START Survey the scene.

→
→

Check for victim →

Perform If victim is not breathing

Perform chest Open the airway and

Verify if patient has a

Determine if rhythm is
AED arrives shockable or non
shockable
I. FRACTURE MANAGEMENT
a. FRACTURE
= a disruption or break in the
continuity of the integrity of
the bone that affects the patient’s
ability to perform
ADLs optimally
= classification of fractures:
1. According to the status of the
skin
a. Closed (simple) = skin is still = common causes of fractures:
intact 1. Trauma
b. Open (compound) = skin is 2. Pathological conditions
broken = common manifestations:
2. According to the level of damage 1. Edema and swelling
a. Complete = break/damage is 2. Pain and tenderness
THROUGH the bone 3. Muscle spasm (irritation)
b. Incomplete = break/damage 4. Deformity (abnormal position)
occurs partly in the shaft 5. Ecchymosis
3. According to the direction of the 6. Loss of function
fracture line 7. Crepitation (grating or crunching
a. Linear = vertical crack together of bone
b. Oblique = diagonal crack surfaces/fragments)
c. Transverse = horizontal crack
d. Longitudinal = vertical crack b. SPECIFIC INTERVENTIONS
but longer 1. CAST / CASTING
e. Spiral = twisting crack = a temporary circumferential
immobilization
device/technique
= purposes:
➔ To immobilize fractured area
 ➔ To promote healing economical expensive 10.Once completely, dry apply cast covers.
➔ To allow patient to still less maceration more maceration (properly fitted)
continue ADLs
= dependent intervention (requires = role of the RN: ASSISTANTS to
prescription from application as removal
a physician/nurse practitioner
who specializes in NURSING CONSIDERATIONS WHEN ASSISTING
orthopedics) IN CAST APPLICATION
= indications:
➔ Fractures 1. ASSESS for contraindications.
➔ Dislocations (ex. DDH) 2. Verify neurovascular status of the
➔ Sprains (ligament) and strains extremity.
(fascia/tendon) of the muscles 3. Administer analgesics prior to cast
(last resort) application. (OPIOIDS OR PCA).
4. Perform hand hygiene and don clean
= contraindications: gloves.
➔ active bleeding 5. Position or assist in positioning the
➔ burns client’s affected extremity.
➔ dermatitis 6. Observe patient’s tolerance while
➔ infection practitioner/physician applies the cast MOST COMMON COMPLICATION:
= materials used for casting: material on the affected extremity. COMPARTMENT SYNDROME (compression of
i. natural = Plaster of Paris 7. Touch the casted extremity or support the extremity)
ii. synthetic = fiberglass the casted material with the PALMS = manifestations: 5Ps
(flat). (fingertips can cause indentations 1. Paresthesia (earliest manifestation)
PLASTER OF PARIS FIBERGLASS in the casted material) 2. Pain (unrelieved by normal levels of
8. Expose casted extremity to open air. If analgesic and elevation)
24-72 hours until it 15 to 30 minutes using a blower, make sure to adjust the 3. Pallor (due to poor blood circulation)
completely dries until it completely equipment to COOL settings. (warm 4. Pulselessness (due to poor blood
dries settings can melt the material) . circulation)
heavyweight lightweight 9. Elevate the casted extremity to promote 5. Paralysis (last manifestation)
affected by water not affected by water venous return.
= COMPLICATION: necrosis of the casted
extremity
= PRIORITY ACTION: Report to the physician!
= MEDICAL MANAGEMENT: Bivalving on the
LONGER end of the
cast