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FRACTURE |
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Definition |
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說明 |
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A fracture is a disruption or break in the continuity of the structure of a bone. Traumatic injuries account for the majority of fractures, although some fractures are secondary to a disease process (pathologic fractures). Fractures are described and classified according to (1) type, (2) communication or noncommunication with the external environment, and (3) location. |
骨折就是骨結(jié)構(gòu)連續(xù)體的裂開或打斷。雖然有些骨折是由疾病引起的（病理性骨折)，但外傷性骨折還是占了大部分。骨折可根據(jù)其類型、與外界是否相通及解剖部位加以描述和分類。 | |
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Fractures are also described as stable or unstable. A stable fracture occurs when some of the periosteum is intact across the fracture and either external or internal fixation has rendered the fragments stationary. Stable fractures are usually transverse, spiral, or greenstick. An unstable fracture is grossly displaced during injury and is a site of poor fixation. Unstable fractures are usually comminuted or oblique. |
骨折也可以分為穩(wěn)定性或不穩(wěn)定性骨折。穩(wěn)定性骨折是指骨折部位某些骨膜完整無損，經(jīng)內(nèi)固定或外固定后斷片不易移位。穩(wěn)定性骨折通常表現(xiàn)為橫紋骨折、螺旋骨折、青枝骨折。不穩(wěn)定性骨折在損傷期間移位明顯，固定性差。不穩(wěn)定性骨折通常是粉碎性或斜形骨折。 | |
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Clinical Manifestations |
臨床表現(xiàn) | |
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The patient's history indicates an injury often associated with immediate localized pain, decreased function, and inability to use the affected part. The patient guards and protects the part against movement. The fracture may not be accompanied by obvious bone deformity. |
病史表明，損傷常常與直接的局部疼痛、功能下降、患側(cè)無能等相聯(lián)系。病人警惕并保護(hù)骨折部位不會(huì)移動(dòng)。骨折也可能沒有明顯的骨變形。 | |
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Manifestations include edema and swelling, pain and tenderness, muscle spasm, deformity, ecchymosis, loss of function, and crepitation. |
臨床表現(xiàn)包括浮腫、隆起、疼痛、觸痛、肌痙攣、變形、瘀斑、功能喪失和有劈拍聲等。 | |
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Complications |
并發(fā)癥 | |
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The majority of fractures heal without complications. If death occurs after a fracture, it is usually the result of damage to underlying organs and soft tissue or of certain complications of the fracture. |
多數(shù)骨折愈合后沒有并發(fā)癥。如果骨折后發(fā)生死亡，這通常是由潛在器官和軟組織毀壞或骨折的某些并發(fā)癥引起的 | |
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The ossification process is arrested by causes such as inadequate immobilization and reduction, excess movement, infection, and poor nutrition. |
一些因素導(dǎo)致骨化過程的停止，如固定及復(fù)位不夠、移動(dòng)過多、感染和營養(yǎng)不良等。 | |
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Direct complications of fractures include problems with bone union, avascular necrosis, and bone infection. Indirect complications are associated with blood vessel and nerve damage resulting in conditions such as compartment syndrome, venous thrombosis, fat embolism, and traumatic or hypovolemic shock. |
直接由骨折引起的并發(fā)癥包括與骨連接、無血管性壞死和骨感染相關(guān)的問題。間接并發(fā)癥則與血管和神經(jīng)損傷有關(guān)，會(huì)導(dǎo)致出現(xiàn)間室綜合征、靜脈血栓、脂肪栓塞、外傷性或低血容量性休克等。 | |
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Although most musculoskeletal injuries are not life-threatening, open fractures or fractures accompanied by severe blood loss and fractures that damage vital organs are medical emergencies requiring immediate attention. |
雖然多數(shù)肌骨損傷并不威脅生命，但是，開放性骨折或伴有大量失血的骨折及破壞重要器官的骨折都應(yīng)當(dāng)然以急診處理。 | |
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Diagnostic Studies |
診斷檢查 | |
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An x-ray examination is used to determine the presence of a fracture. |
通過X光片確定是否骨折。 | |
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Therapeutic Management of Fractures |
骨折的治療 | |
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The goals of fracture treatment are (1) anatomic realignment of bone fragments, (2) immobilization to maintain realignment, and (3) restoration of function of the part.醫(yī)學(xué) 全在.線提供www.med126.com |
骨折的治療目的是：（1)斷骨的解剖復(fù)位；（2)復(fù)位固定；和（3)恢復(fù)功能。 | |
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Nursing Management |
骨折的護(hù)理 | |
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Goals |
目的 | |
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The patient with a fracture will have no associated complications, obtain satisfactory pain relief, and achieve maximal rehabilitation potential. |
骨折患者無相關(guān)并發(fā)癥，疼痛得到有效緩解，達(dá)到最大康復(fù)潛力。 | |
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Nursing Diagnoses/Collaborative Problems |
護(hù)理診斷/合作性問題 | |
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Pain related to edema, movement of bone fragments, and muscle spasms |
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疼痛 與浮腫、骨折片移動(dòng)和肌痙攣有關(guān) |
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Risk f'or infection related to disruption of skin integrity and presence of environmental pathogens secondary to open fracture or external fixation pins |
有感染危險(xiǎn) 與皮膚完全性受損及繼發(fā)于開放性骨折或外固定引起的外界病菌有關(guān) | |
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Activity intolerance related to prolonged immobility |
活動(dòng)耐受不良 與長期不能運(yùn)動(dòng)有關(guān) | |
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Risk for peripheral neurovascular dysfunction related to nerve compression |
有外周神經(jīng)血管功能障礙危險(xiǎn) 與神經(jīng)壓迫有關(guān) | |
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Risk for impaired skin integrity related to immobility and presence of cast |
有皮膚完整性受損危險(xiǎn) 與固定和打石膏有關(guān) | |
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Ineffective management of therapeutic regimen related to lack of knowledge regarding muscle atrophy, exercise program, and cast care |
治療處理無效 與肌肉萎縮、運(yùn)動(dòng)計(jì)劃和石膏護(hù)理知識(shí)缺乏有關(guān) | |
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Potential complication: fat embolism related to fracture of a long bone |
潛在并發(fā)癥：脂肪栓塞 與長骨骨折有關(guān) 醫(yī)學(xué) 全在.線提供 | |
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Nursing Interventions |
護(hù)理措施 | |
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The patient with a fracture may be treated in an emergency department or physician's office and released to home care, or the patient may require hospitalization. Specific nursing measures depend on the type of treatment used and the setting in which the patient is placed. |
骨折患者可以在急診室或醫(yī)生診室治療后回家中護(hù)理，也可要求住院。具體護(hù)理措施取決于治療手段及病人所處的環(huán)境。 | |
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Preoperative management. If surgical intervention is required to treat the fracture, the patient will need preoperative preparation. In addition to the usual preoperative nursing measures, the nurse should inform the patient of the type of immobilization device to be used and expected activity limitations. |
術(shù)前處理。如需手術(shù)治療，病人就應(yīng)進(jìn)行術(shù)前準(zhǔn)備。除了平時(shí)的術(shù)前護(hù)理準(zhǔn)備外，護(hù)士應(yīng)告訴病人所用的固定裝置類型及活動(dòng)限止。 | |
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Proper skin preparation is an important part of preoperative preparation. The aim of skin preparation is to clean the skin and remove debris and hair to reduce the possibility of infection. |
皮膚準(zhǔn)備是術(shù)前準(zhǔn)備的重要內(nèi)容之一，皮膚準(zhǔn)備的目的是清潔皮膚除去雜質(zhì)和毛發(fā)，減少感染機(jī)會(huì)。 | |
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The patient must be assured that all needs will be met by the nursing staff until the patient can again meet his/her own needs Assurance that pain medication will be available if needed is often beneficial. |
使病人相信，在其能自行滿足需要前，他的所有需要都將由護(hù)理人員來滿足，使他相信必要的止痛藥是有益的。 | |
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Postoperative management. Frequent neurovascular assessments of the affected extremity are necessary to detect subtle changes. Any limitations of movement or activity related to turning, positioning, and extremity support should be monitored closely |
術(shù)后護(hù)理。必須經(jīng)常對(duì)患肢進(jìn)行神經(jīng)血管評(píng)估，發(fā)現(xiàn)細(xì)微變化。與翻身、體位及肢體支撐相關(guān)的移動(dòng)或活動(dòng)限制都應(yīng)加以密切監(jiān)護(hù)。 | |
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Pain and discomfort can be minimized through proper alignment and positioning. |
體恣端正或適當(dāng)體位可以減輕疼痛與不適 | |
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Dressings or casts should be carefully observed for any covert signs of bleeding or drainage. Increased bleeding can be monitored by drawing a circle on the cast around an area of drainage and by noting the date and time. A significant increase in the size of the drainage area should be reported. |
應(yīng)仔細(xì)觀察敷裹或石膏，及時(shí)發(fā)現(xiàn)不明顯的出血或滲液跡象�？稍跐B液周圍的石膏上畫一圓圈，記錄日期和時(shí)間，以此監(jiān)視出血的增多。如滲液范圍明顯擴(kuò)大，就應(yīng)馬上報(bào)告。 | |
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If a wound-drainage system is in place, patency of the system and volume of drainage should be assessed at least once each shift. Whenever the contents of a drainage system are measured or emptied, the nurse should use sterile technique to avoid contamination. |
如使用引流系統(tǒng)，至少要每輪班評(píng)估一次引流的通暢度與引流量。在測定或處置引流系統(tǒng)時(shí)，護(hù)士都應(yīng)采取無菌技術(shù)，避免污染。 | |
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If the patient is immobilized as a result of the fracture, the nurse must plan care to prevent constipation and renal calculi. |
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Constipation can be prevented by maintenance of a high fluid intake and a diet high in bulk and roughage. If these measures are not effective in maintaining the patient's normal bowel pattern, stool softeners, laxatives, or suppositories may be necessary. Maintaining a regular time for elimination despite bed rest is effective in promoting regularity. |
便秘可以通過飲食纖維含量高的食物或粗糧得以預(yù)防。如果這些措施無法維持病人的正常排便習(xí)慣，可使用軟便劑、緩瀉藥、開塞露等。盡管病人臥床休息，但保持定期排泄對(duì)養(yǎng)成規(guī)律很有效。 | |
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Renal calculi can develop as a result of bone demineralization caused by immobilization. Unless contraindicated, a fluid intake of 2100 to 2800 ml/day is recommended. Cranberry juice is often recommended to acidify the urine and discourage development of stones. |
臥床造成骨頭礦物質(zhì)脫落，最終出現(xiàn)腎結(jié)石。因此，除禁忌者外，應(yīng)建議每天攝取2100－2800 ml的液體。桔子汁可以酸化尿液，阻礙結(jié)石的形成。 | |
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Rapid deconditioning of the circulatory system can occur as a result of bed rest. These effects can be diminished by permitting the patient to sit on the side of the bed, allowing the lower limbs to dangle over the bedside, and performing standing transfers (unless these measures are contraindicated). |
由于臥床，循環(huán)系統(tǒng)適應(yīng)功能迅速下降�？赏ㄟ^下列方法減少這些影響：允許病人坐在床沿、使下肢垂在床邊，做站立過渡練習(xí)（禁忌者除外)。 | |
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When the patient is allowed to increase activity, careful evaluation should be made to assess for orthostatic hypotension. |
許可病人增加運(yùn)動(dòng)時(shí)，應(yīng)對(duì)病人進(jìn)行仔細(xì)的評(píng)估，確認(rèn)沒無體位性低血壓。 | |
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Patient Teaching |
病人宣教 | |
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Because a fracture often is cast in an outpatient setting, the patient may require only a short hospitalization or none at all. Therefore patient education is an important nursing responsibility to prevent complications. In addition to giving specific instructions for cast care and recognition of complications, the nurse should encourage the patient to contact the clinic or care provider if questions arise. The nurse should validate patient understanding of these instructions before discharge from the clinic or hospital. |
在門診中，骨折常常就是打石膏，病人住院時(shí)間很短，甚至不用住院。因此，進(jìn)行病人宣教，防止并發(fā)癥發(fā)生，這是一項(xiàng)重要的護(hù)理職責(zé)。除了給予具體的石膏護(hù)理指導(dǎo)和并發(fā)癥確認(rèn)教育外，護(hù)士應(yīng)鼓勵(lì)病人有疑問時(shí)聯(lián)系診所或施護(hù)人員。在出院前，護(hù)士應(yīng)確認(rèn)病人已經(jīng)理解這些指導(dǎo)。 |
