Exam 1 Material : Fractures Flashcards
True or false? Fractures are mostly caused by injury but some can be caused by pathologic illnesses?
True. Cancer and osteoporosis can cause fractures
What are the different types of fractures?
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.
What are the clinical manifestations of fractures?
Pain, edema, ecchymosis, muscle spasms.
Deformity, crepitation (crunching noises of bone fragments rubbing other bone fragments), loss of function
What are the steps of Fracture Healing?
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)
What diagnostic tests can be done for Fractures?
X-ray, CT, MRI
For the average fracture, fracture reduction is used in order properly align the bones as they heal. What are the type of reductions?
Closed reduction (manual realignment of bone)
Open reduction internal fixation (ORIF) (surgical reduction)
What are the nursing considerations for Fractures?
DVT, pneumonia, pressure ulcers
What do tractions do?
Helps improve bone alignment, reduce muscle spasms and improves circulation
What is a possible complication from open fractures?
Fat emboli.
Look for signs of infection and SOB for post-op open fracture patients.
What care should be done for open fractures?
Surgical debridement (clean the wound)
Prophylactic antibiotics
Tetanus immunization and immobilization
What care can be done if the fracture has to be immobilized?
Casts
Knee immobilizer
External Fixation (pins, rods and screws) (used when multiple procedures are needed to realign the bone)
What are the signs of Compartment Syndrome for Patients with a Cast on?
Pale and cool skin
Diminished pulses
Out of proportion pain
What should be done if signs of Compartment Syndrome appears?
Call orthopedic surgeon for a fasciotomy
What care should be done if a patient has a traction on?
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
What is included in the Neurovascular assessments?
the 5 P’s
Pain Pulse Pallor Paresthesia Paralysis
What care should be done for patients with a cast?
Neurovascular assessments
Elevate extremity
ROM exercises
If itchy, use hair dryer on cool setting. DO NOT STICK ANYTHING DOWN IN CASE
What are the signs of complications a patient with a cast on should report to their physician?
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.
What are things that a patient with a cast SHOULD NOT do?
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
What are the symptoms of Hip fractures?
External rotation (affected leg is rotated outward and shortened. Can be tender, bruised, and painful at site)
Muscle spasms
Severe pain
True or false. Hip fractures are more common in women due to their increased risk for osteoporosis?
True
Where do Hip Fractures occur?
upper third of femur
What is the Pre-op procedure for hip fractures?
Buck’s traction until physical condition becomes stable for surgery
What care needs to be done for Hip fracture patients?
Neurovascular assessments
Prevent dislocation
How can a nurse prevent dislocation for a Hip fracture patient?
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.
