Editing Medical-Surgical Nursing (section)

=== Fractures and Immobilization ===

Findings include pain, deformity, swelling, crepitus, loss of function, and ecchymosis. Neurovascular assessment distal to any injury, cast, or splint is performed routinely and includes pain, pallor, pulse, paresthesia, paralysis, and poikilothermia, with temperature, capillary refill, and movement documented.

Cast care: elevate the extremity above heart level for the first day or two, apply ice as ordered, handle a wet plaster cast with palms rather than fingertips, allow air drying without covering, never insert objects under the cast to scratch, and keep the cast dry. Report increasing pain, numbness, foul odor, drainage, or a hot spot.

Traction: maintain continuous pull with weights hanging freely and off the floor, keep the patient in proper alignment, do not remove weights without an order, and provide pin site care for skeletal traction while monitoring for infection.

Nursing application: compartment syndrome is caused by increased pressure within a fascial compartment that compromises circulation. The hallmark is pain out of proportion to the injury that is unrelieved by opioids and increases with passive stretch, along with paresthesia and tightness. Pulselessness is a very late finding, so waiting for a lost pulse is a serious error. Report immediately, elevate no higher than heart level, and prepare for possible fasciotomy. Do not elevate above the heart, because that reduces arterial perfusion.

Fat embolism syndrome typically occurs twenty-four to seventy-two hours after fracture of a long bone or pelvis and presents with sudden dyspnea, hypoxemia, tachycardia, confusion, and a petechial rash over the chest, neck, and axillae. Support oxygenation and notify the provider urgently.