Chapter 51- Fractures Flashcards
1
Q
The death rate from injury is highest among which age group?
A
over 65 years
2
Q
Why do older adults with traumatic injury higher mortality and morbidity rates.
A
- they have limited psychological reserve\
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
4
Q
what is a fracture?
A
a break in the continuity of a bone usually caused by trauma most of the time
5
Q
complete fracture
A
a break in the width of the bone where it is completely divided in 2
6
Q
incomplete fracture
A
fracture does not completely divide the bone
7
Q
displaced fracture
A
fracture moves from original placement
8
Q
open/compound fracture
A
a break in the bone through the skin
worried about infection
9
Q
closed/simple
A
bone is broken within the skin (opening in the skin)
10
Q
Pathological/ fragility/ spontaneous
A
Pathological (bone weakened by disease)
- minimal trauma
- – osteoporosis
- – Cancer
- bone metastases
11
Q
stress/ fatigue
A
- excessive stress on bones
- Athletes
12
Q
compression
A
vertebrae compresses
13
Q
comminuted
A
bone shattered, in pieces
14
Q
spiral fracture
A
- in children…from arm twisting
15
Q
when does bone healing start?
A
immediately
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)
17
Q
healthy bones take……. weeks to heal
A
6 weeks for young healthy
18
Q
How does gender effect
A
- menopause
- decrease estrogen
- affects bone formation
19
Q
poor circulation increased
A
bone healing time
20
Q
improper healing in cast
A
- malunion
- infectsion
- ACS
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
22
Q
Patho of ACS
A
- increased compartment pressure— increases capillary permeability—-edema(fluid shifting—– causing decreased perfusion—–increased pressure, edema—-ischemia—-necrosis
23
Q
compartments contain
A
- muscle
- blood vessels
- nerves
24
Q
Early signs of acute compartment syndrome
A
- Paresthesia (numbness and tingling)
- Pain out of proportion
Pain Pulse Pallor Paresthesia Paralysis
25
Late signs of acute compartment syndrome
- loss of movement
| - decreased plus
26
pressure sources in ACS can be
external or internal
external- tight dressing or cast
internal- blood, fluid accumulation
27
ACS pressure reading can be done with a
striker
28
striker normal reading
0-8 mm Hol
29
ACS treatment
- if external, take it off
| - Fasciatomy to receive pressure
30
late recognition of ACS
can cause persistent motort deficits
- necrosis
- infection
31
what is crush syndrome
- 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
32
Rhabdo is a result of what?
crush syndrome
33
Normal CK
25- 175
34
CK level considered for rhabdo
>1000
35
symptoms of rhabdo
- body hurts
- muscle hurts
- my urine is dark
36
treatment for rhabdo
- IVF! to flush out toxins
- monitor urine out put
Monitor kidney function( BUN, Creatinine)
Blood test
37
why is hypovolemic shock a risk of bone injuries?
- Bones are vascular and arteries are being lacerated
38
What is Fat embolism syndrome ?
- fat globules from bone marrow dialog and enter circulation and logde into blood vessels and usually right to lung
39
what happens when fat globule lodges in lungs?
- SOB
- hypoxemia
- decreased perfusion
- decreased Mental status - confused
Late sign- Petichial (rash
40
early sign FE
- SOB
- hypoxemia
- decreased perfusion
- decreased Mental status - confused
41
late sign of FE
Late sign- Petichial (rash)
42
who develops Venous thromboembolism- DVT, PE
- smoker
- immobile its
- travelers
- surgical patients
- cancer patient( hyper coagulable
- pregnant patients- post part
43
common wound Infections after musculoskeletall trauma
tetanus
osteomyelitis-
MRSA
44
what is a chronic complication of a fracture?
Avascular necrosis (which is dying blood vessels)
Delayed wound healing
Chronic regional pain syndrome
45
MOI Red flags include
```
Windshield shattered
Broken steering wheel
Vehicular ejection
Airbag deployment
High speed
```
46
Hemorrhage? Which fractures are we most worried about internal bleeding?
pelvis and femoral
47
Neurovascular assessment CRITICAL
```
- color, temperature
, movement,
sensation,
pulses,
cap refill,
pain- every hour for the first 24 hours
```
48
psychosocial assessment-
stress,
depression,
decreased energy,
mobility
49
Flail chest
2 or more broken ribs in 2 or more areas of the chest.
50
FAST Exam looks for what?
Internal bleeding
51
What areas are the FAST Exam Checking in
```
Kidney
Liver
Pericardium,
Spleen,
Bladder
```
52
Nonsurgical Management includes
- Splints
- Casts
- Reduction
53
whats the upside to using a splint?
they allow room for swelling without compromising perfusion
54
Casts
- hard and rigid
| - may cause ACS
55
reduction is used for
the realignment of the bone ends for proper healing
| uses conscious sedation
56
Reductions are used for what type of fractures?
- displaced or misaligned
57
Complications with casts
Perfusion impairment
Infection- pressure necrosis (skin breakdown)
Peripheral nerve damage
Prolonged immobilization causes joint contractures
Muscle atrophy, risk osteoporosis, osteoarthritis
*Patient education- essential*
58
3 classifications of traction?
- traction
- Running
- Balanced suspension
59
Traction-
pulling force to provide reduction, alignment and rest. Also decreases muscle spasm, prevents or corrects deformity and tissue damage.
60
Running-
pulling force in one direction- patient’s body acts as countertraction- moving the body or bed position can alter countertraction force
61
Balanced suspension-
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
Traction- types
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
Nursing assessment for traction pts
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
Health promotion/maintenance
```
Fall prevention
Osteoporosis screening
Home safety
Drinking and driving- educate!
Drug safety- particularly sedating medications
Helmet use
```
65
Surgical management of fractures
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 infectionsosteomyelitis
66
What is most important in post op care?
```
pin site assessment
- pain control
- physical therapy/early mobility- to prevent what?
- CONTRACTION
-DVT'S
- SKIN BREAKDOWN
UTI
```
67
side effects of analgesia opiod
- decreased responsive.
- decreased BP
- Allergies
68
infection prevention open fracture
- Likely to be on braod spectrum antibiotics...s/p wound debridement
wound irrigation
wound VAC- quicker wound closure
69
What does a pt w/ an infection look like?
- Redness
- fever
- altered mental status
70
Improving physical mobility
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
Crutches to be given to those with
strong arm muscles, balance and coordination
72
crutch teaching
2-3 finger widths between axilla and tip of crutch
- Elbow flexed no more than 30 degrees
can cause axillary nerve damage
73
Considerations for discharge home
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
Most common Upper extremity fractures
distal radius fracture- treated with closed reduction and splint (usually)
75
Most common Upper extremity fractures in elderly
Common in elderly- proximal humerus- treated with sling, unless displaced- then ORIF
76
After an ORIF, pts are at risk for _________Prevent adduction and rotation- keep leg in proper alignment- pillow
hip dislocation.
77
Elderly post op also at risk for _________ pull tubes, get out of bed. Skin assessment- keep heels off bed.
DELIRIUM-
78
what is a compression fracture
- when bone within the vertebra becomes weakened and causes vertebral body to collapse
79
Whats the difference between elective vs traumatic amputation?
elective= planned
| possible result of a condition: diabetes,
80
how to assess for internal abdominal trauma
- FAST exam
- blood at meatus
- - abdominal distention
81
Complications of amputations
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
Carpal tunnel syndrome
Median nerve becomes compressed, causing pain and numbness
Pain worse at night
83
Carpal tunnel syndrome diagnosed with
Phalen’s wrist test, Tinel’s sign
84
Carpal tunnel syndrome treatment
NSAIDs, immobilize, steroid injections
| OR surgery to relieve pressure on nerve- decompression
85
Strain definition
strain- excessive stretching of a muscle or tendon when it is weak or unstable. “muscle pull”
86
strain treatment
Cold and heat, exercise, activity limitation, anti-inflammatories, muscle relaxer
87
sPrain-
excessive stretching of a ligament. Typically from twisting motions. Cause pain and swelling.
88
what does the rotator cuff do?
stabilizes the head of the humerus in glenoid cavity during shoulder abduction
89
rotator cuff tear can occur
- during trauma
- while throwing a ball
- heavy lifting
90
treatment for a partial rotator cuff tear
- NSAIDs
- steroid injection
- PT
- activity limitation
91
treatment for a full thickness rotator cuff tear
- surgical repair of cuff
