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NSG 320 (mcp) > Fractures > Flashcards

Fractures Flashcards

1
Q

How are fractures Classified?

A
  1. Extent of break
  2. Cause
  3. Type
  4. Extent of soft tissue damage
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2
Q

Fracture Classification by Extent of Break & Extent of Soft Tissue Damage:

A

Extent of Break:

1) Complete
2) Incomplete

Extent of Soft Tissue Damage:

1) Open (Compound)
2) Closed (Simple)

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3
Q

Fracture Classification by Cause

A
  1. Pathologic/Spontaneous
  2. Fatigue
  3. Compression
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4
Q

Fracture Classification by Type

A 
Displaced
Spiral
Greenstick
Fragmented or Comminuted
Oblique
Impacted

Don’t need to know per Messer

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5
Q

Complete versus Incomplete Fracture:

Classification category?

A

Complete = fracture divides the bone into two distinct segments.

Incomplete = fracture doesn’t divide the bone into two distinct segments; partial break

Classification by Extent of break

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6
Q

Open versus Closed Fracture:
AKA?
Classification category?

A

Open (AKA Compound) = fracture that extends thru the skin; visible wound

Closed (AKA Simple) = fracture that doesn’t extend thru the skin; no visible wound

Classification by Extent of soft tissue damage

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7
Q

Pathologic AKA Spontaneous Fracture:

Classification category?

A

A fracture that occurs after minimal trauma to a bone that’s been weakened by disease (osteoporosis, etc).
-AKA “fragility fracture”

Classification by Cause

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8
Q

Fatigue Fracture:
Who might we see this type of fracture in?
Classification category?

A

A fracture that results from excessive strain and stress on the bone; AKA a “stress” fracture.
-Common in Athletes

Classification by Cause

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9
Q

Compression Fracture:
What bones and population might we see this type of fracture?
Classification category?

A

A fracture caused by pressure (loading force) on the bone.
-Common in the vertebrae of older adults with OP

Classification by Cause

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10
Q

fdfd

A

fdfd

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11
Q

Risk factors for Fractures (5):

A
  1. Riding in cars (go vroom vroom, go boom boom)
  2. Falling (older adults, osteoporsis)
  3. Malnutrition
  4. Sports
  5. Osteoporosis
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12
Q

____ (bone) fractures have the highest incidence in Adults.

A

Rib

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13
Q

____ (bone) fractures have the highest incidence in Young and Middle-aged populations?

A

Femoral

fractures of the femoral shaft

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14
Q

____ (bone) fractures have the highest incidence in Older Adults.

A

Femur

proximal femur fractures at the hip or shaft

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15
Q

What Health Promotion activities have been/can be implemented to prevent the incidence of fractures? (5)

A
  1. Seat belts
  2. Airbags
  3. Reducing driving while impaired (Uber home you drunk hussy)
  4. Osteoporosis screening/ treatment
  5. Fall Prevention
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16
Q

Fractures + Patient History

What do we want to know about a patient coming in with a fracture?

A
  1. Type of Injury (How’d ya wreck yaself?)
  2. Alcohol and drug use (You be partyin’?)
  3. Disease states
    - Identify Age and any factors that increase fracture risk
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17
Q

Fractures + Physical Assessment

What is our #1 Priority?

A

1 Priority = ABC (primarily C)

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18
Q

Fractures + Physical Assessment

What’s one of the best assessment tools that can help to determine if further imaging, etc. is needed?

A

Pain ***

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19
Q

Fractures + Physical Assessment
What are we looking for (S/S) when performing a Head-to-Toe Assessment?
Will these S/S always be present with a fracture?

A
  1. Change in bone alignment
  2. Shortening
  3. Change in Shape
  4. Bruising & Swelling
    • Compare unaffected limb to affected limb*

NO; sometimes the only S/S present is pain!

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20
Q

Fractures + Physical Assessment:

What Assessment tool helps us evaluate a patient thru-out treatment of a fracture and is especially useful with casts?

A

CMS Assessment

AKA Neurovascular Assessment

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21
Q

CMS Assessment:

What serious complication does this assessment tool help us to prevent/identify?

A

Compartment Syndrome

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22
Q

CMS Assessment:
How do we go about performing this assessment?
(not the details, think big picture)

A

LOOK FOR CHANGES!
Compare extremities bilaterally
Check extremity distal to the injury

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23
Q

CMS Assessment:
C =
What do we assess? (4)

A

Circulation

  • Color
  • Temperature (warm, cool?)
  • Pulses (equal bilaterally?)
  • Capillary refill (<2 secs?)
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24
Q

CMS Assessment:
M =
What do we assess?

A

Motion; Assess Movement

  • Range of motion (any pain present?)
  • Ability to perform ADLs
  • Need for assistive devices

*from book; Messer didn’t list these specifically in PP

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25
Q

CMS Assessment:
S =
What do we assess for? (3)

A

Sensation; focus on fingertips and toes*

  • Tingling?
  • Pain?
  • Numbness?
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26
Q 
Diagnostic Testing for Fractures:
Lab tests (3)
A
  1. HH (bleeding)
  2. WBC (infection)
  3. ESR (inflammation)
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27
Q

Diagnostic Testing for Fractures:
Imaging (3)
What type of imaging is used for Spine & Hip fractures?

A
  1. X-Ray
  2. CT-scan
    • Hip & Spine
  3. MRI
28
Q

Fractures + Interventions:
Interventions are prioritized based on ___ ____ & ___.

What is our #1 Priority?

A

Clinical situation & Presentation

Sterile gauze
Reduction
Immobilization

Elevation
Ice

29
Q

Fractures + Interventions:

List the Interventions in priority (excluding ABC)

A
  1. Pain management
  2. Immobilization via Splint
  3. Reduction (realignment)
  4. Immobilization again following
30
Q

Fractures + Interventions:
List 3 other Interventions
(think infection, blood flow to heart, & pain)

A
  1. Sterile gauze (If open/compound fracture)
  2. Elevation
  3. Ice
31
Q

What is a Closed Reduction?

a) What is the most common fracture type that we use this method for?
b) How do we confirm it worked?
c) What is the nurse’s role?

A

Realignment of bones by utilizing traction and moving the ends to the proper position for bone healing.

a) SIMPLE fractures
b) Placement confirmed by X-ray
c) RN’s Role: Supporting the patient & provider
1. Administer meds (patient is moderately sedated)
2. Monitor patient

32
Q

List the 4 Types of Immobilizers:

A
  1. Bandage
  2. Splint
  3. Cast
  4. Traction
33
Q

List the Immobilizers used AFTER Reduction is performed:

A
  1. Splint
  2. Orthopedic Shoe or Boot
  3. Casts
34
Q

Splints are more commonly used for

A

Immobilizing body parts that DON’T bear-weight

35
Q

Orthopedic Shoes or Boots are used for

A

Immobilizing ankles or feet when weight-bearing IS allowed

36
Q

Casts are used for ______ and ____ _____ fractures, as well as correction of _______.

What might a cast be used in conjunction with? (2)

A

COMPLEX and LOWER EXTREMITY (LE) Fractures, as well as correction of deformities

A sling or Crutches

37
Q

What are the two types of materials used for Casts and which one is preferred?

A
  1. Fiberglass –> PREFERRED

2. Plaster (not used much anymore today)

38
Q

What do both Fiberglass and Plaster Casts require?

A
  1. Stockinette

2. Padding

39
Q

What are the benefits (and one possible disadvantage) of using a Fiberglass Cast?

A
  1. Dries and hardens quickly
  2. Reduces skin breakdown
  3. Can get wet with use of Gore-Tex

Disadvantage:
The padding underneath CAN’T get wet

40
Q

What patient teaching should be provided regarding a Plaster Cast?
Describe the “layers” of a Plaster Cast:

A
  1. Takes 24 hrs to dry
  2. Cast may feel warm and uncomfortable while drying
  3. If stockinette is at all wrinkled, skin breakdown can occur.

Plaster cast layers from inside –> outside:
Stockinette –> Plaster –> Padding –> Plaster

41
Q

What Assessment findings (4) related to Casts do nurses need to look for and also teach patients to look for?

A

Assess & Teach patients the S/S of Neurovascular (CMS) compromise!

  1. Increased Pain
  2. Increased Drainage (if appropriate)
  3. Fowl smell
  4. Circulation (Motion, Sensation)
    Distal fingers/toes:
    -Should be able to move
    -Feel warm
    -Should NOT feel numb
42
Q

What Patient Teaching do we need to provide related to Casts?

A
  1. S/S of Neurovascular (CMS) compromise
43
Q

If the skin is open, a ______ can be placed in the cast to perform wound care.
Why do we need to replace it following?

A

Window

Replaced with gauze wrapped around it to prevent localized edema in the area!

44
Q

What interventions can be done if the Cast is Too Tight?

A
  1. Bivalve (cut it lengthwise into two equal pieces)
  2. Elevation
  3. Ice
45
Q

What is Traction?

Uses? (4)

A

The application of pulling force with pulleys and weights
-NOT REALLY USED TODAY! (immobility=DVT)
Uses:
1. Reduction
2. Alignment
3. Rest
4. Sometimes to decrease Muscle Spasms & Pain

46
Q

Running Traction exerts force in ___ ____ only.

Balanced Traction suspends a fractured extremity with ___ _____ forces.

A

One plane

Two opposing forces

47
Q

Skin Traction applies force ____ to the bone with the use of a ____or ____.

Skeletal Traction applies force ____ to the bone with the use of ___ inserted into the bone.

A

applies force INDIRECTLY with the use of a bandage or splint.

applies force DIRECTLY with the use of PINS inserted into the bone.

48
Q

______ Traction is a type of _______ and ____ Traction used for ____ ________.

A

Buck’s Traction
Running (one plane) and Skin Traction (noninvasive)
PAIN REDUCTION

49
Q

What is the most common surgery for Reducing/Fixing a fracture?

A

Open Reduction with Internal Fixation (ORIF)

“Open” surgery

50
Q

Open Reduction with Internal Fixation (ORIF) involves external _______ of the affected area by using metal pins, rods, protheses, or plates to keep it _______.

A

FIXATION of the affected area using metal pins, rods, prostheses, or plates to keep affected area IMMOBILE

51
Q

What is the benefit of Open Reduction with Internal Fixation (ORIF)?

A
  1. Allows for MOBILITY and immediate Ambulation!
52
Q

What are the benefits (3) of an External Fixation surgical procedure to repair a fracture?

A
  1. Early Ambulation
  2. Less Blood loss
  3. Promotes Bone healing
53
Q

Postoperative Surgical Interventions: (5)

A
  1. PAIN MANAGEMENT
    - Set pain goals based on a functional perspective
    - Need to get up to prevent DVTs, etc.
  2. Ambulation
  3. Prevent Complications
  4. PT consult
  5. Monitor for NV Compromise
54
Q

Complications related to Fractures (8)

A
  1. Acute Compartment Syndrome*
  2. Hypovolemic Shock
  3. Fat Embolus Syndrome*
  4. VTE (PE)*
  5. Infection (Including osteomyelitis)
  6. Avascular Necrosis
  7. Delayed Union
  8. Volkmann’s Contracture
55
Q

What complication are we MOST concerned about?

A

Acute Compartment Syndrome!!
75% of ACS cases involved a fracture!

CAN CAUSE LOSS OF LIMB AND DEATH!

56
Q

Acute Compartment Syndrome Interventions & Treatment:

A

INTERVENTIONS:

  1. Avoid tight dressings and casts
  2. Frequent CMS Assessments
  3. Monitor for the 6 P’s
    (1) Pain
    (2) Pallor
    (3) Paralysis
    (4) Paraesthesia
    (5) Poikilothermia
    (6) Pulselessness

TREATMENT:
1. Fasciotomy

57
Q

If left untreated, Acute Compartment Syndrome related to a fracture in the forearm can result in _____’s Contracture.

A

Volkmann’s Contracture

58
Q

A small percentage of people may develop ___ _____ ______, which presents similar to a __, resulting from fat globules released by ____ bone fractures; Can also occur from ___ and ____ arthroplasty.

A

Fat Embolism Syndrome (FES)
PE
LONG bone fractures
Hip and Knee Arthroplasty

59
Q

When do the S/S of Fat Embolism Syndrome (FES) present?

What 3 Organs are mainly affected?

A

Occur 24-72 hours after trauma

  1. LUNGS
    - Low O2 saturation, Dyspnea, Tachypnea
  2. BRAIN
    - Confusion, Altered LOC, HA, Seizure
  3. SKIN
    - Petechiae on neck, chest, and arms
60
Q

How do we Prevent Fat Embolism Syndrome (FES)? (2)

A
  1. Early fixation

2. Surgical technique

61
Q

Interventions for Fat Embolism Syndrome (FES)? (3)

A

SUPPORTIVE INTERVENTIONS

  1. Oxygen
  2. Fluids
  3. Albumin (bind fat emboli)
62
Q

What type of fracture has an increased risk for infection? What can infection lead to?

A

OPEN (Compound) fractures

Osteomyelitis

63
Q

A Surgical site Infection is defined as:

A

a site that becomes infected within 30 days of surgery
OR
hardware that becomes infected within the 1st year

64
Q

Interventions for an Upper Extremity Fracture: (6)

A
  1. Remove jewelry
  2. Perform NV assessment
  3. Immobilize
  4. Elevate
  5. Apply Ice
  6. Manage Pain
65
Q

Hip Fractures are most common in ___ ____ and the highest risk factor is _______.
Interventions for a Hip Fracture: (3)
What should we avoid?

A

Older Adults; Osteoporosis –> HIGH MORTALITY RATE

  1. IV Morphine/ PCA
  2. Delirium interventions
  3. Mobility –early ambulation is key!*

AVOID Demerol! Increased delirium risk

66
Q

Priority Assessment for a Chest Fracture?

Priority Assessment for Pelvic Fractures?

A

Chest –> ABC; breathing issues &/or internal damage

Pelvic –> MONITOR FOR BLOOD LOSS

  • blood in stool or urine
  • abdominal rigidity or swelling
67
Q

Spinal Fractures are most commonly associated with what 3 disease states?

A

Osteoporosis, Cancer, and Multiple Myeloma (MM)

NSG 320 (mcp) (24 decks)

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