Fractures Flashcards

1
Q

What are the types of fractures?

A

Transverse, Spiral, Greenstick, Comminuted, Oblique, Pathologic, Stress

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2
Q

Fractures: Emergency care

A
Assess: Airway, Breathing, Head injury
Splint fracture
Immobilization
Maintain body alignment
Elevate body part
Apply cold pack 1st 24 hours
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3
Q

What are the three goals of fracture treatment?

A

Reduce
Immobilize
Restore function

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4
Q

What does it mean to reduce a fracture?

A

Replace bone fragments in the correct anatomical position

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5
Q

What are the two types of reduction

A

Closed reduction and Open reduction

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6
Q

What is a closed reduction?

A

Non surgical, manual realignment of bone fragments

Local anesthesia is used

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7
Q

What is open reduction?

A

Surgical reduction. Nails, screws and plates often used

Also called “Open reduction with internal fixation”

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8
Q

What is the purpose of immobilization?

A

To hold broken bones together until healing takes place.

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9
Q

What are the different types of external immobilization devices?

A
Cast 
Splint
Brace 
Traction
External Fixators
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10
Q

What are the different types in internal immobilization devices?

A
Metal plates
Pins 
Screws
Nails
With or without bone grafts
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11
Q

What are casts?

A

Temporary circumferential immobilization device

Common treatment after closed reduction

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12
Q

What are common cast materials?

A

Most common = fiberglass

Plaster of Paris not used much anymore

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13
Q

What are the different types of casts?

A

Arm
Leg
Body/Spica

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14
Q

Cast care (Plaster of Paris)

A

1- heat is felt. 2 - Handle with palms while wet. 3 - petal edges

No covering (blankets)
Reposition q 1-2 hours until set
Neurovascular checks q 1 hours X 24 hours
Be able to stick a finger or two inside the cast to make sure there is room
Ice first 24 - 36 hours to reduce swelling

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15
Q

Peripheral neurovascular assessment

A
Assess for 5 Ps
Pain
Pallor
Pulselessness
Paresthesia
Paralysis 

First sign is Pain
Late signs are Pallor, Pulselessness, Paralysis

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16
Q

Complications of casts

A

Infection r/t pressure necrosis
Circulation Impairment
Peripheral nerve damage
Complications of immobility

17
Q

Splints and Immobilizers are?

18
Q

Braces are?

A

Adjustable

19
Q

Traction

A

Applies pulling force on fractured extremity

Pulling force must be continuous (unless ordered intermittent)

20
Q

Skin traction

A
Short term (skin cant tolerate very long)
5-10 lbs
21
Q

Skeletal traction

A

5 - 45 lbs

Pins used to immobilize part

22
Q

Running vs Countertraction

A

Running - pulling force goes one way. Unidirectional. If on leg pt will be slipping down toward foot of bed.

Countertraction - pulling force in different directions

23
Q

What is bucks traction?

A

Simplest form of skin traction
Provides straight pull on affected extremity (running)

Used: Relieve muscle spasm or temporary immobilization before ORIF (surgery)

24
Q

What is Russell traction?

A

Skin traction
Permits pt to move, somewhat, in bed. (due to countertraction)
Permits flexion of knee joint

Used: Relieve muscle spasm/ back pain

25
Balanced Suspension traction (skin or skeletal)
Provides countertraction Prevents pt from sliding to end of bed Pulling force of traction is not altered when bed or pt is moved Allows for increased pt movement and facilitates care Nurse must maintain constant traction, no interruption in weights
26
The line of pull
Must never be interrupted
27
External fixators
Screws are placed above and below the fractures and a device is attached to the screws on the outside of the skin
28
Pins: Nursing implications
Assess for pin loosening Assess for infection Meticulous pin care - 1/2 and 1/2 (peroxide and saline) followed by normal saline - Avoid ointments Teach to avoid touching
29
Internal devices: Types
Pins Screws Plates
30
Related nursing problem: Risk for peripheral neurovascular dysfunction
Elevate extremity above heart level Apply ice compress Notify provider immediately if increase of pain unrelieved by meds Teach signs of NV dysfunction
31
Related nursing problem: Acute pain
ATC medication Non-drug measures Sudden inability of pain medication to relieve pain? Compartment syndrome
32
Compartment syndrome
Swelling out of control in only a few hours Fasciotomy procedure done to relieve
33
Related nursing problem: Risk for infection
``` Assess pin insertion sites for indicators of infection Aseptic technique Culture site PRN Administer antibiotics Monitor temp Monitor WBCs ```
34
Related nursing problem: Risk for impaired skin integrity
Examine potential pressure areas q4 hours (Braden scale daily) Petal cast edges (if plaster of paris) Do not insert items into cast to scratch Instruct pt to report increased pain, warmth, or foul odor Moisture contributes to breakdown Turn if permissible. avoid friction/shearing
35
Related nursing problem: Impaired Physical mobility
Pain control before ROM AROM/PROM physical therapy Weight bearing or non weight bearing (are they allowed to bear weight) Instruct use in assistive devices
36
These patients are at increased risk for what?
``` Venous thromboembolism Fat embolism (Long bone fracture) ``` Monitor for CP, tachypnea, cyanosis, apprehension, tachycardia, hypoxemia