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Med Surg 3 > Chapter 51- Fractures > Flashcards

Chapter 51- Fractures Flashcards

1
Q

The death rate from injury is highest among which age group?

A

over 65 years

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2
Q

Why do older adults with traumatic injury higher mortality and morbidity rates.

A
  • they have limited psychological reserve\
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3
Q

Older adults are at risk for fractures because

A
  • delayed reaction times
  • gait and balance disturbances
  • decreased visual acuity
  • hearing loss
  • osteoporosis, decreased muscle mass
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4
Q

what is a fracture?

A

a break in the continuity of a bone usually caused by trauma most of the time

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5
Q

complete fracture

A

a break in the width of the bone where it is completely divided in 2

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6
Q

incomplete fracture

A

fracture does not completely divide the bone

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7
Q

displaced fracture

A

fracture moves from original placement

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8
Q

open/compound fracture

A

a break in the bone through the skin

worried about infection

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9
Q

closed/simple

A

bone is broken within the skin (opening in the skin)

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10
Q

Pathological/ fragility/ spontaneous

A

Pathological (bone weakened by disease)

  • minimal trauma
  • – osteoporosis
  • – Cancer
  • bone metastases
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11
Q

stress/ fatigue

A
  • excessive stress on bones

- Athletes

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12
Q

compression

A

vertebrae compresses

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13
Q

comminuted

A

bone shattered, in pieces

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14
Q

spiral fracture

A
  • in children…from arm twisting
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15
Q

when does bone healing start?

A

immediately

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16
Q

5 stages of wound healing

A 
1. 42-72 hrs...hematoma formas
2 3 days to 2 weeks( granulation tissue
3. callous (hard)
4. Reabsorbed and turned in to bone 
5. Bone gets reformed (heals)
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17
Q

healthy bones take……. weeks to heal

A

6 weeks for young healthy

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18
Q

How does gender effect

A
  • menopause
  • decrease estrogen
  • affects bone formation
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19
Q

poor circulation increased

A

bone healing time

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20
Q

improper healing in cast

A
  • malunion
  • infectsion
  • ACS
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21
Q

Possible complications of fractures

A
  • ACS
  • Crush syndrome
  • Hypovolemic shock
  • fat embolism
  • venous thromboembolism
  • infection
  • ischemic necrosis
  • delayed union
  • complex regional pain syndrome
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22
Q

Patho of ACS

A
  • increased compartment pressure— increases capillary permeability—-edema(fluid shifting—– causing decreased perfusion—–increased pressure, edema—-ischemia—-necrosis
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23
Q

compartments contain

A
  • muscle
  • blood vessels
  • nerves
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24
Q

Early signs of acute compartment syndrome

A
  • Paresthesia (numbness and tingling)
  • Pain out of proportion
Pain
Pulse
Pallor
Paresthesia
Paralysis
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25
Q

Late signs of acute compartment syndrome

A
  • loss of movement

- decreased plus

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26
Q

pressure sources in ACS can be

A

external or internal

external- tight dressing or cast

internal- blood, fluid accumulation

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27
Q

ACS pressure reading can be done with a

A

striker

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28
Q

striker normal reading

A

0-8 mm Hol

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29
Q

ACS treatment

A
  • if external, take it off

- Fasciatomy to receive pressure

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30
Q

late recognition of ACS

A

can cause persistent motort deficits

  • necrosis
  • infection
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31
Q

what is crush syndrome

A
  • trauma that crushed the muscle and bone
    causes injury to muscle that releases content that can be toxic to kidneys

releases
- myoglobin
- potassium
CK- creatinine Kinase

Kidneys go into overdrive trying to filter and then they give up

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32
Q

Rhabdo is a result of what?

A

crush syndrome

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33
Q

Normal CK

A

25- 175

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34
Q

CK level considered for rhabdo

A

> 1000

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35
Q

symptoms of rhabdo

A
  • body hurts
  • muscle hurts
  • my urine is dark
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36
Q

treatment for rhabdo

A
  • IVF! to flush out toxins
  • monitor urine out put
    Monitor kidney function( BUN, Creatinine)
    Blood test
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37
Q

why is hypovolemic shock a risk of bone injuries?

A
  • Bones are vascular and arteries are being lacerated
38
Q

What is Fat embolism syndrome ?

A
  • fat globules from bone marrow dialog and enter circulation and logde into blood vessels and usually right to lung
39
Q

what happens when fat globule lodges in lungs?

A
  • SOB
  • hypoxemia
  • decreased perfusion
  • decreased Mental status - confused
    Late sign- Petichial (rash
40
Q

early sign FE

A
  • SOB
  • hypoxemia
  • decreased perfusion
  • decreased Mental status - confused
41
Q

late sign of FE

A

Late sign- Petichial (rash)

42
Q

who develops Venous thromboembolism- DVT, PE

A
  • smoker
  • immobile its
  • travelers
  • surgical patients
  • cancer patient( hyper coagulable
  • pregnant patients- post part
43
Q

common wound Infections after musculoskeletall trauma

A

tetanus
osteomyelitis-
MRSA

44
Q

what is a chronic complication of a fracture?

A

Avascular necrosis (which is dying blood vessels)
Delayed wound healing
Chronic regional pain syndrome

45
Q

MOI Red flags include

A 
Windshield shattered 
Broken steering wheel 
Vehicular ejection 
Airbag deployment 
High speed
46
Q

Hemorrhage? Which fractures are we most worried about internal bleeding?

A

pelvis and femoral

47
Q

Neurovascular assessment CRITICAL

A 
- color, temperature
, movement, 
sensation, 
pulses, 
cap refill, 
pain- every hour for the first 24 hours
48
Q

psychosocial assessment-

A

stress,
depression,
decreased energy,
mobility

49
Q

Flail chest

A

2 or more broken ribs in 2 or more areas of the chest.

50
Q

FAST Exam looks for what?

A

Internal bleeding

51
Q

What areas are the FAST Exam Checking in

A 
Kidney
Liver
Pericardium, 
Spleen,
 Bladder
52
Q

Nonsurgical Management includes

A
  • Splints
  • Casts
  • Reduction
53
Q

whats the upside to using a splint?

A

they allow room for swelling without compromising perfusion

54
Q

Casts

A
  • hard and rigid

- may cause ACS

55
Q

reduction is used for

A

the realignment of the bone ends for proper healing

uses conscious sedation

56
Q

Reductions are used for what type of fractures?

A
  • displaced or misaligned
57
Q

Complications with casts

A

Perfusion impairment
Infection- pressure necrosis (skin breakdown)
Peripheral nerve damage
Prolonged immobilization causes joint contractures
Muscle atrophy, risk osteoporosis, osteoarthritis
Patient education- essential

58
Q

3 classifications of traction?

A
  • traction
  • Running
  • Balanced suspension
59
Q

Traction-

A

pulling force to provide reduction, alignment and rest. Also decreases muscle spasm, prevents or corrects deformity and tissue damage.

60
Q

Running-

A

pulling force in one direction- patient’s body acts as countertraction- moving the body or bed position can alter countertraction force

61
Q

Balanced suspension-

A

provides countertraction so that the pulling force of the traction is not altered when the bed or patient is moved- allows for increased movement and facilitates care

62
Q

Traction- types

A

Skin- used to decrease painful muscle spasms that accompany fractures. Weight is used as a pulling force (5-10 lbs)

Skeletal- screws surgically inserted directly into bone. Allows longer traction time and heavier weights (15-30 lbs)- aids in bone realignment but impairs mobility

63
Q

Nursing assessment for traction pts

A

Inspect skin at least every 8 hours

inspect ropes, knots, pulleys at least every 8-12 hours for loosening, fraying, positioning

check weight for consistency against provider order- hang freely- do not remove without order

muscle spasm? Weight may be too heavy or may need to realign pt

NV status!!! Every hour for the first 24 hours after traction is applied and every 4 hours thereafter

64
Q

Health promotion/maintenance

A 
Fall prevention
 Osteoporosis screening 
 Home safety
 Drinking and driving- educate! 
 Drug safety- particularly sedating medications 
 Helmet use
65
Q

Surgical management of fractures

A

Open reduction with internal fixation (ORIF)-

common, preferred due to early mobility- reduce and immobilize the fracture-directly visualize fracture site and use metal pins, screws to immobilize fx during healing

External fixation with closed reduction-

pins or wires inserted through skin and affected bone and then connected to rigid external frame- helpful with open fractures for wound care- increased risk pin site infectionsosteomyelitis

66
Q

What is most important in post op care?

A 
pin site assessment
- pain control
- physical therapy/early mobility- to prevent what? 
- CONTRACTION
-DVT'S
- SKIN BREAKDOWN
UTI
67
Q

side effects of analgesia opiod

A
  • decreased responsive.
  • decreased BP
  • Allergies
68
Q

infection prevention open fracture

A
  • Likely to be on braod spectrum antibiotics…s/p wound debridement

wound irrigation

wound VAC- quicker wound closure

69
Q

What does a pt w/ an infection look like?

A
  • Redness
  • fever
  • altered mental status
70
Q

Improving physical mobility

A

PT- exercises to increase ROM, reintroduce weight bearing, muscle strengthening

Also- ice/heat to help pain, reduce edema. Electrical muscle stimulation

Crutches, canes, walkers

71
Q

Crutches to be given to those with

A

strong arm muscles, balance and coordination

72
Q

crutch teaching

A

2-3 finger widths between axilla and tip of crutch
- Elbow flexed no more than 30 degrees

can cause axillary nerve damage

73
Q

Considerations for discharge home

A

Safety! Stairs, rugs, bathroom access

Wound care r/t splint or cast, ex fix

Monitoring for infection

Healthy diet- protein, calcium for bone and tissue healing

74
Q

Most common Upper extremity fractures

A

distal radius fracture- treated with closed reduction and splint (usually)

75
Q

Most common Upper extremity fractures in elderly

A

Common in elderly- proximal humerus- treated with sling, unless displaced- then ORIF

76
Q

After an ORIF, pts are at risk for _________Prevent adduction and rotation- keep leg in proper alignment- pillow

A

hip dislocation.

77
Q

Elderly post op also at risk for _________ pull tubes, get out of bed. Skin assessment- keep heels off bed.

A

DELIRIUM-

78
Q

what is a compression fracture

A
  • when bone within the vertebra becomes weakened and causes vertebral body to collapse
79
Q

Whats the difference between elective vs traumatic amputation?

A

elective= planned

possible result of a condition: diabetes,

80
Q

how to assess for internal abdominal trauma

A
  • FAST exam
  • blood at meatus
    • abdominal distention
81
Q

Complications of amputations

A

Hemorrhage, which can lead to…?
Infection (in wound or bone)
Phantom limb pain- be empathetic with your response
Neuroma- tumor made of damaged nerve cells
Flexion contractures

82
Q

Carpal tunnel syndrome

A



Median nerve becomes compressed, causing pain and numbness

Pain worse at night

83
Q

Carpal tunnel syndrome diagnosed with

A

Phalen’s wrist test, Tinel’s sign

84
Q

Carpal tunnel syndrome treatment

A

NSAIDs, immobilize, steroid injections

OR surgery to relieve pressure on nerve- decompression


85
Q

Strain definition

A

strain- excessive stretching of a muscle or tendon when it is weak or unstable. “muscle pull”

86
Q

strain treatment

A

Cold and heat, exercise, activity limitation, anti-inflammatories, muscle relaxer

87
Q

sPrain-

A

excessive stretching of a ligament. Typically from twisting motions. Cause pain and swelling.

88
Q

what does the rotator cuff do?

A

stabilizes the head of the humerus in glenoid cavity during shoulder abduction

89
Q

rotator cuff tear can occur

A
  • during trauma
  • while throwing a ball
  • heavy lifting
90
Q

treatment for a partial rotator cuff tear

A
  • NSAIDs
  • steroid injection
  • PT
  • activity limitation
91
Q

treatment for a full thickness rotator cuff tear

A
  • surgical repair of cuff

Med Surg 3 (5 decks)

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