A fracture is a normal breakup bone or cartilage caused by violence. (E. Oerswari, 1989: 144).
Fracture or fracture is a break of continuity of bone or cartilage tissue which is generally caused by involuntary (Mansjoer, 2000: 347).
Closed fracture is when there is no fracture relations with the outside world. Open fracture is a bone fragment extends through the muscle and skin, where the potential for infection (Sjamsuhidajat, 1999: 1138).Femoral fracture is a break continuity femoral stem that can result from direct trauma (traffic accidents, falls from heights), and more typically experienced by adult males. Fractures in this area can cause bleeding quite a lot, resulting in a fall pendertia shock (Faculty of medicine, 1995:543)Olecranon fracture is a fracture that occurs in the elbow caused by direct violence, usually comminuted and accompanied by other fractures or anterior dislocation of the joints (Faculty of medicine, 1995:553).
II. EtiologyAccording to Sachdeva (1996), the cause of the fracture can be divided into three, namely:a. Traumatic injuryTraumatic injury to the bone can be caused by:1) direct injury means a direct blow to the bone so that bone pata spontaneously. Beatings and transverse fractures usually cause damage to the overlying skin.2) Injury does not necessarily imply a direct blow to be away from the location of impact, such as dropping the hand and lead berjulur clavicle fracture.3) Fractures caused a sudden violent contraction of the muscles strong.b. Pathological fracturesIn this case of bone damage due to the disease process in which minor trauma can cause fractures can also occur in the following circumstances:1) bone tumors (benign or malignant): growth of new tissue uncontrolled and progressive.2) infections such as osteomyelitis: can occur as a result of an acute infection or may arise as a progressive process, slow and painful illness.3) Rickets: a bone disease caused by vitamin D deficiency that affects all other skeletal tissues, usually caused by a dietary deficiency, but sometimes failure can be caused by the absorption of vitamin D or calcium intake or due to a low phosphate.c. Spontaneously: stress caused by continuous bone in diseases such as polio and the person in charge dikemiliteran.
III. Classification of femoral fracturea. Closed fracture (closed), when there is no relationship between the bone fragments with the outside world.b. Open fracture (open / compound), if there is a relationship between bone fragemen with the outside world because of the need in the skin, open fractures were divided into three degrees, namely:1) Grade I- Wound less than 1 cm- Slight damage to soft tissue injury with no signs of crumbling.- Simple fracture, transverse, or cumulative obliq light.- Contamination light.2) Degree II- Laceration more than 1 cm- Soft tissue damage, not widespread, avulse- Fractures are local community.3) Grade IIISoft tissue damage which broadly covers the structure of skin, muscles and neurovascular as well as a high degree of contamination.c. Complete fracture• Broken bones in the midline and usually experience the shifting (shifting from its normal position).d. Incomplete fracture• Fracture occurs only in a portion of the bone diameter.e. A special type of fracturea) form a broken line1) transverse fracture line2) Line pata obliq3) spiral fracture line4) Compression Fractures5) avulsion fractureb) The number of broken lines1) Fracture komunitif more than one fracture line and interconnected.2) Fractures segmental fracture line is more than one but interrelated3) multiple fracture lines broken more than one bone but different.c) Shift-not shifted fracture line does not shift Patali kompli but both fragments are not shifted. Fractures shift, a shift in fracture fragments at the site which is also called fragments (Smeltzer, 2001:2357).
IV. PathophysiologyWound healing process consists of several phases:1. Phase hematum• Within 24 hours of bleeding arise, edema, fractures around hematume• After 24 hours the blood supply around the fracture increases2. Phase of granulation tissue• Occurs 1-5 days after injury• At this stage of the product's active phagositosis neorosis• Itematome turned into granulation tissue that contains new blood vessels and osteoblasts fogoblast.3. Callus formation phase• Occurs 6-10 harisetelah injury• Granulation shaped callus changes4. Phase ossificasi• Starting at 2-3 weeks after the fracture to heal• Callus permanent rigid finally formed bone with calcium salt deposits that unites the fracture5. Phase consolidasi and remadelling• Within 10 weeks over the exact form of callus formed by osteoblasts and osteuctas oksifitas (Black, 1993: 19).
V. SIGNS AND SYMPTOMS1. DeformityBlistering power muscle strength causing bone fragments to move from its place and Contur balance changes occur such as:a. Bone shortening rotationb. Suppression of bone2. Swelling: edema emerge quickly from location and ekstravaksasi blood in the tissue adjacent to the fracture3. Echumosis of Bleeding Subculaneous4. Involunters spasm muscle spasm near the fracture5. Tenderness / tenderness6. Pain may be caused by muscle spasm and move the bones of the place of damage to adjacent structures.7. Loss of sensation (numbness, nerve damage may occur from / bleeding)8. Abnormal movements9. Hypovolemic shock results from blood loss10. Crepitus (Black, 1993: 199).
VI. EXAMINATION SUPPORT1. X-ray To find the location of the fracture and the fracture line directly Knowing the place and the type of fractureUsually taken before and after surgery and during the healing process periodically2. Tomography bone score, score C1, Mr1: can be used to identify soft tissue damage.3. Artelogram suspected when there is vascular damage4. A complete blood count may be elevated HT (hemoconcentration) or menrurun (significant bleeding on the side of the fracture or distant organs in multiple trauma)SDP is an increase in the number of normal stress response after trauma5. Coagulation profile changes can occur at multiple transfusions of blood loss or injury to the liver (Doenges, 1999: 76).
VII. MANAGEMENT1. Reduction of fracture Manipulation or closed reduction, non surgical manipulation manually realignment of bone fragments of the previously autonomous position. open a decrease in bone repair surgery incision canal alignment, often include internal viksasi to fracture the wire, screw rod intramedulasi pin plates, and nails. Type the location of the fracture depends on the age of the client.Traction equipment:o Skin Traction is usually for short-term treatmento Traction muscle or surgery is usually for a long term period.2. Immobilization of Fractures bandaging (gypsum) External Fixation Internal Fixation Selection Fraction3. Fraction open Surgical debridement and irigrasi tetanus immunization prophylactic antibiotic therapy Immobilization (Smeltzer, 2001).
NURSING MANAGEMENTI. ASSESSMENTAssessment is the first step in the nursing process and basic overall (Boedihartono, 1994: 10).Post op patient assessment frakture olecranon (Doenges, 1999) include:a. CirculationSymptoms: a history of heart problems, GJK, pulmonary edema, peripheral vascular disease, or vascular stasis (increased risk of thrombus formation).b. Ego integritySymptoms: feelings of anxiety, fear, anger, apathy; multiple stress factors, such as financial, relationship, lifestyle.Mark: can not break, increasing tension / sensitive excitatory; sympathetic stimulation.c. Food / fluidSymptoms: pancreatic insufficiency / DM, (predisposition to hypoglycemia / ketoacidosis), malnutrition (including obesity), dry mucous membranes (restriction intake / preoperative fasting period).d. BreathingSymptoms: infection, chronic conditions / cough, smoking.e. SecuritySymptoms: allergic / sensitive to medications, foods, plaster, and the solution; immune deficiency (peningkaan risk of systemic infection and delay healing); emergence of cancer / latest cancer therapies; family history of malignant hyperthermia / reaction to anesthesia; history of hepatic disease (effect of detoxification and drugs can alter coagulation); history of blood transfusion / transfusion reactions.Signs: menculnya infection exhausting process; fever.f. Counseling / LearningSymptoms: pengguanaan anticoagulation, steroids, antibiotics, antihypertensive, cardiotonic glokosid, antidisritmia, bronchodilator, diuretic, decongestants, analgesics, anti-inflammatory, anticonvulsant or tranquilizer and also counter medications, or recreational drugs. Alcohol use (risk of kidney damage, which affects coagulation and anesthesia options, and also the potential for postoperative withdrawal).
II. Nursing DiagnosisNursing diagnosis is a unification of the problem of real or potential patients based on the data that has been collected (Boedihartono, 1994: 17).Nursing diagnoses that appear in patients with post op fracture (Wilkinson, 2006) include:1. Pain associated with the breakdown of bone tissue, bone fragments movement, edema and tissue injury, equipment traction / immobilization, stress, anxiety2. Activity intolerance related to dyspnea, weakness / fatigue, lack of oxygenation edekuatan, anxiety, and sleep disorders.3. Damage to skin integrity related to pressure, changes in metabolic status, decreased sensation and circulation damage evidenced by a wound in / ulceration, weakness, weight loss, poor skin turgor, there is necrotic tissue.4. Barriers to physical mobility related to pain / discomfort, damage muskuloskletal, therapeutic activity restrictions, and decreased strength / resistance.5. Risk of infection related to stasis of body fluids, depressed inflammatory response, and invasive procedures penusukkan lines, wound / skin damage, surgical incision.6. Lack of knowledge challenged condition, prognosis and treatment needs associated with cognitive limitations, lack of exposure / recall, misinterpretation of information.
III. INTERVENTION AND IMPLEMENTATION
Intervention is planning nursing actions that will be implemented to address the problem in accordance with the nursing diagnoses (Boedihartono, 1994:20)Implementation is the realization of management and nursing plans that had been developed at the planning stage (Effendi, 1995:40).And implementation of nursing interventions that occur in patients with post-op frakture olecranon (Wilkinson, 2006) include:1. Pain is a sensory and emotional experience that is unpleasant and increased as a result of actual or potential tissue damage, described in terms of such damage; onset sudden or slowly from heavy to light intensity samapai can end in anticipation or less predictable and duration of six months.Purpose: The pain can be reduced or lost.Results Criteria: - Pain is reduced or lost- The client seemed calm.Intervention and Implementation:a. Approach the client and familyR / client relationship that makes both cooperative and familyb. Assess the level of intensity and frequency of painR / level of pain intensity and pain frequency scale showsc. Explain to the client the cause of painR / explanation would add to the knowledge of the client's pain.d. Observation of vital signs.R / to find out the client's developmente. Collaboration with the medical team in the delivery of analgesicsR / is dependent nursing actions, which serves to block the analgesic pain stimulation.
2. Activity intolerance is a condition is an individual who does not quite have the physiological or psychological energy to endure or meet the needs or daily activities desired.Purpose: The patient has enough energy to move.Criteria results: - Behavioral reveals the ability to meet the needs of self.- Patients expressed able to do some activities without assistance.- Coordination of muscle, bone and other limbs either.Intervention and Implementation:a. Plan adequate rest periods.R / reducing activity is not required, and the energy collected can be used for optimal activity secar necessary.b. Provide training activity gradually.R / stages are given to help the process of the activity slowly with energy saving but the exact purpose, early mobilization.c. Aids in meeting the needs of patients as needed.R / reduces energy consumption up to force the patient to recover.d. After reviewing the exercises and activities of the patient's response.R / keep the possibility of an abnormal response of the body as a result of the exercise.
3. Damage to skin integrity is the state of one's skin that changes are not desirable.Goal: Achieve wound healing at the appropriate time.Results Criteria: - no signs of infection such as pus.- Do not clean the wound moist and not dirty.- Vital signs are within normal limits or tolerable.Intervention and Implementation:a. Assess skin and wound identification at this stage of development.R / know the extent of injuries facilitate the development of appropriate action.b. Assess the location, size, color, odor, and the number and type of wound fluid.R / identify the severity of the injury will facilitate intervention.c. Monitor the increase in body temperature.R / increased body temperature can be identified as the process of inflammation.d. Provide wound care with aseptic technique. Dressing the wound with sterile gauze and a dry, use paper tape.R / aseptic technique helps accelerate wound healing and prevent infection.e. If recovery does not occur collaboration further action, such as debridement.R / to be foreign or infected tissue is not widespread in other areas of normal skin.f. After debridement, dressing bandage as needed.R / dressing can be substituted one or two times a day depending on the condition of severe / not his wounds, to prevent infection.g. Collaboration antibiotics as indicated.R / antibiotics to kill pathogenic microorganisms useful in areas at risk of infection.
4. Barriers to physical mobility is a limitation in self-reliance, beneficial physical movement of the body or a limb or more.Goal: patient will indicate the optimal level of mobility.Criteria results: - appearance of a balanced ..- Do the movement and displacement.- Maintaining optimal mobility that can be tolerated, with the characteristics:
0 = fully independent
1 = require aid.
2 = requires assistance from another person for assistance, supervision, and teaching.
3 = needs help from others and aid.
4 = dependence; did not participate in the activity.Intervention and Implementation:g. Assess the need for health care and the need for equipment.R / identify the problem, facilitate intervention.h. Determine the patient's level of motivation to perform the activity.R / affecting the assessment of the ability of the activity is due to the inability or unwillingness.i. Teach and monitor patients in the use of tools.R / judge limits the ability of optimal activity.j. Teach and support patients in active and passive ROM exercises.R / maintain / increase muscle strength and endurance.k. Collaboration with a physical or occupational therapist.R / as a source suaatu planning to develop and maintain / improve patient mobility.
5. The risk of infection associated with inadequate peripheral defense, circulation changes, high blood sugar levels, invasive procedures and skin damage.Objective: infection does not occur / controlled.Criteria results: - there are no signs of infection such as pus.- Do not clean the wound moist and not dirty.- Vital signs are within normal limits or tolerable.Intervention and Implementation:a. Monitor vital signs.R / identify the signs of inflammation, especially when the body temperature rises.b. Perform wound care with aseptic technique.R / controlling the spread of pathogenic microorganisms.c. Perform maintenance on inpasif procedures such as intravenous fluids, catheters, wound drainage, etc..R / to reduce the risk of nosocomial infection.d. If signs of infection collaboration for blood tests, such as hemoglobin and leukocytes.R / Hb decrease and increase in the number of normal leukocytes may result from the occurrence of the infection process.e. Collaboration for antibiotics.R / antibiotics to prevent the development of pathogenic microorganisms.
6. Lack of knowledge about the condition, prognosis and treatment needs associated with cognitive limitations, lack of exposure / recall, misinterpretation of information.Purpose: The patient expressed understanding of the conditions, procedures and effects of the treatment process.Results Criteria: - perform the necessary procedures and explain the rationale of an action.- Initiate the necessary lifestyle changes and participate in treatment regimen.Intervention and Implementation:a. Assess the level of knowledge of the client and family about the disease.R / to find out how much experience and knowledge of the client and family about the disease.b. Give an explanation to the client about his illness and his condition now.R / to find out the disease and its present state, the client and his family will feel calm and reduce anxiety.c. Encourage clients and families to pay attention to her diet.R / diet and proper diet helps the healing process.d. Ask the client and reiterated family of materials that have been given.R / to find out how far the understanding of clients and their families and assess the success of the action taken.
IV. EVALUATIONAddalah evaluation stage on the nursing process in which the degree of success in achieving the goals of nursing assessed and the need to modify or nursing intervention defined purpose (Brooker, 2001).Evaluation expected in patients with postoperative fracture is:1. Pain can be reduced or disappear after the act of nursing.2. Patients have enough energy to move.3. Achieve wound healing at the appropriate time4. Patients will show optimum level of mobility.5. Infection is not the case / control6. Patients expressed an understanding of the conditions, procedures and effects of the treatment process.
REFERENCESBlack, Joyce M. , 1993. Medical Surgical Nursing. W.B Sainders Company: PhiladelpiaBoedihartono, 1994, at the Hospital Nursing Process. EGC: Jakarta.Brooker, Christine. , 2001. Pocket Dictionary of Nursing. EGC: Jakarta.Brunner and Suddarth, 2002 Medical Surgical Nursing, 3rd Edition, EGC, JakartaDoenges, Marilyn E. , 1999. Nursing Care Plans, 3rd Edition. EGC: Jakarta.E. Oerswari 1989, Surgery and Treatment, PT Gramedia. JakartaNasrul, Effendi. , 1995. Introduction to Nursing Process. EGC. Jakarta.Sjamsuhidajat, R. and Wim de Jong. , 1998. Imu Textbook of Surgery, revised edition. EGC: JakartaWilkinson, Judith M. 2006. Handbook of Nursing Diagnosis, 7th edition. EGC: Jakarta.Smeltzer, Suzanne C. , 2001. Textbook of Medical Surgical Nursing Brunner & Suddarth, Issue 8. EGC: Jakarta.Faculty of medicine. , 1995. Set of Surgery Lecture. Binarupa Literacy: Jakarta
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