Complications Of Fractures Pt 1 Flashcards
Majority of fracture heal without complication
However those that do, what requires an immediate attention? (2)
And death is usually from result of (2)
Open fracture with blood loss
Fractures that damage organs
Damage to underlying organs complications of fracture/immobility
Complications of fractures can be direct or indirect
Examples being?
Direct
Bone infection
Avascular necrosis
Indirect
- compartment syndrome
VTE
Fat embolism
Rhabdomyolysis
Hypovolemic shock
Infection is the highest incidence in open fractures so ___is key!
And we may give them what to help ?
Prevention
Antibiotics!!
Irrigate, impregnated beads, Iv
What is compartment syndrome?
Which also comprises what?
Swelling and increased pressure within a limited space ( muscle compartment)
Neurovascular function of tissue writhing that space
How many compartments in upper and lower extremities ?
It’s often associated with ?
What is the most common?
May occur after what two surgeries is or prolonged what ?
38
Fractured with extensive tissue damage and crush injury
Distal humorous and proximal tibia
Knee or leg
Pressure
What are the 2 causes of compartment syndrome?
Decreased compartment size from restrictive dressing, splints, casts, excessive traction, or premature closure of fascia
Increased compartment contents due to bleeding; inflammation, edema or IV infiltration
How does edema effect compartment syndrome?
Arterial flow compromised ->
Ischemia ->
Cell death ->
Loss of function
Causes pressure that obstructs circulation and venous occlusion leads to that edema
It’s important to early ___
And treat essential to avoid ___
May occur initially wiyh inury or could be ___
Ischemia can occur within how many hours after onset?
Recognition
Irreversible damage
Delayed
4-8hours
What are the clinical manifestations of compartment syndrome ?
6Ps
Pain
Pressure
Paresthesia
Pallor
Paralysis
Pulseless
Interprofessional care for compartment syndrome
The most important thing a nurse should do is?
Prompt accurate diagnosis via regular neurovascular assessment
What are early signs of compartment ?(3)
Notify pain unrelieved by drugs
Paresthesia
Reliving the source of pressure may prevent progression
What is the 3 late signs of compartment syndrome?
Pulselessness
Paralysis
May require amputation
If compartment syndrome is suspected what are the (2)most important things to not do?
And why?
Do not elaborate above heart
Do not apply cold compresses/ice
This causes vasoconstriction and reduced circulation to already compromised extremity
How do you treat compartment syndrome ? (3)
Relive pressure
Surgical decompression ( fasciotomy )
Amputation
What is a fasciotomy ?
It’s super important to try reduce the risk of?
A surgical decompression that is left open for several days to allow adequate soft tissue decompression
Infection!!
Notes
Venous thromboembolism
High susceptibility due to inactivity of muscles
You want to use antiemovolism stocking
ROM exercise
Anticoagulants
What is fat embolism?
Notes
Most common with fracture of long bones, ribs, tibia and pelvis
( spinal fusion, liposuction, bone marrow transplants )
Systemic fat globules from fracture that are distributed into tissues( circulatory system ) and organs
( brain and lungs )
Early recognition is crucial to decrease the risk of death for FES
Because symptoms will start to show within 24-48 hours after inury
Fat emboli in the lungs causes a hemorrhagic interstitial pneumonitis that leads to?
What are symptoms ?
ARDS
Chest pain
Tachypnea & cardia
Cyanosis
Dyspnea
Apprehension
Hypoxemia
What are the distinguishing manifestation of fat embolism syndrome ?
Petechia on neck, chest wall, axillar, buccal
Conjunctiva
FES
Clinical course of FES may be ___ and ___
Meaning
Pallor can quickly become ___ ; comatose
Notes
- fat cells in blood.urine.sputum
- pa02 < 60mm hg
- ST segment changes
- decrease platelet count
- prolonged prothrombin time
- !!!!! What is this
- chest X ray -> white out
Rapid and acute
Cyanosis
Increased ESR ( high erythrocyte sedimentation rate )
What is the prevention of FES? (2)
Careful immbolization & handling of long bones
- reposition as little as possible prior to immbolization and stabilization to prevent dislodging fat droplets into circulation
What are the 3 types of fractures ?
Colles
Humeral shaft
Pelvic
What is a Colles fracture?
Occurs how?
Age ?
Consider doing what below that age ^?
Distal radial fracture
Occurs during fall with outstretched arms
Above 50 years
Consider osteoporosis evaluation if younger
What is a humeral shaft fracture?
You want to protect ___ from ___ and skin breaks down due to immbolization devices
What should do during healing?
Shaft damage
( Complications including radial nerve injury, brachial artery injury)
Axilla from moisture
Exercise shoulders hands and fingers
What is a pelvic fracture associated with?
Caused what?
Notes
- stable nondisplaced fracture require rest, complex fracture require fixation
Rare but associated with high dead rate
Abdominal injury
Laceration/hemorrhage of abdominal structures
Notes
Hip fractures
95% related to a fall
37% die within a year of the injury
More in women
Hip fracture present with shortening and extrenal rotation of affect limb
Femoral head necrosis is a danger !!
What is the initial treatment for a hip fracture?
Bucks traction
If bucks traction can’t help, we can do a surgery to help repair the hip (4)
What the 4 surgeries
Closed reduction
Rapid with internal fixation
Hemisrthroplasty
Totals hip replacement
Notes postoperative care
General post ip care
Elevate leg
Maintain limb alignment with pillows when turning to non operative site
Trapeze
Physical therapy
Exercise
Hemiarthroplastly or THR by posterior approach
The main goal is to?
Precent dislocation
What should you do and not do for hemiarthroplasty?
Use elevated toilet seat
Remain seated on chair in shower/tub
Flex hip greater than 90
Addict hip
Keep hip in neutral position
Internally rotate hip
cross legs at knees or ankles
Notify surgeon of pain
Put on own shoes for 4-6weeks
Sit on chairs without arms
Discuss risk of infection
Yes
Yes
No
No
Yes
No
No
Yes
No
No
Yes
Notes for hemiarthroplastly
Avoid hyper extension
Weight bearing 6-12 weeks
No bathing/driving 4-6 weeks
Occupational therapist
Physical therapy exercise & ambulate
What are the complications that can occur with hip fracture?(5)
Notes
Provide psychosocial support as well
Nonunion
Avascular necrosis
Dislocation
- suddenly pain or lump
- treat with closed reduction
Osteoarthritis
Shorter leg
Notes
Nursing management hip fracture
Ambulatory care
Rehabilitation
Home health care with PT
Pain management
Monitor infection
Prevent VTE
Exercise with PT
Home safety to prevent falls
Evulation
Expected outcomes
Report pain relief
No complications
Exercise therapy
Notes
Gerontologic considerations
Risk for falling
- altered center of gravity
- decrease fat and muscle
- decrease skeletal strength
- gait and balance problems
- altered vision and hearing
- slower reflexes
- Orthostatic hypotension
- medication use
Notes
Gerontologic considerations
Hip fractures
Home safety
- eliminate tripping hazard
- add grab bars in and out of showers
- railings on both sides of stairs
- good lighting
- extrenal hip protectors
- vitamin D and calcium
- Bisphosphonates drug
What is amputation and it’s often done for?
Removal of limb
Often done for PVD
Diagnostics for amputation is?
Assessment of blood flow
Sensation
Skin integrity
What is the goal of amputation ?
Preserve greatest length and function of extremity
What is disarticulation?
Amputation through a joint
Notes
Closed amputation
- weight bearing stump
- suture line is posterior
Open amputation
- left open to left infection clear
- second surgery to close later
Notes
Nursing assessments
- assess for preexisting illnesses
- assess vascular and neurologist conditions
Nursing diagnosis
- disturbed body image
- impaired tissue integrity
- chronic pain
- impaired mobility
Planning
- have adequate relief
- have pain relief
- reach maximum rehabilitation
- cope with body image
- satisfying lifestyle adjustments
Implantation
- monitor for PSTD
- monitor for Infection, hemorrhage
If hemorrhage occur
- have a tourniquet available
- partial weight bearing
- permanent prosthesis ( extra leg ) 3 months after amputation if no problems
- no prosthesis : wheelchair usage
Patients who are amputated may feel phantom limb sensation which is?
This can subside or be chronic
But we typically use what Therapy in order to help them?
Shooting burning or crushing pain and feelings of coldness heaviness and cramping
Even though nothing is there
Mirror therapy- visual information replaces sensory feedback
Notes
Post operatives
Active ROM & strengthening exercises
Crutch walking
Patient education
Rehabilitation
- success depends on physical and emotional health
- PT and OT involvement
- Flexion contractures delay
- proper bandaging
Ambulatory care
- prosthesis fitting : molded and measures
- avoid skin breakdown
- care and cleaning
- regular maintenance
Special consideration in upper limb amputations
Have an emotional implications why?
Because they don’t replace moment and functional capacity
Which leads to depression and frustrations
Notes
Gerontologic considerations
Amputation
Lower limb : previous ability affect recovery
Significant strength and energy
40% below the knee
60% above the knee
Talk realistic expectations
Amputation evaluation (4)
Accpeted body image
No skin breakdown
No pain
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