Ch. 44 Flashcards
fracture
break or disruption in continuity of a bone
complete fracture
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
incomplete fracture
the fracture does not divide the bone into two portions because the break is through only part of the bone
- not typically displaced
open or compound fracture
the skin surface over the broken bone is disrupted, which causes an external wound
- graded to define the extent of tissue damage
closed or simple fracture
does not extend through the skin and therefore no visible wound
pathologic (spontaneous) fracture
aka fragility fracture
occurs after minimal trauma to a bone that has been weakened by disease
- bone cancer or osteoporosis patient
fatigue or stress fracture
results from excessive strain and stress on the bone
- commonly seen in recreational and professional athletes
compression fracture
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
oblique fracture
diagonal break
occult fracture
break is hidden or not easily recognized
open fracture
fragment of bone protruding through an open wound
pathologic
break as a result of disease rather than injury
segmented
bone is splintered into pieces
spiral
twisted break
transverse
horizontal break
green stick
partially bent; partially broken
impacted
bone is wedged into the interior of the other
bone healing: stage one
within 4-72 hours after the injury, hematoma forms at the site of the fracture because bone is extremely vascular
bone healing: stage two
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
bone healing: stage three
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
bone healing: stage four
healing continues, the callus is gradually resorbed and transformed into bone. this stage usually takes 3-8 weeks
bone healing: stage five
remodeling/healed
acute complications (of fractures)
- VTE
- infection
- acute compartment syndrome
- crush syndrome
- hemorrhage or hypovolemic shock
- fat embolism syndrome
chronic complications
- complex regional pain syndrome (CRPS)
incidence of fractures
depends on the location of the injury
health promotion and maintenance: teaching to prevent fractures
- Osteoporosis screening
- Fall prevention
- Home safety
- Dangers of drinking and driving under the influence
- Use of helmets
assessment: history
- Determine cause of fracture
- Events leading up to injury
- Substance use (especially opioids)
- Occupational and recreational activities
physical assessment & s/sx
- 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
psychosocial assessment
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
imaging assessment
- CT
- MRI
- XRay
lab assessment
- Hemoglobin
- Hematocrit
- ESR
- WBC
- Serum calcium, and phosphorus
patient problems/ nursing diagnoses
- 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
Interventions
- Managing acute pain
- Increasing mobility
- Preventing and monitoring for neurovascular compromise
- Preventing infection
closed reduction devices
- 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
fiberglass synthetic cast
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
skeletal traction
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)
external fixation device
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
preventing and monitoring for neurovascular compromise
- perform neurovascular assessments
- be aware of symptoms of acute compartment syndrome and the 6 P’s:
- pain
- pressure
- paralysis
- paresthesia
- pallor
- pulselessness
preventing infection
- 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
care coordination and transition management
- home care management
- self-management education
- health care resources
evaluation of patient with a fracture
- 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
