Exam 1 Material : Fractures

Question 1

True or false? Fractures are mostly caused by injury but some can be caused by pathologic illnesses?

Answer 1

True. Cancer and osteoporosis can cause fractures

Question 2

What are the different types of fractures?

Answer 2

Open/Compound fracture = Bone is exposed and skin is broken

Transverse = horizontal fracture

Spiral = fracture caused from twisting motion

Greenstick = Fracture is splintered and not complete. Common in pediatric

Comminuted = lots of bone fragments. Bone is crushed.

Oblique = Fracture is on an angle.

Stress fracture = Pathologic. Occurs in the foot. Lost of weight and repeated stress on the toe bone.

Question 3

What are the clinical manifestations of fractures?

Answer 3

Pain, edema, ecchymosis, muscle spasms.

Deformity, crepitation (crunching noises of bone fragments rubbing other bone fragments), loss of function

Question 4

What are the steps of Fracture Healing?

Answer 4

Hematoma (within 72 hours)

Granulation tissue (3-14 days after)

Callus formation (2 weeks after)

Ossification (3 weeks-6 months)

Consolidation ( up to 1 year after)

Remodeling (complete bone reunion)

Question 5

What diagnostic tests can be done for Fractures?

Answer 5

X-ray, CT, MRI

Question 6

For the average fracture, fracture reduction is used in order properly align the bones as they heal. What are the type of reductions?

Answer 6

Closed reduction (manual realignment of bone)

Open reduction internal fixation (ORIF) (surgical reduction)

Question 7

What are the nursing considerations for Fractures?

Answer 7

DVT, pneumonia, pressure ulcers

Question 8

What do tractions do?

Answer 8

Helps improve bone alignment, reduce muscle spasms and improves circulation

Question 9

What is a possible complication from open fractures?

Answer 9

Fat emboli.

Look for signs of infection and SOB for post-op open fracture patients.

Question 10

What care should be done for open fractures?

Answer 10

Surgical debridement (clean the wound)

Prophylactic antibiotics

Tetanus immunization and immobilization

Question 11

What care can be done if the fracture has to be immobilized?

Answer 11

Casts

Knee immobilizer

External Fixation (pins, rods and screws) (used when multiple procedures are needed to realign the bone)

Question 12

What are the signs of Compartment Syndrome for Patients with a Cast on?

Answer 12

Pale and cool skin

Diminished pulses

Out of proportion pain

Question 13

What should be done if signs of Compartment Syndrome appears?

Answer 13

Call orthopedic surgeon for a fasciotomy

Question 14

What care should be done if a patient has a traction on?

Answer 14

Skin assessments, pin-site care, check weights and anatomical position

PAIN MANAGMENT = NSAIDS for mild pain or OPIOIDS for severe pain

ROM exercises

ADL assistance and bedpan

Neuorvascular Assessments

Question 15

What is included in the Neurovascular assessments?

Answer 15

the 5 P’s

Pain 
Pulse
Pallor 
Paresthesia 
Paralysis

Question 16

What care should be done for patients with a cast?

Answer 16

Neurovascular assessments

Elevate extremity

ROM exercises

If itchy, use hair dryer on cool setting. DO NOT STICK ANYTHING DOWN IN CASE

Question 17

What are the signs of complications a patient with a cast on should report to their physician?

Answer 17

Tingling under the cast

Discoloration of the skin

Swelling

Excess pain

Changes of color or sensitivity of temperature on the tips of their fingers or toes

Any foul smells from the cast.

Question 18

What are things that a patient with a cast SHOULD NOT do?

Answer 18

Get the cast wet

Remove padding on cast

Insert objects in the cast

Bear weight on cast for first 48 hours

Cover cast with plastic for a long period of time

Question 19

What are the symptoms of Hip fractures?

Answer 19

External rotation (affected leg is rotated outward and shortened. Can be tender, bruised, and painful at site)

Muscle spasms

Severe pain

Question 20

True or false. Hip fractures are more common in women due to their increased risk for osteoporosis?

Answer 20

True

Question 21

Where do Hip Fractures occur?

Answer 21

upper third of femur

Question 22

What is the Pre-op procedure for hip fractures?

Answer 22

Buck’s traction until physical condition becomes stable for surgery

Question 23

What care needs to be done for Hip fracture patients?

Answer 23

Neurovascular assessments

Prevent dislocation

Question 24

How can a nurse prevent dislocation for a Hip fracture patient?

Answer 24

Pillows or abductor pillow between legs when turning.

Don’t let legs cross over midline or a hip flexion greater than 90 degrees

Towel rolls or pillows placed on lateral side of legs

Avoid turning the patient on affected side until approved by surgeon

Keep the hip in neutral, straight position.