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NCLEX - HURST REVIEW (Orthopedics) > Fractures > Flashcards

Fractures Flashcards

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1
Q

What are signs and symptoms of Fractures ?

A
  • 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)
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2
Q

What are the Tx’s for Fractures ?

A
  • 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
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3
Q

What do you do with Open Fractures ?

A

Preferably cover with something sterile

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4
Q

What does a Neurovascular check consist of ?

A
  • Pulses
  • Color
  • Movement (neuro)
  • Sensation (neuro)
  • Capillary refill
  • Temperature (vascular status)
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5
Q

What are complications of Fractures ?

A
  • Shock
  • Fat embolism
  • Compartment syndrome
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6
Q

Shock depends on what ?

A

Depends on the amount of trauma and type of injury

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7
Q

Shock is a potential complication specifically with what ?

A
  • Pelvic fractures
  • Crushing fractures
  • Multiple long bone fractures
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8
Q

With what types of Fractures do you see Fat embolisms ?

A

The same fractures that can lead to shock

  • Long bones (femur)
  • Pelvic fractures
  • Crushing injuries
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9
Q

What are the signs and symptoms of a Fat emboli ?

A

Symptoms depend on where the fat embolus goes

  • Petechiae or rash over the chest
  • Conjunctival hemorrhages
  • Snow storm on CXR (or “patchy infiltrates”)
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10
Q

When are clients at greatest risk for a fat emboli ?

A

First 36 hours (then at risk for DVT after that)

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11
Q

Who is at greatest risk for a fat emboli and why ?

A

Young males d/t risky behavior

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12
Q

What do you want to try and prevent in clients with Fractures ?

A

Compartment Syndrome

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13
Q

What is compartment syndrome ?

A

Increased pressure within a limited space

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14
Q

What is the Pathophysiology of Compartment Syndrome ?

A
  • 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
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15
Q

What are the common areas with Compartment Syndrome ?

A

Forearms & Quadriceps

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16
Q

If Compartment Syndrome goes undetected, what may result ?

A

May result in Nerve damage and possible amputation

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17
Q

True or False:

You can develop Compartment Syndrome with any type of Trauma ?

A

True

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18
Q

What are the Treatment’s for Compartment Syndrome ?

A
  • 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
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19
Q

With Cast saws what do you want to explain to the client ?

A

That the saw does not touch the skin, but it does vibrate

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20
Q

What is a Fasciotomy ?

A

The PHP cuts down into the tissue to relieve pressure and restore circulation

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21
Q

Cast care:

How do you want to care for Plaster Casts ?

A
  • 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
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22
Q

What do you do if your client with a cast reports pain ?

A

NEUROVASCULAR CHECKS!

  • most pain is relieved by elevation, cold packs, and analgesics. IF THESE THINGS DO NOT RELIEVE THE PAIN…..THINK COMPLICATION!
23
Q

How long does it take for Fibergalss Casts to dry ?

A

Dry within 30 minutes

24
Q

Why are the advantages to Fiberglass casts ?

A
  • Lightweight
  • Waterproof
  • Stronger than plaster casts
  • Different colors
25
Q

X-ray imaging is higher quality with what type of casts ?

A

Fiberglass casts

26
Q

Fiberglass casts allow the client to do what earlier ?

A

Bear weight earlier

27
Q

What is the Disadvantage with Fiberglass Casts ?

A

They are difficult to mold and contour

28
Q

Fiberglass casts are primarily used for what ?

A

Simple fractures

29
Q

How does Traction work ?

A

Uses a pulling force to reduce (align things) and immobilize fractures

30
Q

What is the goal with Traction ?

A
  • To reduce muscle spams & pain
  • Realign the bones
  • Prevent deformities
31
Q

Should skeletal tractions be intermittent or continuous ?

A

Continious

32
Q

With Traction, how should weights hang ?

A

Freely! - and NOT rest on the bed or floor

33
Q

How do you want to keep a client in bed who has Traction ?

A

Keep client pulled up in bed and centered with good alignment

34
Q

What should you exercise in a client in tractions ?

A

Exercise the non-immobilized joints

35
Q

The ropes in traction should do what ?

A

Move freely and knots should be secure

36
Q

Special mattresses such as what can be used with Traction ?

A

Air filled OR high density foam mattresses

37
Q

What do you want to prevent in a client with Traction ?

A

Foot drop

can utilize things like a foot drop boot or high top shoe

38
Q

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 -
A
39
Q

What are the 2 types of Traction ?

A
  • Skin traction

- Skeletal traction

40
Q

When is Skin Traction used ?

A

Used SHORT term to relieve muscle spasms and immobilize until surgery

41
Q

How does skin traction used ?

A

This is when tape, a boot, splint, or some type of material is applied directly to the skin and the weights pull against it

42
Q

Is the skin penetrated with Skin traction ?

A

No

43
Q

What is a common type of Skin traction ?

A

Buck’s traction

44
Q

What is Buck’s traction used with ?

A

Hip & Femoral fractures

45
Q

With Skin traction, what must you do ?

A

Good skin assessments (at least 3x a day)

  • Ankle and achilles tendon area
46
Q

How is Skeletal traction applied ?

A

Applied directly to the bone with pins and wires

47
Q

When is Skeletal Traction used ?

A

Used when PROLONGED TRACTION is needed

48
Q

What are types of Skeletal Traction ?

A
  • Steinman pins
  • Crutchfield
  • Gardner
  • Wells tongs
  • Halo vest
49
Q

How frequently must you assess the pin sit in a client with Skeletal Traction ?

A

Every 8 hours

50
Q

When does Pin care begin in a client with Skeletal Traction ?

A

48 to 72 hours after insertion (perform daily)

51
Q

Does Skeletal Traction require sterile technique ?

A

Yes

52
Q

Is Serous (clear) drainage okay in Skeletal Traction ?

A

Yes

53
Q

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 ?

A
  1. ) Immobilize their leg

2. ) Next, you would call the Primary Healthcare Provider

NCLEX - HURST REVIEW (Orthopedics) (3 decks)

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