Fractures Flashcards
What are signs and symptoms of Fractures ?
- Pain and Tenderness
- Unnatural movement
- Deformity (possible)
- Shortening of extremity (d/t muscle spasms)
- Crepitus (bones grating together)
(can be a feeling or a sound) - Swelling
- Discoloration
- Worry about Compartment Syndrome!!
(can loose extremity)
What are the Tx’s for Fractures ?
- Immobilize the bone ends plus the adjacent joints
- Support fracture above and below site
- Move extremity as little as possible
(All of the above prevent further injury) - Splints (help prevent fat emboli and muscle spasms)
- Neurovascular checks!!
- Open fracture = perferably cover with something sterile
What do you do with Open Fractures ?
Preferably cover with something sterile
What does a Neurovascular check consist of ?
- Pulses
- Color
- Movement (neuro)
- Sensation (neuro)
- Capillary refill
- Temperature (vascular status)
What are complications of Fractures ?
- Shock
- Fat embolism
- Compartment syndrome
Shock depends on what ?
Depends on the amount of trauma and type of injury
Shock is a potential complication specifically with what ?
- Pelvic fractures
- Crushing fractures
- Multiple long bone fractures
With what types of Fractures do you see Fat embolisms ?
The same fractures that can lead to shock
- Long bones (femur)
- Pelvic fractures
- Crushing injuries
What are the signs and symptoms of a Fat emboli ?
Symptoms depend on where the fat embolus goes
- Petechiae or rash over the chest
- Conjunctival hemorrhages
- Snow storm on CXR (or “patchy infiltrates”)
When are clients at greatest risk for a fat emboli ?
First 36 hours (then at risk for DVT after that)
Who is at greatest risk for a fat emboli and why ?
Young males d/t risky behavior
What do you want to try and prevent in clients with Fractures ?
Compartment Syndrome
What is compartment syndrome ?
Increased pressure within a limited space
What is the Pathophysiology of Compartment Syndrome ?
- Fluid accumulates in the tissue and impairs tissue perfusion
- The muscle becomes swollen and hard and the client reports severe pain that IS NOT RELIEVED WITH PAIN MEDS
- The pain is disproportionate to the injury
- Common areas = forearms and quadriceps
What are the common areas with Compartment Syndrome ?
Forearms & Quadriceps
If Compartment Syndrome goes undetected, what may result ?
May result in Nerve damage and possible amputation
True or False:
You can develop Compartment Syndrome with any type of Trauma ?
True
What are the Treatment’s for Compartment Syndrome ?
- If they have a cast –> loosen the cast to restore circulation
- Cast cutters to remove or loosen the cast
- Cast saws
- Fasciotomybe careful in picking the answer “remove cast” as it could cause more injury
With Cast saws what do you want to explain to the client ?
That the saw does not touch the skin, but it does vibrate
What is a Fasciotomy ?
The PHP cuts down into the tissue to relieve pressure and restore circulation
Cast care:
How do you want to care for Plaster Casts ?
- Place ice packs on the side of the cast for the first 24hrs (b/c cast is still wet)
- Prevent indentations (can cause pressure sore)
- Use palms of hands for first 24 to 72 hours
- Do not use fingertips (will cause indentation in cast) - Keep the cast uncovered and allow for air-drying
- Do not rest on hard surface or sharp edge
- Rest cast on soft pillow (NO plastic)
- Mark breakthrough bleeding (circle area, date and time site)
- Cover cast close to groin with plastic (once the cast is dry)
- Neurovascular checks with the 5 p’s
What do you do if your client with a cast reports pain ?
NEUROVASCULAR CHECKS!
- most pain is relieved by elevation, cold packs, and analgesics. IF THESE THINGS DO NOT RELIEVE THE PAIN…..THINK COMPLICATION!
How long does it take for Fibergalss Casts to dry ?
Dry within 30 minutes
Why are the advantages to Fiberglass casts ?
- Lightweight
- Waterproof
- Stronger than plaster casts
- Different colors
X-ray imaging is higher quality with what type of casts ?
Fiberglass casts
Fiberglass casts allow the client to do what earlier ?
Bear weight earlier
What is the Disadvantage with Fiberglass Casts ?
They are difficult to mold and contour
Fiberglass casts are primarily used for what ?
Simple fractures
How does Traction work ?
Uses a pulling force to reduce (align things) and immobilize fractures
What is the goal with Traction ?
- To reduce muscle spams & pain
- Realign the bones
- Prevent deformities
Should skeletal tractions be intermittent or continuous ?
Continious
With Traction, how should weights hang ?
Freely! - and NOT rest on the bed or floor
How do you want to keep a client in bed who has Traction ?
Keep client pulled up in bed and centered with good alignment
What should you exercise in a client in tractions ?
Exercise the non-immobilized joints
The ropes in traction should do what ?
Move freely and knots should be secure
Special mattresses such as what can be used with Traction ?
Air filled OR high density foam mattresses
What do you want to prevent in a client with Traction ?
Foot drop
can utilize things like a foot drop boot or high top shoe
TESTING STRATEGY:
NEVER release traction (unless you’ve got a primary healthcare provider’s Prescription)
- b/c releasing it will cause muscle spasms, pain, and potential injury -
What are the 2 types of Traction ?
- Skin traction
- Skeletal traction
When is Skin Traction used ?
Used SHORT term to relieve muscle spasms and immobilize until surgery
How does skin traction used ?
This is when tape, a boot, splint, or some type of material is applied directly to the skin and the weights pull against it
Is the skin penetrated with Skin traction ?
No
What is a common type of Skin traction ?
Buck’s traction
What is Buck’s traction used with ?
Hip & Femoral fractures
With Skin traction, what must you do ?
Good skin assessments (at least 3x a day)
- Ankle and achilles tendon area
How is Skeletal traction applied ?
Applied directly to the bone with pins and wires
When is Skeletal Traction used ?
Used when PROLONGED TRACTION is needed
What are types of Skeletal Traction ?
- Steinman pins
- Crutchfield
- Gardner
- Wells tongs
- Halo vest
How frequently must you assess the pin sit in a client with Skeletal Traction ?
Every 8 hours
When does Pin care begin in a client with Skeletal Traction ?
48 to 72 hours after insertion (perform daily)
Does Skeletal Traction require sterile technique ?
Yes
Is Serous (clear) drainage okay in Skeletal Traction ?
Yes
NCLEX CRITICAL THINKING EXERCISE:
You are assessing a client with Steinman pins in their leg. During assessment you notice that one of the pins has fallen out and is lying on the bed. What are you going to do ?
- ) Immobilize their leg
2. ) Next, you would call the Primary Healthcare Provider
