Ch. 27: Fractures Flashcards
A fracture occurs when the resistance between a bone and an applied stress yields to the _____, resulting in a disruption to the integrity of the bone
Applied stress
Who is bone healing and remodeling in: children or adults? Why?
Children—thicker periosteum and good blood supply
What type of injuries may result in altered bone growth?
Epiphyseal plate injuries
What is plastic deformation (bend fracture)?
The bone is bent no more than 45 degrees
What is buckle (torus) fracture?
Compression of the bone resulting in a bulge or raised area at the fracture site
What is greenstick fracture?
Incomplete fracture of the bone
What is transverse fracture?
Break is straight across the bone
What is oblique fracture?
Break is diagonal across bone
What is spiral fracture?
Break spirals around the bone
What is growth plate fracture?
Injury to the end of the long bone on the growth plate
What is stress fracture?
Tiny cracks in the bone
What is complete fracture?
Bone fragments are separated
What is incomplete fracture?
Bone fragments are still attached
What is closed or simple fracture?
The fracture occurs w/o break in the skin
What is open or compound fracture?
The fracture occurs with an open wound and bone protruding
What is complicated fracture?
The fracture results in injury to other organs and tissues
Nursing care: What is first thing to do when providing emergency care at the time of injury?
Maintain ABC
Neuro assessment: What are parts of this?
- Sensation
- Skin temp
- Skin color
- Cap refill
- Pulses
- Movementh
What does loss of sensation indicate?
Nerve damage
If we give an opioid analgesia for pain, what do we monitor?
Resp. depression and constipation
What casts are heavy, not water resistant, and can take 10-72 hours to dry?
Plaster or paris casts
What casts are light, water resistant, and dry very quickly (5-20 min)?
Synthetic fiberglass
What should be done prior to casting?
Skin area should be observed for integrity, cleaned, and dry
Bony prominencies should be padded to prevent skin breakdown
How can we provide atruamatic care =?
Show procedure on doll or toy
Elevate the cast _______ during the first ____ to prevent ____
Elevate the cast ABOVE THE LEVEL OF THE HEART during the first 24-48 hours to prevent SWELLING
Apply ____ for the first 24 hours to decrease swelling
Ice
How often should we turn and position client?
Every 2 hours so that dry air circulates around and under the cast for faster drying—this will also prevent pressure from chaining the shape of the cast
How should affected extremitiy be supported when sitting?
With a sling or elevated
What could indicate infection on the cast?
Increased warmth or hot spots on the casts surface
Plaster casts: use palms of hands to avoid _____, expose the cast to air to promote drying
Denting
What should we use over any rough area of the cast that may rub against the clients skin?
Moleskin
What should client do after removal of cast?
Soak extremity in warm water and apply lotion
What is used to align, immobilize, and reduce muscle spasms associated with certain fractures?
Traction, countertraction, and friction
Traction care: Through the use of forward pulling force and a backward force adding or removing weight controls the degree of force applied to maintain ____ & ____
Traction and allignment
Uses a pulling force that is applied by weights (may be used intermittently)–using tape and straps applied to the skin along with boots and/or cuffs, weights are attached by a rope to the extremity (back, russell, bryant traction)
Skin traction
Uses a continuous pulling force that is applied directly to the skeletal structure and/or specific bone. A pin or rod is inserted through or into the bone. Force is applied through the use of weights attached by a rope. This traction allows the client to change positions w/o interfering with the pull of the traction and decreases complications associated with immobility and traction
Skeletal traction
Suspends the leg in a flexed position; the hip and hamstring muscles are relaxed
Balanced suspension traction
Uses a halo-type bar that encircles the head. Screws are inserted into the outer table of the skull. This attaches to either bed traction or rods that are secured to a vest worn by the client
Halo traction (cervical traction)
Nursing actions: What should we do with halo traction —assure what?
Assure the wrench to release the rods is attached to the best when using halo traction in the event that CPR is necessary
Nursing actions: What do we assess pin sites for?
Pain Redness Swelling Drainage Odor
Nursing actions: How should the hardware be?
Tight and that bed is in correct position
Nursing actions: How should the weights and ropes be? What should we NOT do?
Weights to hang freely and the ropes are free of knots
Do NOT life or remove weights unless prescribed and supervised by the provider!!!
Nursing actions: How should we remove the sheets to be changed?
From the HOB to the foot of bed, and remake bed in same manner
What are the fractures that are the most common for requiring surgery?
Supracondylar fractures and fractures of the humerus and femur
After a surgery to fix a fracture, when should we encourage mobilization?
As soon as prescribed!
What are the 2 big complications of fractures?
- Compartment syndrome
2. Osteomyelitis
Compression of nerves, blood vessels and muscle inside a confined place
Compartment syndrome
What happens if compartment syndrome gets untreated?
Tissue necrosis can result
What are some findings for compartment syndrome?
- Increased pain that is unrelieved with elevation or analgesics
- Intense pain when passively moved
- Paresthesia, numbness
- Pulselessness distal to the fracture
- Inability to move digits
- Warm digits with skin that is tight and shiny
- Pallor
What is prevention of compartment syndrome?
- Loosen the constrictive dressing or cut the bandage or tape
- Elevate the extremity and apply ice
Client education for compartment syndrome?
Tell client to report pain that is not relieved by analgesics, pain that continues to increase in intensity, numbness or tingling, or a change in color of the extremity
Infection w/in the bone secondary to a bacterial infection from an outside source, such as with an open fracture (endogenous) or from a blood borne bacterial source
Osteomyelitis
What are the clinical manifestations of osteomyelitis?
- Appearing ill
- Irritability
- Fever
- Tachycardia
- Edema
- Pain
- Not wanting to use affected extremity
- Site of infection is tender, and bone pain worsens with movement
What do we assist with in osteomyelitis?
- Assit with diagnostic procedures (obtaining skin, blood, and bone cultures)
- Assit with joint or bone biopsy
- Assit with proper positioning to promote comfort
What should we administer for patents who have osteomyelitis?
- Administer IV and oral antibiotic therapy
- Administer pain med as prescribed
A nurse is caring for a child who is in a plater spica cast. Which of the following is an appropriate action for the nurse to take?
A. Use a heat lamp to facilitate drying
B. Avoid turing child until cast is dry
C. Assist client with crutch walking after cast is dry
D. Apply moleskin to edges of cast
D
A nurse is teaching a group of parents about fractures. Which of the following should be included in the teaching?
A. Children need a longer time to heal from a fracture than an adult
B. Epiphyseal plate injuries may result in altered bone growth
C. A greenstick fracture is a complete break in the bone
D. Bones are unable to bend, so they break
B
A nurse is caring for a child who sustained a fracture. Which of the following are appropriate for the nurse to take (SATA)?
A. Place a heat pack on the site of injury
B. Elevate the affected limb
C. Assess neuromuscular status frequently
D. Encourage ROM of the affected limb
E. Stabilize the injury
B, C, E
A nurse is caring for a child who has a fracture. Which of the following are clinical manifestations of a fracture? (SATA)
A. Crepitus B. Edema C. Pain D. Fever E. Ecchymosis
A, B, C, E
A nurse is caring for a chid who is in a Russell traction. Which of the following are appropriate actions for the nurse to take? (SATA)
A. Remove the boots once a day for a bath
B. Assess the child’s position frequently
C. Assess pin sites q4h
D. Ensure the weights are hanging freely
E. Ensure the buttocks is raised off the bed
B, E
