Introduction to Medical-Surgical Nursing, 6th ed.
Slide 53
Question 1
• Open fractures are graded by severity. Which grade is a moderately severe injury, with
skin and muscle contusions?
A. Grade I
B. Grade II
C. Grade III
D. Grade IV
TALKING POINTS:
Slide 54
Question 2
• Fracture healing occurs in stages. Which stage is described in the following statement?
“Within 3 weeks to 6 months after the break, a permanent bone callus, known as woven
bone, forms. It is during this stage that the ends of the broken bone begin to knit.”
A. Stage 1
B. Stage 2
C. Stage 3
D. Stage 4
TALKING POINTS:
_____________________________________________________________________ Chapter 44Fractures 17
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 44.1
Activities
Classroom Choose from below to make 30 minutes
1
ASSESS BASELINE
• Have the class complete the Pretest. Collect
their work and use the results to guide how
you teach the class.
DISCUSS
• Discuss the differences in signs and
PRACTICE
• Divide the class into three groups, and
assign each group one of the following
groupings of fracture types:
18 Chapter 44Fractures ______________________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 44.1
2
DISCUSS
• Discuss the five stages in the healing
process.
• Discuss the risk of complications at each
stage in the healing process.
PRACTICE
• Divide the class into small groups. Present
each of the following fracture healing
3
DISCUSS
• Discuss preventable complications of
fractures and the nursing actions that can
help the patient avoid these complications.
• Discuss both acute and chronic
complications of fractures.
PRACTICE
• Divide the class into small groups. Have
each group identify typical signs, symptoms,
_____________________________________________________________________ Chapter 44Fractures 19
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 44.1
4
DISCUSS
• Discuss open and closed fracture repairs.
Review the conditions under which each
procedure is indicated.
5
DISCUSS
• Discuss the use of assistive devices such as
• Divide the class into five groups, and assign
each group one of the following subjects:
• Reduction and fixation of fractures
• Casts and cast care
• Crutch training, including all gait
20 Chapter 44Fractures ______________________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 44.1
Critical Thinking Question
An 18-year-old patient is admitted to the orthopedic unit with a fracture of the left femur after
a motor vehicle accident. He undergoes a surgical reduction of the fracture with the
insertion of pins and application of skeletal traction. The patient has 15 pounds of traction
applied. What is the most important nursing care the nurse should implement?
Discussion Guidelines: Skeletal traction applies continuous, steady pull for prolonged periods.
Instructor Notes/Student Feedback
_____________________________________________________________________ Chapter 44Fractures 21
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 44.2
Textbook Objectives Covered
6. Discuss the nursing care of a patient with a fracture.
7. Describe specific types of fractures, including hip fractures, Colles fractures, and pelvic
fractures.
Lesson Preparation Checklist
• Prepare lecture from TEACH lecture slides available on Evolve.
• Student performance evaluation of all entry-level skills required for student comprehension of
principles underlying fractures, including:
• The five stages in the healing process
• Assemble materials and supplies needed for each lesson as indicated below.
Materials and Supplies
• computer and PowerPoint
projector
Key Terms
• bone remodeling (p. 973)
• closed reduction or
• delayed union (p. 974)
• fat embolism (p. 973)
• nonunion (p. 974)
• open or compound fracture
Assignments 2 hours
6
READ – Textbook (pp. 982-985)
REVIEW
22 Chapter 44Fractures ______________________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 44.2
7
READ – Textbook (pp. 985-987)
REVIEW
• Figure 44-10: Femoral fractures (p. 986)
• Part IIIK: 1, 3 (p. 295)
50-Minute Lesson Plan
Lecture Outline 20 minutes
6
Slide 55
Assessment
• Health history
• The cause, type, and extent of the injury
• Symptoms associated with the injury
• Other medical problems that may have been related to the cause of the fracture
TALKING POINTS:
Assessment (cont.)
• Physical examination
• Deviations in bone alignment
TALKING POINTS:
• Because fractures usually involve some type of accidental injury, be alert for signs of
serious complications, such as head, thoracic, or abdominal injuries.
Interventions
• Acute pain
• Ineffective tissue perfusion
_____________________________________________________________________ Chapter 44Fractures 23
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 44.2
Slide 58
Nutrition Considerations
• Calcium and calcium supplements are recommended to prevent fractures
• Prolonged immobilization contributes to loss of calcium and protein
6
&
7
Slide 59
Fracture of the Hip
• Medical diagnosis
• Radiography
TALKING POINTS:
• By age 90, 17% of men and more than 30% of women sustain hip fractures.
• What is the most common location of hip fractures?
• For older patients, surgical repair of the fracture is often the treatment of choice because it
allows them to move around sooner and results in fewer complications related to
immobility.
• Following internal fixation, weight-bearing on the affected side is limited initially and then
is gradually increased as tolerated.
Slide 60
Fracture of the Hip (cont.)
• Assessment
• Pain, impaired peripheral circulation on the affected side, complications of immobility,
skin breakdown, and ability to carry out activities of daily living
TALKING POINTS:
Slide 61
flexion/adduction can dislocate the prosthesis
Fracture of the Hip (cont.)
• Interventions
• Relieving pain, promoting mobility and independence, and preventing complications
• Proper body alignment is extremely important in preventing injury to the fracture area
TALKING POINTS:
• What comfort measures may be used to enhance the effect of pain medications?
24 Chapter 44Fractures ______________________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 44.2
Slide 62
Colles Fracture
• A break in the distal radius (wrist area)
• Medical diagnosis
• Radiography
• Medical treatment
• Closed reduction or manipulation of the bone and immobilization in either a splint or a
cast
TALKING POINTS:
• Colles fractures often occur in older adults, particularly older women, when an
Slide 63
Colles Fracture (cont.)
• Assessment
• Pain and swelling following treatment of the fracture
Slide 64
Fracture of the Pelvis
• Medical diagnosis
• Radiography
Slide 65
Fracture of the Pelvis (cont.)
• Medical treatment
• A less severe non–weight-bearing fracture treated with bedrest on a firm mattress or
bed board for a few days to 6 weeks
• Severe weight-bearing fracture may require a pelvic sling, skeletal traction, double hip
spica cast, or external fixation
Slide 66
Fracture of the Pelvis (cont.)
• Assessment
Slide 67
Fracture of the Pelvis (cont.)
• Interventions
• When handling patients, take extreme care to prevent displacement of the fracture
fragments
_____________________________________________________________________ Chapter 44Fractures 25
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 44.2
Activities
Classroom Choose from below to make 30 minutes
6
DISCUSS
• Discuss the nursing care plan for a patient
with a fracture. Review the nursing
diagnoses, outcomes, and interventions.
fractured pelvis.
PRACTICE
• Divide the class into small groups, and
assign each group one of the following
patient scenarios:
• A 2-year-old with a spiral fracture of the
femur that resulted from her leg being
7
DISCUSS
• Discuss the signs and symptoms of hip,
pelvis, and Colles fractures. Describe the
medical treatment required for each type of
fracture.
PRACTICE
• Divide the class into three groups, and
assign each group one of the following types
of fractures:
• Hip fracture
26 Chapter 44Fractures ______________________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 44.2
Critical Thinking Question
A patient has a fracture of the right wrist following a fall on the ice. What initial nursing care
of the fracture should be provided?
Instructor Notes/Student Feedback
_____________________________________________________________________ Chapter 44Fractures 27
Introduction to Medical-Surgical Nursing, 6th ed.
44
Assessments for
Fractures
CHAPTER OBJECTIVES
Lesson 44.1:
2. Describe the five stages of the healing process.
4. Compare the types of medical treatment for fractures, particularly reduction and fixation.
5. Describe common therapeutic measures for fractures, including casts, traction, crutches, walkers,
and canes.
Lesson 44.2:
7. Describe specific types of fractures, including hip fractures, Colles fractures, and pelvic fractures.
Assessments by Lesson & Objective
Lesson 44.1
1
Study Guide
• Part IA: 1-8 (p. 285)
• Part IG: 1-5 (p. 290)
Evolve Instructor Resources
• Test Bank: 12, 24, 28
Evolve Student Resources
• NCLEX Review: 1
• Prioritization: 4
2
Study Guide
• Part IE: A-F (p. 288)
Evolve Instructor Resources
Evolve Student Resources
• Prioritization: 1, 3
Introduction to Medical-Surgical Nursing, 6th ed.
Evolve Instructor Resources
• Test Bank: 1, 3, 4, 17, 25, 26
• Open Book Quiz: 2, 3
4
Study Guide
• Part II I: 6, 7 (p. 292)
Evolve Student Resources
• NCLEX Review: 3
5
Study Guide
• Part IC: 1-8 (p. 286)
Evolve Instructor Resources
• Test Bank: 8-11, 13, 15, 19, 21-23, 27, 30
• Open Book Quiz: 5-7
Lesson 44.2
6
Study Guide
• Part II I: 16-22 (p. 293)
• Part IIIJ: 1, 2 (p. 294)
Evolve Instructor Resources
• Test Bank: 14, 18, 20–23
• Open Book Quiz: 8
_____________________________________________________________________ Chapter 44Fractures 29
Introduction to Medical-Surgical Nursing, 6th ed.
Assessments by Lesson & Objective
7
Study Guide
• Part IH: A-E; 1-4 (p. 291)
Evolve Instructor Resources
Evolve Student Resources
Instructor’s Notes/Student Feedback