Fracture

Question 1

What does an open v closed fracture determine?

Answer 1

Whether the patient is at increased risk for infection

Question 2

What does the direction (linear, oblique, transverse, longitudinal, spiral) tell us about the fracture?

Answer 2

The forces applied to cause fracture

Question 3

5 Stages of Bone Healing

Answer 3

1. hematoma formation: caused by bleeding at ends of bones (72 hours)
2. Organization of hematoma into fibrous network
3. Invasion of osteoblasts, lengthening of collagen, and deposition of calcium
4. Callus formation
5. Callus reabsorption and bone remodelling

Question 4

What are the 4 collaborative care goals of treatment for a fraction patient?

Answer 4

1. reduction (closed, open, traction)
2. immobilization (casts, fixation, traction)
3. drug therapy (pain and infection
4. improve mobility

Question 5

Priority Assessments for Fracture patient?

Answer 5

1. Pain - (PQRSTU)
2. Neurovascular (CSM)
3. Peripheral Vascular (colour, temperature, capillary refill, pulses, edema)
4. Peripheral Neurological (sensation, motor, pain)

Question 6

What abnormal lab values would you expect from a fracture patient?

Answer 6

Low HgB: Post operative anemia
High WBC: elevated following surgery
ESR/CRP: inflammatory markers

Question 7

4 Priorities for fracture patients/key things to monitor?

Answer 7

1. acute pain
2. decreased mobility
3. potential for NV compormise r/t altered perfusion
4. infection r/t altered tissue integreity

Question 8

Nurse management of casts:

Answer 8

1. frequent NV checks to assure cast is not too tight
2. ice and elevation for first 24-48hr
3. report breaks in cast integrity

Question 9

Nurse management of traction care:

Answer 9

1. ensure proper functioning equipment
2. inspect skin around slings/pins

Question 10

Nurse pharmacological management for fractures:

Answer 10

1. pain control
2. opioid monitoring r/t timing of administration

Question 11

Nurse management related to wound care for fractures:

Answer 11

1 dressing changes

2. patient education

Question 12

Describe 5 points of general postoperative care

Answer 12

1. vitals
2. focussed assessment
3. assess dressings/casts for bleeding/drainage
4. prevent complications of immobility through deep breathing/coughing and repositioning
5. NVC

Question 13

5 Complications of Fractures

Answer 13

1. Bone non-union
2. Infection
3. Venous Thrombosis
4. Fat Embolism Syndrome
5. Compartment Syndrome

Question 14

What can bone infection lead to?

Answer 14

Osteomyelitis and avascular necrosis

Question 15

What causes venous thrombosis in fracture patients?

Answer 15

Venous stasis caused by incorrectly applied casts/traction placing local pressure on a vein
OR
immobility

Question 16

What causes fat embolism syndrome in fracture patients?

Answer 16

fat droplets leak from fractured bone & embolize to the lungs

Question 17

6 P’s of Compartment Syndrome

Answer 17

o Paresthesia (unrelieved by narcotics): numbness and tingling
o Pain (unrelieved by narcotics)
o Pressure
o Pallor (loss of normal colour/coolness)
o Paralysis
o Pulselessness (↓ or absent pulses)

Question 18

If a patient is experiencing compartment syndrome, what are the nursing actions?

Answer 18

1. compare extremities
2. assess peripheral pulses (would be absent)
3. urine would indicate myoglobinuria r/t rhabdo
4. do not apply ice or elevate above heart
5. loosen bandage/remove
6. reduce traction
7. fasciotomy