Complications of Fractures and Immobilization

Question 1

Osteomyelitis

Answer 1

Infection of bone

Question 2

Systemic Sx of Osteomyelitis

Answer 2

1. Fever/Chills
2. Restlessness
3. Nausea
4. Malaise
5. Increased WBC

Question 3

Local Sx of osteomyelitis

Answer 3

1. Pain/Tenderness
2. Swelling
3. Warmth
4. Restricted Movement
5. Drainage

Question 4

Osteomyelitis Diagnosis

Answer 4

Risk for or actual infection r/t impaired protective mechanisms, artifical devices (pins, etc)

Pt. will show no signs of infection, will have WBC wnl, temp wnl, extremity temp wnl, no redness, no drainage, etc

• Assess incision q shift
• 6 P assessment
• VS
• Labs
• Pin or incision care
• Client teaching

Question 5

Compartment Syndrome

Answer 5

• Compression of structures within a closed compartment which includes blood vessels, nerves, and soft tissue
• May be due to decreased compartment size or increased compartment content

Question 6

Treatment of osteomylitis

Answer 6

• 6 weeks-6 months of IV antibiotic therapy
• Very costly
• Surgical treatment includes debridement (removal of poor vascularized and dead bone) or amputation of the extremity

Question 7

Etiologies Compartment Syndrome

Answer 7

1. Decreased compartment size resulting from restrictive dressings, splints, casts
2. Increased compartment content related to bleeding, edema, IV infiltration, etc

Question 8

How does compartment syndrome occur?

Answer 8

1. Increased tissue edema results from soft tissue injury
2. Increased pressure within tissue from edema causes venous occulusion
3. Venous occulusion leads to increased edema with increased pressure in tissue
4. As pressure increases, compromise of arterial flow
5. Tissue ischemia
6. Tissue necrosis

Question 9

Clinical Manifestations of Compartment Syndrome

Answer 9

1. S/Sx can occur within a few hours to 12 hours
2. Earliest sign is progressive intense pain distal to the injury
3. changes in 6 Ps

Question 10

Compartment Syndrome Nursing Diagnosis

Answer 10

Peripheral Neurovascular dysfunction and Imparied tissue perfusion

Pt. will have CMS within normal parameters

• Frequent nurovascular assessment
• early recognition 6 Ps
• Do not elevate
• Do not ice
• splitting of cast
• Fasciotomy

Question 11

Fasciotomy

Answer 11

Incision to surgically decompress the compartment

Question 12

Fat Embolism

Answer 12

Can occur after injury to long bones where a fat globule is released from the marrow of the fractured bone and travels to the lung and other organs such as the brain

Question 13

Fat Embolism Assessment

Answer 13

1. Acute respiratory distress: chest pain, dyspnea, tachypnea, cyanosis
2. Apprehension/feeling of impending doom
3. Confusion
4. Increased HR
5. Increased O2 sat
6. Petechiae
7. All symptoms caused by poor oxygenation

Question 14

Fat Embolism Nursing Diagnosis

Answer 14

Ineffective breathing pattern and Impaired Gas Exchange

Pt. will have RR wnl, o2 > 92%, no signs of resp. distress, no signs of confusion, no petechiae

• Symptom dependent
• Supportive care: oxgen, IVFs
• Prevention is best treatment: immobilize fractures early

Question 15

Deep Vein Thrombosis

Answer 15

Venous Thrombosis d/t venous stasis and inactivity

prophylactic anticoagulants used

lovenox, heparin, and warfarin most common