Finals sir Erich_ fractures And Complications Flashcards
any disruption in the continuity of the bone, when more stress is placed on it than it can absorb
Fractures
compound or complex) break in tissue over site of the bone injury
Open fracture
break across entire cross-section of bone & often displaced
Complete Fracture
(greenstick) though only part of the cross-section
Incomplete Fracture
: (simple) intact skin over site of injury
Closed Fracture
produces several bone fragments
Comminuted
Characterized by neurologic dysfunction, pulmonary insufficiency, and petechial rash on chest, axilla & upper arms
FAT EMBOLISM SYNDROME
Age of people having complication of fat embolism
Age 20-30 yrs old
Manifestations of fat emboli occur within 24-72 hours but may be up to a week after injury:
Hypoxia PaO2 < 60 mm Hg
Tachypnea, tachycardia, pyrexia
Deterioration in LOC
Confusion , agitation
Respiratory distress response – tachypnea, dyspnea, crackles, wheezes, precordial chest pain, copious thick white sputum, tachycardia petechiae: chest, shoulders, axilla, mouth, conjunctival sac
Preventionof Fat Embolism
Immobilize fractures: early & gentle stabilization
Gentle care
Adequate hydration
O2
Aware of those at high risk
Management for Fat Embolism
O2
Fluid replacement Mechanical ventilation Corticosteroids
Vasoactive medications Maintain Hgb
Calm, supportive environme
Fat Embolism Nursing Responsibility
MONITOR RESPIRATORY STATUS EVERY SHIFT.
Fifty percent (50%) of persons with fat emboli die.
Complications for Fat embolism
Infection
Drainage
Unpleasant Odor
Sudden increased temp
HOT SPOT felt
Osteomyelitis
Classic symptom of deep vein thrombosis.
Note the unilateral right leg swelling. especially at thigh and calf
at thigh
and calf.
What helps for fat embolism?
Bed cradle
Heat
Avoid heavy sedation
Avoid pressure in popiteal space Minimize compression
Active & passive exercises as ordered Frequent change in position
COMPLICATION OF FRACTURE
Shock and Blood Loss
usually done under anesthesia Carried out through manual traction to move fracture fragments & restore bone alignment Followed by immobilization device (cast)
Closed reduction
incision and realignment Usually performed with internal fixation devices (screws, pins, plates, wires)
Open Reduction
maintain position for unstable fractures & for weakened muscles, allow for use of contiguous joints while affected part remains immobilized. Common sites include face & jaw, pelvis, fingers.
External Fixation
application of a pulling force to an injured body part or extremity while a counter-traction pulls in the opposite direction.
Traction
Types of internal fixation
Tension band Wiring #phalanx
Compression plate & screw # femur
An abdominal flat-plate is ordered.
This is due to an extrinsic compression of
the third portion of the duodenum by the superior mesenteric artery
CAST SYNDROME
Windows maybe cut in dried casts:
- relieve pressure from abd. distension (body cast)
- To prevent “Cast Syndrome”
- To assess radial pulse (check circulation in a casted arm)
- To inspect areas of discomfort or areas of suspected
tissue damage - To remove drains or care for wounds.
Cast Drying Time
Synthetic casts - 20-30mins
Plaster casts - set rapidly but take several hrs to days to completely dry
Traction applied to an extremity puts pressure on the peroneal nerve where it passes around the neck of the fibula to just below the knee.
● Pressure at this point may cause________, leading to inability to_________ the foot.
Cause footdrop
dorsiflex the food
Inability to plantarflex indicates damage to the_________
tibial nerve.
Edema from a fracture causes an increase in compartmental pressure that decreases capillary blood perfusion.
When the local blood supply unable to meet tissue metabolic demands ischemia begins = compromised circulation.
Increase pressure in a confined space due to tight cast, edema or bleeding.
Compartmental Syndrome:
COMPARTMENT SYNDROME TREATMENT
Fasciotomy
Bloating feeling
-Prolonged nausea: repeated vomiting
- Abdominal distension: vague
abdominal pain
-Shortness of breath
-Untreated may lead to death!
Cast Syndrome
A common complication of elbow fractures
May lead to permanently stiff, claw-like deformity of arm & hand
Volkmann’s
KNOW THE SIX PS: CAST ASSESSMENT
● Pain
● Pallor
● Paresthesia
● Pulselessness ● Paralysis
● Polar
Neuro-vascular problems
Monitor neurovascular status of distal aspects of involved extremities in comparison with corresponding body part after the initial post op period & every 2 hours for the following 24 hours and every 4 to 12 hours thereafter
Irreversible tissue death occurs in______
4 to 12 hours..
Hemorrhage
Stage 1 = 15% = 750ml
Stage 2 = 15-30% = 1,500ml (subtle sign)
Sage 3 = 30-40%1,500- 2,000ml
(Obvious sign)
Stage 4= 40% >2,000
Powerful involuntary muscle contractions shorten the flexor muscles & cause extreme pain. This may be triggered by hypoxia of muscle tissue.
MUSCLE SPASM
INTERVENTION: DVT/PE/FES
▪ Client wears elastic stockings.
▪ Teach leg exercises.
▪ Observe for changes in mental status, chest
pain and SOB.
▪ Observe for swelling, redness and pain in legs
(DO NOT MESSAGE).
▪ Fat embolism is the most lethal complication of
Stage I
15%
( up to 750ml)
Stage II
15-30%
(Up to 1500ml) subtle sign
Stage III
30-40%
(1500-2000ml)- obvious shock
Srage IV
40%
(over 2000ml)
●
● ●
● ● ●
●
●
Bones are very vascular. In combination with collateral damage to adjacent structures/vessels, the patient is at risk for hemorrhage.
Shock fully develops if a healthy client looses 1/3 of normal blood volume.
7 - 8% of body wt is blood. An adult hasabout5.5Lof blood.
10% volume loss = tachycardia
30% loss affects B.P
1 unit of packed cells raises Hgb about 1 gram. Check with physician about expected normal loss.
POTENTIAL BLOOD LOSS FOLLOWING FRACTURES (LITERS)
This is not what is expected but what is possible!
Check with surgeon to determine extent of expected blood loss
THR.
healing of the bone occur by interstitial groeth of bone in rigid fixation by plate or nai
Primary healing of fracture
healing occurs with adequate callus information both interstitial and surroundings, when micro movement occur in stable fixation by POP , cast, locking, plate external fixation.
Secondary fracture healing
FRACTURE HEALING OPERATIVE
Reduction and compression
- primary bone healing
- process rehabilitation rapid high risk
Niling or external fixtion
- healing by cllus
- rapid process rehailitation rapid lesser risk
