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Gout Management and Fracture Types

This document discusses fracture nursing management. It describes the types of fractures including close/simple fractures where the skin is intact and open/complex fractures where the bone protrudes through the skin. It outlines nursing priorities for close fractures such as health teaching and monitoring for pain relief and for open fractures such as preventing infection, promoting healing, and assessing neurological status. Surgical management options like open reduction open fixation using titanium plates and closed reduction manipulating fractures manually are mentioned. Potential early complications of fractures include hypovolemic shock and fat embolism. Fracture healing depends on the individual and typically takes 3-12 weeks in children and 6 months or more in adults.

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Nurse Notes
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30 views3 pages

Gout Management and Fracture Types

This document discusses fracture nursing management. It describes the types of fractures including close/simple fractures where the skin is intact and open/complex fractures where the bone protrudes through the skin. It outlines nursing priorities for close fractures such as health teaching and monitoring for pain relief and for open fractures such as preventing infection, promoting healing, and assessing neurological status. Surgical management options like open reduction open fixation using titanium plates and closed reduction manipulating fractures manually are mentioned. Potential early complications of fractures include hypovolemic shock and fat embolism. Fracture healing depends on the individual and typically takes 3-12 weeks in children and 6 months or more in adults.

Uploaded by

Nurse Notes
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.

FRACTURE NURSING MANAGEMENT

Is a complete or incomplete disruption in the continuity of Close fracture


bone structure and is defined according to its type and extent.
 Health teaching
TYPES OF FRACTURE  Promote safe environment
 Document and monitor closely if the pain is
1. Close fracture (simple fracture) – does not cause a break relieved
in the skin, the skin is still intact but the bone is broke.
2. Open fracture (complex fracture)– Open fracture
Open fractures are graded according to these criteria:
• Type I – clean wound less than 1 cm long  Prevent infection of the wound
• Type II – larger wound without extensive soft tissue  Promote healing of the bone and soft tissue
• Type III (A, B, C) – highly contaminated and has extensive  Wound irrigation
soft tissue damage. May be accompanied by traumatic  Elevate extremity to minimize edema
amputation and is the most severe.  Assess Neuromuscular status frequently
 Monitor VS and sign of infection
3. Intra-articular fracture – a fracture that extends into the
joint surface (nearby joint) of a bone. Open reduction open fixation

 w/ the use of titanium to fix the fracture. It is


4. Complete fracture – the fracture completely separates the
most suitable, lessen the possibility for the body
bone into two
to reject this material
5. Incomplete fracture- does not break all through out
> common in pedia pt.  healing process of bone is more than 6 months
>green stick fracture- periosteum in pedia is more Closed reduction
flexible and stronger
 They manually manipulate the fracture.
SPECIFIC TYPE OF FRACTURE Ex. Hilot
1. Avulsion-  Commonly happen on our ball joints
 Tendon- corrective tissue that connect muscle to  Dislocation cases
bone Mal-union- a fractured bone that healed wrongly
2. Comminuted-
 Common in vehicular accidents External fixator-
3. Compression
Internal fixator-
 Common in the vertebrae
4. Depressed- Fasciotomy- surgical management to decompress the area.
 On the head part Pupunitin yung fascia
5. Epiphyseal
 End part of the long bone Fracture healing and complications
6. Green stick- only part of the bone is damage.
 Depend on the client
common in pediatric pt.
 3-12 weeks
7. Impacted-
 Child tend to heal faster because of the
8. Oblique- Slant yung crack
periosteum
9. Transverse- horizontal crack
10. Open- compound fracture EARLY COMPLICATIONS
11. Pathologic- osteoporosis
12. Simple- only the bone is damage  Hypovolemic shock
13. Spiral-  - hypo-tachy-tachy
14. Stress- overuse bone. Ex. Weightlifting  Fat embolism
 - usually occurs in long bone fractures
CLINICAL MANIFESTATION  Rapid onset- 12-72 hours
 B.R.O.K.E.N  Common in male

EMERGENCY MANAGEMENT CLINICAL TRIAD

MEDICAL MANAGEMENT  Hypoxemia- b


 Neurologic compromise
 Closed reduction- manual manipulation/  Petechial rush
reduction
 Open reduction- Surgical approach
- Common site- toe
- Cause: too much intake of high purine intake. Ex.
 COMPARTMENT SYNDROME
Internal organs, beer, red meats
 a condition in which there is increased pressure
- By product of purine is uric acid
within a closed osteofascial compartment,
- Alipurinol-
resulting in impaired local circulation.
- Colchicine- common meds for gout. Most common
 Nagkakaroon sa compartment (fascia) and it will
side effect is diarrhea, stop the meds
cause pressure, and pain
- Diet- low purine diet
 6P’s (Cardinal sign) - Increased fluid intake
 Pain- deep throbbing unrelenting pain - Worst complication is renal impairment- acute/
unrelieved by pain meds chronic kidney failure
 Paresthesia- pins and needles -
 Pallor- poor blood supply
 Paralysis-
 Poikilothermia-  Systemic
 Pulselessness (late sign)- severe case  accumulation of metabolic ash
 Result of abnormal amount of uric acid
DELAYED COMPLICATION
 Uric acid-
 Delayed union- healing is delayed Risk factor
 Nonunion- bones don’t unite
 Malunion- bone is misaligned - Family history
- Age & sex- Common in men; 30-50 yrs. old
MEDICAL MANAGEMENT- Nonsurgical - Recent surgery / trauma
1. Ultrasound stimulation - Diet- diet rich in red meat
2. Electrical bone stimulation - Weight
- Medical condition- high blood pressure, diabetes
Surgical - Certain medication
1. Autograph- galling sa mismong body nila Gout tophi- accumulation of uric acid on the
2. Allograph- galling sa iba
DIAGNOSIS

AVASCULAR NECROSIS - Joint fluid test


 Bone loses its blood supply and dies - Blood test
- X-ray imaging
COMPLEX REGIONAL PAIN SYNDROME
 Chronic pain in a limb after an injury MEDICATION

- NSAIDs
- Colchicine- Diarrhea
- Ulasimang bato- herbal meds for gout

COMPLICATIONS

 Recurrent gout
 Advanced gout
 Kidney stones

OSTEOARTHRITIS

 Degenerative joint disease


 Pagtanda ng tao
 Localized disease
 Starts at 40 yrs. Old
GOUT, OSTEOARTHRITIS & RHEUMATIOD ARTHRITIS  Women; African American
GOUT- Cause by disposition of uric acid in the bones  Cartilage begin to breakdown
(metatarsals). Can be develop when the disease is chronic  Decrease joints movements
 Wear and tear

Rheumatoid Arthritis

 Systemic disease
 Auto immune problem of pt.
 Symmetric joint pain
 Deformities of hands

Early RA

- Methotrexate
- NSAID’s- ibuprofen
- Aspirin toxicity- bilateral hearing loss
- COX-2- risk for cardiovascular disease
- Analgesics-

 Common complain to arthritis is pain- immobilize the


area
READ!!
 Carpal tunnel syndrome
 Low back pain
 Laws

Common questions

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Medical management enhances fracture healing via nonsurgical methods like ultrasound and electrical bone stimulation . Surgical interventions, such as autographs (using patient’s own tissue) and allographs (using donor tissue), are effective for nonunion cases . Avascular necrosis requires addressing blood supply issues to prevent bone death . These techniques aim to stimulate healing and compensate for the body's limited natural repair mechanisms.

CRPS develops after fractures due to chronic pain and aberrant inflammatory responses. Its characteristics include persistent limb pain, changes in skin texture, color, temperature, and swelling . Post-injury nerve dysfunction leads to increased sensitivity and pain, indicating a severe autonomic and sensory disruption in the affected area .

Osteoarthritis (OA) is characterized by degenerative joint disease, leading to cartilage breakdown and reduced joint movement, primarily affecting older populations . Symptoms gradually worsen and are localized to specific joints. In contrast, rheumatoid arthritis (RA) is an autoimmune disease causing systemic symmetric joint pain and deformities, especially in the hands . RA causes chronic inflammation and can occur at any age, often resulting in severe mobility issues.

Untreated gout can lead to recurrent attacks, chronic arthritis, and gouty tophi formation, causing joint deformities and impaired mobility . A major renal complication is the formation of kidney stones and potential acute or chronic kidney failure due to urate crystal deposits . These conditions can lead to significant renal damage and require management to prevent further systemic complications.

Key risk factors for developing gout include a diet high in purines, obesity, hypertension, diabetes, and familial predisposition . Consuming red meat, seafood, and alcohol increases uric acid levels, potentially leading to gout . Preventive measures focus on dietary modifications, weight management, and adequate hydration to reduce uric acid levels and prevent exacerbation .

Hypovolemic shock in fracture patients results from significant blood loss due to bone and soft tissue injury . This decrease in circulating blood volume leads to reduced cardiac output and perfusion, triggering compensatory mechanisms like tachycardia and systemic vasoconstriction . Without timely intervention, hypoxia and tissue ischemia ensue, with potentially life-threatening consequences .

Bone healing is faster in children due to a more vascularized, flexible periosteum and greater osteogenic potential . Their bones can remodel extensively, recovering remarkably from fractures . In adults, slower metabolism and reduced cellular activity lead to longer healing times and increased risk of complications like malunion . Nutritional status, health conditions, and mechanical stability also influence healing outcomes across age groups.

Closed fractures focus on health teaching, promoting a safe environment, and monitoring pain relief. In contrast, open fractures require preventing infection, promoting healing, wound irrigation, elevating extremities to minimize edema, frequent neuromuscular assessments, and vital sign monitoring for infection .

Different types of fractures are associated with distinct causes and anatomical implications. For instance, comminuted fractures often result from vehicular accidents and involve multiple bone fragments. Compression fractures are common in the vertebrae due to pressure, whereas green stick fractures occur partially in children due to flexible periosteum . In contrast, avulsion fractures involve the detachment of a bone fragment near tendon attachments, and transverse fractures are characterized by horizontal breaks .

Early complications of fractures include hypovolemic shock and fat embolism, commonly in long bone fractures with rapid onset symptoms like hypoxemia, neurologic compromise, and petechial rash . Compartment syndrome involves increased pressure impairing local circulation . Delayed complications include delayed union, nonunion, malunion, and avascular necrosis, all potentially impacting long-term recovery by hindering proper healing and function .

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