: Can increase the risk of
fractures (pathologic fractures), with bones breaking
even minor accidents
 Twisting Forces: Such injuries are often seen in
football and skiing accidents where a person's foot is
caught and twisted with enough forces to fracture a leg
bone.

9. Signs And Symptoms Of Fractures
 The primary symptom of fracture is PAIN.
 Pain is often severe and constant and is felt at or near the site
of fracture
 Swelling and discoloration
 These begin shortly after injury
 Discoloration my start as reddening of the skin
 Tenderness Or Discomfort which may lead to severe
restriction or use of the area affected
 Bone may BREAK through the skin
 Deformity.

10. General principles for treatment of fractures
 Establish and maintain an open airway
 Control hemorrhage
 Close sucking chest wound
 Begin fluid resuscitation
 After dealing with life-threatening conditions, identify and
immobilize all fractures.
 Immobilization is accomplished by splinting.

11. Splints
A splint is a device used to immobilize a fracture.
Types:
 Improvised:
 Rolled newspaper
 Wood
 Strong cartons
 Cane
 Ironing board
 Any object that can provide stability

12.  Commercially Available Splints:
 Rigid splints (padded board, aluminum splint)
 Inflatable splints
 Traction splints

13. General Principles Of Splinting:
 The clothing is best removed from the area of any suspected
fracture or dislocation
 Note and record motion and sensation status distal to the site
of injury
 The splint should immobilize the joints above and the joints
below the fracture.
 During splint application, minimal movement of the limb
should be allowed.

14.  Severely deformed limb should be straightened with constant
gentle manual traction so that the limb can be incorporated in to the
splint.
 If gentle traction increases the patient's pain significantly or if
resistance to the limb alignment is encountered, the limb must be
splinted in the position of deformity.
 Cover all wounds with dry sterile dressing before applying a splint.

15.  Pad the splint to prevent local pressure.
 Do not move or transport patients before splinting
extremely injuries.
 when in doubt, splint.

17.  Hemorrhage means extravasation of blood.
 Classification:
 - External - Internal

18. External hemorrhage
 Types:
 Arterial bleeding: loss of blood from arteries
 Blood loss is rapid and profuse
 The color of blood is bright red
 Blood spurts as the heart beats
 Venous Bleeding: loss of blood from veins
 Blood loss is a steady flow
 The color of blood is dark
 Capillary Bleeding: loss of blood from
capillary bed
 Blood flow is slow
 The color of blood is red but less bright

19. Methods used to control external bleeding
 Direct pressure: is a most effective method
 Apply direct and firm pressure to the wound
 Elevation of the limb
 Pressure point on the artery
 Splinting: used in sever laceration or cut extends over
the length of the extremity.
 Blood pressure cuff: the cuff is placed above the
wound, and can be left for up to 30min.
 Mast Garments: pneumatic counter-pressure devices
for serious abdominal bleeding
 Applying Tourniquet: is a last resort used only
when other methods to control bleeding have
failed.

20. Internal hemorrhage
 Causes of internal hemorrhage:
 Deep chest or abdominal wound
 Any cut into muscle or fracturing of bone
 Bleeding ulcers

21. Detecting internal bleeding
 : assume internal bleeding whenever the following
are present
 Wound that have penetrated the skull
 Blood in the ear
 Vomiting or coughing up blood

22.  Wound that have penetrated the chest or
abdomen
 Large areas of bruised abdomen
 Abdominal tenderness, rigidity, or spasm
 Blood in urine
 Rectal bleeding
 Bone fractures mainly the long bone of the arm
or thigh.

23. Epistaxis
 Epistaxis (nose bleeding): means hemorrhage from
the nose, due to mainly spontaneous rupture of
minute vessels.

24. Local causes
 Trauma
 Nose picking
 Blow on the nose
 Foreign body
 Infection: acute / chronic rhinitis
 Violent sneezing
 Eroding neoplasm in the nasal cavity,
nasopharynx, or sinuses.

25. General and systemic causes
Hypertension
 Blood diseases
 Acute infectious fever
 High altitudes

26. First aid treatment
 Apply pressure by pinching the nostrils
 Keep the patient in a setting position
 Apply ice over the nose
 Keep the patient quite

27. Hospital emergency care
 Simple packing of the nose
 Use of adrenaline nasal pack
 Use of diathermy
 In hypertension cases: sedation and reduce blood
pressure
 Check for blood coagulative disorders.