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Other Drugs: Antibiotics, antispasmodics

Independent

Follow the priorities of pain management, emotional support to cope with a sudden threat to health status, and prevention of complications. Pain may be caused by ineffective use of some treatment methods for fractures. Casts, traction, and fixation devices, once applied, should not cause pain. Improperly padded casts or ones that have been damaged may cause irritation and pressure to the casted area. Skin traction that causes friction also leads to impaired skin integrity.

If the patient has soft tissue wounds that require treatment, a window in the cast may be needed. Maintain the functional integrity of the cast with attention to both immobilization of the fracture and prevention of further damage to the tissues.

Pain that seems extreme when a patient is casted or in skeletal traction may signal the advent of a compartment syndrome, a condition in which an edematous extremity is constricted by the cast. The patient complains of a burning sensation or other paresthesia. Edema may be present; pulses ordinarily remain intact. Even in the presence of substantial edema, the use of ice is con-traindicated because of the danger of increased neurovascular compromise. The surgeon may bivalve the cast, remove the traction, or perform a fasciotomy.

The patient and family need a great deal of support to cope with a serious injury. Allow time each day to listen to concerns, discuss the patient's progress, and explain upcoming procedures. If the patient is a young trauma patient, you may need to work out a schedule with the patient's friends so that they can see the patient but also allow the patient adequate rest. Young adults enjoy diversional activities such as a television, tapes, compact discs, and radios. Older patients may experience depression and loss if the injury has long-term implications about their self-care. Consult with social workers and advanced practice nurses if the patient's anxiety or fear is abnormal. If the patient is a heavy drinker or was intoxicated at the time of injury, encourage the patient to evaluate his or her drinking patterns and the link between drinking and injury. If needed, refer the patient appropriately for a full evaluation for substance abuse.

Immobilization involving the whole person, rather than one extremity, requires aggressive prevention of the hazards of immobility. Motivate and educate the patient in order to help her or him anticipate and prevent complications. Delayed healing of either wound or bone may occur as a complication of the patient's status at the time of the fracture or as a result of immobility. Encourage a balanced diet with foods that promote healing, such as those that contain protein and vitamin C. Stimulation of the affected area by isometric and isotonic exercises also helps promote healing. Instruct the patient in those techniques, which may not initially seem possible to her or him. They provide a partial substitute for the stimulation to bone remodeling that is otherwise provided by weight bearing. Remember the design adage that is also useful in orthopedics: Form follows function.

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