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Control bleeding Immobilize - splint ©) Learning Objectives By the end of this lecture, students will be able to: Define a fracture and describe the types of fractures Identify treatments for various fractures Describe nursing interventions, comfort measures, and post-op care Explain the types of slings, casts, traction, and surgical repairs (e.g., ORIF) Identify complications associated with fractures Discuss special considerations for hip fractures in the elderly Provide appropriate patient teaching for fracture care and recovery ee »S I. What is a Fracture? A fracture is a break in the continuity of a bone due to trauma, disease, or stress. @ Il. Types of Fractures Fracture Type Description Closed (Simple) Bone is broken but does not penetrate the skin Open (Compound) Bone protrudes through the skin; high infection risk Greenstick Incomptete fracture; common in children Compression Common in vertebrae; due to osteoporosis or trauma Caused by underlying disease (e.g., cancer, osteoporosis)2 or more bones crushed or in pieces Stress (Hairline) Small crack from repetitive stress or overuse Pathological 54 lil. Fracture Treatments 1. Closed Reduction e Non-surgical alignment of bone ¢ Immobilization with splints or casts 2. Open Reduction (Surgery) ¢ ORIF: Open Reduction with Internal Fixation (plates, screws, rods) ¢ xternal Fixation: Pins/wires attached to an external frame 3. Immobilization e Casts, splints, braces ¢ Traction (manual or mechanical) & IV. Nursing Interventions Acute Phase (Immediate Care) e AsOsess neurovascular status (6 Ps: pain, pallor, pulse, paresthesia, paralysis, poikilothermia) Supports arm/elbow fractures or dislocations Velpeau sling Shoulder and humerus support Collar and cuff Supports wrist/elbow injuries Arm sling B. Casts Cast Type Use Short arm/long arm Forearm, wrist, or elbow fractures Ankle, tibia, fibula, or femur Short leg/long le; oes fractures Spica cast Hip or femur in children Body cast Spine or pelvic injuries Care Tips: e Keep dry e Do notinsert anything inside the cast ¢ Monitor for swelling, pain, discoloration, foul odor e Check capillary refill and sensation e Tape edges of cast so skin is better protected e = Itching- hair drier set on cool only, no hangers && C. Traction Traction Type Description Skin traction (Buck’s) Short-term; used before surgery (e.g., hip fracture) Pins/wires inserted into bone for long-term alignment Cervical traction Aligns cervical spine; halo traction is an example Skeletal traction Nursing Responsibilities: KR VIII. Surgical Repair: ORIF (Open Reduction and Internal Fixation) ¢ Indications: Comminuted, open, or displaced fractures e Uses hardware (screws, plates, rods) to stabilize bone ¢ Nursing care: Watch for infection, bleeding, neurovascular compromise e Early mobilization encouraged A\ IX. Complications of Fractures Complication Compartment syndrome Signs/Symptoms Pain out of proportion, decreased pulse, swelling, increased pressure in muscle compartment that impairs circulation to that area 5 “ps Pain-intense Parasthesia — Don't apply cold Paralysis-do not elevate Pallor-Call mD Pulselessnes- Prepare for OR Fin site care; Clean dalty, monitor for intection Activity restrictions: Follow weight-bearing orders Mobility: Use of assistive devices; don’t skip PT Nutrition: High calcium, protein, vitamin D for healing Complication signs: Teach warning signs (e.g., numbness, swelling, pain, fever) Prevention: Safety at home, proper footwear, bone density screening Summary Fractures vary in type and severity and require tailored interventions Nurses play a key role in monitoring neurovascular status, pain, and mobility Casts, slings, traction, and surgical repair are common treatments Elderly patients with hip fractures require special care and monitoring Teaching patients and families is crucial for successful recovery and prevention of future injury Il. Overview Parkinson’s disease (PD) is a progressive neurodegenerative disorder affecting movement due to loss of dopamine-producing neurons in the brain, particularly in the substantia nigra. Il. Risk Factors Risk Factor Details Age Most common >60 years Gender More common in males Genetics Family history may increase risk Environmental Pesticide exposure, rural living Trauma Head injuries increase risk Oxidative May contribute to neuronal stress damage © NCLEX Tip: Remember Parkinson's is not normal aging, though incidence increases with age. Ill. Pathophysiology 1. Degeneration of dopaminergic neurons in the substantia nigra 2. Results in + dopamine, which disrupts balance between dopamine and acetylcholine VI. Complications e Aspiration pneumonia e Falls and injury e Malnutrition and weight loss e Bowel and bladder dysfunction e Depression and socialisolation e¢ Cognitive decline/dementia ¢ Medication-related side effects (e.g., dyskinesia, hallucinations) Vil. Nursing Interventions Area Mobility Nutrition Communicatio n Safety Psychosocial Bowel care Nursing Actions Encourage ROM exercises, PT/OT, assistive devices Small frequent meals, high-calorie, monitor for dysphagia Use of speech therapy, allow time to speak Fall precautions, remove hazards, use raised toilet seats Encourage support groups, promote social interaction Increase fluids, fiber, and use of stool softeners ® NCLEX Alert: Assist with ADLs but encourage independence where possible. VOTIVENS (0 vyskinesia, Nausea, Ortnostatic Dopami_ Carbidopa- oe ae dopamine in hypotension, hallucinations, dark nergic Levodopa (Sinemet) brain urine Dopami . 7 . he Pramipexole Stimulate Sleep attacks, impulse control Agonist (Mirapex), Ropinirole dopamine issues (e.g., gambling), jonis' . (Requip) receptors hallucinations MAO-B Prevent - ooo F . a - . Hypertensive crisis with tyramine Inhibito Selegiline, Rasagiline dopamine . : foods, insomnia rs breakdown COMT Prolong . -_ : va Entacapone, Diarrhea, hepatotoxicity (monitor Inhibito levodopa Tolcapone LFTs) rs effect . . Reduce . . Antichol Benztropine . 4, Dry mouth, urinary retention, 7 A A tremors/rigidit . inergics (Cogentin) confusion (especially elderly) y _ . Reduces 7 . . Amanta = Antiviral with Livedo reticularis, confusion, . . . symptoms dine dopaminergic effect . edema temporarily Bf ATILippincott Tip: Always assess for on-off phenomena with levodopa—can lead to freezing episodes. IX. Do's & Don'ts of Parkinson's Nursing Care Do SX Don't Encourage ambulation with assistive . . ; . Avoid rushing the patient devices Don't give large meals (may fatigue Use elevated utensils & adaptive clothing . patient) BUULGLIUVIT Lecture Objectives By the end of this session, learners will be able to: Describe the anatomy and pathophysiology of common back problems. Perform a focused musculoskeletal assessment for back pain. Differentiate between acute vs. chronic back pain and red-flag symptoms. Apply evidence-based nursing interventions, including pharmacological and non- pharmacological approaches. PON a 5. Develop patient education plans emphasizing prevention and self-management. I. Anatomy and Physiology Review ¢ Vertebral column: 33 vertebrae (7 cervical, 12 thoracic, 5 tumbar, 5 sacral, 4 coccygeal). ¢ Intervertebral discs: Fibrocartilage; nucleus pulposus (gel-like center) + annulus fibrosus (tough outer ring). Act as shock absorbers. ¢ Spinal nerves: 31 pairs exit through intervertebral foramina; tumbar nerve roots most commonly compressed. ° Supporting structures: Erector spinae, multifidus, abdominal core, ligaments (anterior/posterior longitudinal, ligamentum flavum). Pathophysiology pearl: Degenerative cascade > disc dehydration > loss of height > annular tears > bulging/herniation > nerve root compression or chemical irritation > pain, radiculopathy. Red Condition Key Features Classic Presentation Flags? Muscle strain, MechanicalLBP | tigament sprain, Sudden onset after lifting; worse N lo (90% of cases) facet joint with movement, better with rest dysfunction . wo Nucleus pulposus . Dise/Herniation, rotrudes > Unilateral radicular pain Possible ila » (L4-L5, L5-S1 P at ‘ pal cauda compresses nerve positive straight-leg raise (SLR) . most common) equina root Neurogenic claudicati i ; Narrowing of spinal re genic c ala ion (pain Spinal Stenosis . with walking, relieved by No canaVforamina . flexion/leaning forward) Possible Spondylolisthesi | Vertebral slippage Step-off on palpation; tight in high- s (usually L5 on $1) hamstrings grade slips Cc ressi Height ne non Wedge fracture of Acut in ineldert noel t a racture cute pain in elderly; josis loss . vertebral body se 'y; kyphosi s (osteoporotic) cm Ankylosing HLA-B27+, Morning stiffness >1 hr, No Spondylitis sacroiliitis improves with activity B. Objective 1, Timing. Localized pain, 1 specific area when pushed or pressed. Diffuse pain: Large area can come from deep tissue area Radicular pain: Caused by nerve root, travels along nerve pathway possibly radiating to buttock or thigh (sciatica) Referred pain: Felt in lower back but caused by kidneys, lower abdomen = Stiffness and limited ROM = Muscle spasms or weakness = Numbness or tingling (if nerve involvement) « Difficulthy, standing, walking or sitting = Worse symptoms with movement, lifting or certain positions Functional impact: ADLs, sleep, work, mood. Red-flag screening questions (memorize!): oa090 0 BoweUbladder dysfunction? Saddle anesthesia? Bilateral leg weakness? Fever, weight loss, night pain? History of cancer, IV drug use, trauma? Inspection: Posture, gait (antalgic?), scoliosis, muscle atrophy. Reflexes, muscle strenght Palpation: Spinous processes, paraspinal tenderness, step-off. Range of Motion (ROM): Flexion (40-60), extension (20-309), lateral bending (15— 20°), rotation (30°). Neurological Exam: a. b. Sensory: Light touch dermatomes. c. d Motor: Great toe extension (L5), ankte dorsiflexion (L4), plantarflexion (S1 ). Reflexes: Patellar (L4), Achilles (S1). If absent may be nerve may be pinched . Special tests: eee eee checks onal Pre-op bowel prep, post- Surgical | Microdiscectomy, laminectomy op log-rolling Evidence-based pearl: 90% of acute LBP resolves in 4-6 weeks with conservative care. VII. Patient Education & Prevention (Handout Ready) “Back School” Key Points 1. Ergonomics: Proper body mechanics a. Monitor at eye level, knees 90°, lumbar support. b. Liftwith legs, not back; hold objects close to body. 2. Exercise Prescription: a. Core: Plank 3*30 sec, bird-dog, pelvis tilts, bridges, leg lifts b. Flexibility: Cat-camel stretch, knee-to-chest. 3. Weight Management: BMI goal <25. 4. Smoking Cessation: Nicotine impairs disc healing. 5. When to Call: New weakness, incontinence, fever. 6. Heat/cold therapy 7. Shortterm rest 8. Gradualreturn to activity 9. Yoga/walking 10.Physcial therapy Quick Demo: Teach “neutral spine” during ADLs (e.g., brushing teeth). Meds Pain Management techniques Physcial modalities: Tens unit, massage Cognative behavioural therapy Accupuncture Epidural steroid injections Yoga Mediation Don’t Encourage prolonged bed rest ignore patients pain complaints Allow unsafe activities without guidance Delay reporting worsening neurological signs Ancillary help: PT OT Socail worker/ case manager (for work accommodations or psychosocial support) Pain management specialist 
