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NU 340 > Ch. 44 > Flashcards

Ch. 44 Flashcards

1
Q

fracture

A

break or disruption in continuity of a bone

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2
Q

complete fracture

A

the break is across the entire width of the bone in such a way that the bone is divided into two distinct sections
- may be displaced: called a displaced fracture if the bone alignment is disrupted or altered. the ends of the bone sections are more likely to damage surrounding nerves, blood vessels, and other soft tissues

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3
Q

incomplete fracture

A

the fracture does not divide the bone into two portions because the break is through only part of the bone
- not typically displaced

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4
Q

open or compound fracture

A

the skin surface over the broken bone is disrupted, which causes an external wound
- graded to define the extent of tissue damage

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5
Q

closed or simple fracture

A

does not extend through the skin and therefore no visible wound

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6
Q

pathologic (spontaneous) fracture

A

aka fragility fracture
occurs after minimal trauma to a bone that has been weakened by disease
- bone cancer or osteoporosis patient

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7
Q

fatigue or stress fracture

A

results from excessive strain and stress on the bone
- commonly seen in recreational and professional athletes

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8
Q

compression fracture

A

produced by a loading force applied to the long axis of cancellous bone
- commonly occur in the vertebrae of older patients with osteoporosis and are extremely painful

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9
Q

oblique fracture

A

diagonal break

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10
Q

occult fracture

A

break is hidden or not easily recognized

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11
Q

open fracture

A

fragment of bone protruding through an open wound

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12
Q

pathologic

A

break as a result of disease rather than injury

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13
Q

segmented

A

bone is splintered into pieces

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14
Q

spiral

A

twisted break

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15
Q

transverse

A

horizontal break

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16
Q

green stick

A

partially bent; partially broken

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17
Q

impacted

A

bone is wedged into the interior of the other

18
Q

bone healing: stage one

A

within 4-72 hours after the injury, hematoma forms at the site of the fracture because bone is extremely vascular

19
Q

bone healing: stage two

A

occurs in 3 days-2 weeks, when granulation tissue begins to invade the hematoma. this then prompts the formation of fibrocartilage, providing the foundation for bone healing

20
Q

bone healing: stage three

A

occurs as a result of vascular and cellular proliferation. the fracture site is surrounded by new vascular tissue known as callus (within 3-6 weeks). callus formation is the beginning of a nonbony union

21
Q

bone healing: stage four

A

healing continues, the callus is gradually resorbed and transformed into bone. this stage usually takes 3-8 weeks

22
Q

bone healing: stage five

A

remodeling/healed

23
Q

acute complications (of fractures)

A
  • VTE
  • infection
  • acute compartment syndrome
  • crush syndrome
  • hemorrhage or hypovolemic shock
  • fat embolism syndrome
24
Q

chronic complications

A
  • complex regional pain syndrome (CRPS)
25
Q

incidence of fractures

A

depends on the location of the injury

26
Q

health promotion and maintenance: teaching to prevent fractures

A
  • Osteoporosis screening
  • Fall prevention
  • Home safety
  • Dangers of drinking and driving under the influence
  • Use of helmets
27
Q

assessment: history

A
  • Determine cause of fracture
  • Events leading up to injury
  • Substance use (especially opioids)
  • Occupational and recreational activities
28
Q

physical assessment & s/sx

A
  • Check for trauma to other body systems
  • Assess all body systems for life-threatening complications
  • Check urine for blood
  • Assess for swelling, skin color, and peripheral pulses
29
Q

psychosocial assessment

A

status depends on extent of injury, possible complications, coping ability, and available support systems
patients w/ single, uncomplicated fracture usually returns to daily activities within a few days- less at risk for long-term psychosocial problems
patients with severe or multiple traumas are more at risk for psychosocial trauma
- disruption in life style can create high levels of anxiety, stress, and/or depression
- depression: pain, lonely
- ask patient how they cope w/ stressful events, coping skills
- support systems and love: family, friends, church, community groups
- body image and sexuality may be altered

30
Q

imaging assessment

A
  • CT
  • MRI
  • XRay
31
Q

lab assessment

A
  • Hemoglobin
  • Hematocrit
  • ESR
  • WBC
  • Serum calcium, and phosphorus
32
Q

patient problems/ nursing diagnoses

A
  • Acute pain due to broken bone(s), soft-tissue damage, muscle spasm, and edema
  • Decreased mobility due to pain, muscle spasm, and soft-tissue damage
  • Potential for neurovascular compromise related to impaired tissue perfusion
  • Potential for infection due to a wound caused by an open fracture
33
Q

Interventions

A
  • Managing acute pain
  • Increasing mobility
  • Preventing and monitoring for neurovascular compromise
  • Preventing infection
34
Q

closed reduction devices

A
  • most common nonsurgical method for managing a simple fracture
  • manual pull or traction on the bone: PCP will move bone ends to realign
  • moderate sedation used (monitor O2 sat)
  • splint or boot will be used to keep the bone aligned to heal
35
Q

fiberglass synthetic cast

A

waterproof synthetic casting material
- most often used for fracture immobilization
- can dry and become rigid within minutes and decrease the risk for impaired tissue integrity
- firm, odorless casts

36
Q

skeletal traction

A

screws are surgically inserted directly into the bone
- allow use of longer traction time and heavier weights (15-30lb)
- aids in bone realignment but impairs mobility
- use pressure-reduction measures and monitor for indications of impaired tissue integrity
- pin site care: infection monitoring (clean, doc drainage)

37
Q

external fixation device

A

with closed reduction is used when patients have soft tissue injury (open fracture)
- pins and wires are inserted through the skin and affected bone and then connected to a rigid external frame outside the body to stabilize the fracture during healing
- used for upper or lower extremities, esp with open fractures when wound management is needed
- after removed, patient placed in boot/splint/cast or undergo internal fixation

advantages:
- minimal blood loss compared to internal fixation
- allows early ambulation and exercise of affected body part while relieving pain

38
Q

preventing and monitoring for neurovascular compromise

A
  • perform neurovascular assessments
  • be aware of symptoms of acute compartment syndrome and the 6 P’s:
  • pain
  • pressure
  • paralysis
  • paresthesia
  • pallor
  • pulselessness
39
Q

preventing infection

A
  • Use aseptic technique for dressing changes and wound irrigation
  • Monitor vital signs
  • Notify provider immediately if inflammation, purulent drainage is noted
  • Patient may need antibiotics, VAC system
40
Q

care coordination and transition management

A
  • home care management
  • self-management education
  • health care resources
41
Q

evaluation of patient with a fracture

A
  • has adequate pain control 2-3 on scale 0-10 to accomplish ADL’s
  • is free of physiologic consequences of decreased mobility
  • is free of infection
  • has adequate blood flow to maintain tissue perfusion

NU 340 (26 decks)

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