Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

NURS 347 EXAM 6 > Complications Of Fractures Pt 1 > Flashcards

Complications Of Fractures Pt 1 Flashcards

1
Q

Majority of fracture heal without complication
However those that do, what requires an immediate attention? (2)

And death is usually from result of (2)

A

Open fracture with blood loss
Fractures that damage organs

Damage to underlying organs complications of fracture/immobility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Complications of fractures can be direct or indirect
Examples being?

A

Direct
Bone infection
Avascular necrosis

Indirect
- compartment syndrome
VTE
Fat embolism
Rhabdomyolysis
Hypovolemic shock

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Infection is the highest incidence in open fractures so ___is key!

And we may give them what to help ?

A

Prevention

Antibiotics!!
Irrigate, impregnated beads, Iv

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is compartment syndrome?

Which also comprises what?

A

Swelling and increased pressure within a limited space ( muscle compartment)

Neurovascular function of tissue writhing that space

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

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 ?

A

38
Fractured with extensive tissue damage and crush injury

Distal humorous and proximal tibia

Knee or leg
Pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the 2 causes of compartment syndrome?

A

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 well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How does edema effect compartment syndrome?

Arterial flow compromised ->
Ischemia ->
Cell death ->
Loss of function

A

Causes pressure that obstructs circulation and venous occlusion leads to that edema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

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?

A

Recognition
Irreversible damage

Delayed

4-8hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the clinical manifestations of compartment syndrome ?
6Ps

A

Pain
Pressure
Paresthesia
Pallor
Paralysis
Pulseless

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Interprofessional care for compartment syndrome

The most important thing a nurse should do is?

A

Prompt accurate diagnosis via regular neurovascular assessment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are early signs of compartment ?(3)

A

Notify pain unrelieved by drugs
Paresthesia
Reliving the source of pressure may prevent progression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the 3 late signs of compartment syndrome?

A

Pulselessness
Paralysis
May require amputation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

If compartment syndrome is suspected what are the (2)most important things to not do?
And why?

A

Do not elaborate above heart
Do not apply cold compresses/ice

This causes vasoconstriction and reduced circulation to already compromised extremity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How do you treat compartment syndrome ? (3)

A

Relive pressure
Surgical decompression ( fasciotomy )
Amputation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is a fasciotomy ?

It’s super important to try reduce the risk of?

A

A surgical decompression that is left open for several days to allow adequate soft tissue decompression

Infection!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Notes
Venous thromboembolism
High susceptibility due to inactivity of muscles

You want to use antiemovolism stocking

ROM exercise
Anticoagulants

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is fat embolism?

Notes
Most common with fracture of long bones, ribs, tibia and pelvis
( spinal fusion, liposuction, bone marrow transplants )

A

Systemic fat globules from fracture that are distributed into tissues( circulatory system ) and organs
( brain and lungs )

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

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 ?

A

ARDS

Chest pain
Tachypnea & cardia
Cyanosis
Dyspnea
Apprehension
Hypoxemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the distinguishing manifestation of fat embolism syndrome ?

A

Petechia on neck, chest wall, axillar, buccal

Conjunctiva

20
Q

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

A

Rapid and acute
Cyanosis

Increased ESR ( high erythrocyte sedimentation rate )

21
Q

What is the prevention of FES? (2)

A

Careful immbolization & handling of long bones
- reposition as little as possible prior to immbolization and stabilization to prevent dislodging fat droplets into circulation

22
Q

What are the 3 types of fractures ?

A

Colles
Humeral shaft
Pelvic

23
Q

What is a Colles fracture?
Occurs how?
Age ?
Consider doing what below that age ^?

A

Distal radial fracture
Occurs during fall with outstretched arms
Above 50 years
Consider osteoporosis evaluation if younger

24
Q

What is a humeral shaft fracture?

You want to protect ___ from ___ and skin breaks down due to immbolization devices

What should do during healing?

A

Shaft damage
( Complications including radial nerve injury, brachial artery injury)

Axilla from moisture

Exercise shoulders hands and fingers

25
Q

What is a pelvic fracture associated with?
Caused what?

Notes
- stable nondisplaced fracture require rest, complex fracture require fixation

A

Rare but associated with high dead rate

Abdominal injury
Laceration/hemorrhage of abdominal structures

26
Q

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 !!

A
27
Q

What is the initial treatment for a hip fracture?

A

Bucks traction

28
Q

If bucks traction can’t help, we can do a surgery to help repair the hip (4)

What the 4 surgeries

A

Closed reduction
Rapid with internal fixation
Hemisrthroplasty
Totals hip replacement

29
Q

Notes postoperative care

General post ip care
Elevate leg
Maintain limb alignment with pillows when turning to non operative site
Trapeze
Physical therapy
Exercise

A
30
Q

Hemiarthroplastly or THR by posterior approach
The main goal is to?

A

Precent dislocation

31
Q

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

A

Yes
Yes
No
No
Yes
No
No
Yes
No
No
Yes

32
Q

Notes for hemiarthroplastly

Avoid hyper extension
Weight bearing 6-12 weeks
No bathing/driving 4-6 weeks
Occupational therapist
Physical therapy exercise & ambulate

A
33
Q

What are the complications that can occur with hip fracture?(5)

Notes
Provide psychosocial support as well

A

Nonunion
Avascular necrosis
Dislocation
- suddenly pain or lump
- treat with closed reduction
Osteoarthritis
Shorter leg

34
Q

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

A
35
Q

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

A
36
Q

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

A
37
Q

What is amputation and it’s often done for?

A

Removal of limb
Often done for PVD

38
Q

Diagnostics for amputation is?

A

Assessment of blood flow
Sensation
Skin integrity

39
Q

What is the goal of amputation ?

A

Preserve greatest length and function of extremity

40
Q

What is disarticulation?

A

Amputation through a joint

41
Q

Notes
Closed amputation
- weight bearing stump
- suture line is posterior

Open amputation
- left open to left infection clear
- second surgery to close later

A
42
Q

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

A
43
Q

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?

A

Shooting burning or crushing pain and feelings of coldness heaviness and cramping

Even though nothing is there

Mirror therapy- visual information replaces sensory feedback

44
Q

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

A
45
Q

Special consideration in upper limb amputations
Have an emotional implications why?

A

Because they don’t replace moment and functional capacity

Which leads to depression and frustrations

46
Q

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

A
47
Q

Amputation evaluation (4)

A

Accpeted body image
No skin breakdown
No pain
Mobile

NURS 347 EXAM 6 (17 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions