Fractures Flashcards
Closed or simple
Skin remains intact
Complete
Complete separation into two parts
Compression
Bone is compressed by other bone
Incomplete
Fracture line does not go through the whole bone
open or compound
Exposed to air through a break in the skin
Soft tissue injury or infection
Splint extremity and cover with a sterile dressing
Transverse
Fractured straight across
Reduction
Bone is restored to proper alignment
Internal fixation
Immediate bone stabilization Holds the bone in alignment After an open reduction Infection risk Permits early mobility
External fixation
Skeletal pins are attached to an external support
More freedom of motion
After massive tissue trauma
Infection risk
Traction
pulling force applied in two directions
reduces and immobilizes a fracture
proper bone alignment and reduction of muscle spasms
Cannot remove or lift weights without a PCP’s prescription
Place knots to prevent slipping
Skeletal traction
Pins, wires, tongs
25 to 40 lb
Monitor color, motion, sensation
Skin traction
Elastic bandages, adhesive, foam boot or sling
Cervical skin traction
Relief of muscle spasms and compression in upper extremities or neck
Use powder
30 to 40 degrees
Buck’s
For muscle spasms and lower limb immobilization
Straight pull on limb
No more than 8 to 10 lbs of weight
Elevate HOB
Pelvic skin traction
Low back, hip, or leg pain.
Reduce muscle spasm.
Keep client from slipping down in bed.
Put belt over pelvis and iliac crest.
Balanced suspension traction
Used with skeletal or skin traction
Femur, tibia, fibula
Low-Fowler’s on either side or back
20-degree angle from thigh to bed
Clean pin sites with…
sterile normal saline and hydrogen peroxide or povidone-iodine
Keep casts…
elevated.
Handle with…
palms of the hands until dry.
Turn casts…
every 1 to 2 hours.
Do not (for a cast)…
stick objects inside it.
Notify the PHCP immediately if…
there are signs of pulmonary or fat embolism.
Compartment syndrome…
when pressure increases within one or more compartments.
Problems of compartment syndrome…
decreased blood flow, tissue ischemia, and neurovascular impairment.
Symptoms of compartment syndrome…
Numbness and tingling is one of the first signs.
Unrelieved or increased pain in the limb unrelieved by drugs.
Pale, dusky, or edematous skin.
Pain with passive movement.
Loss of sensation.
Pulselessness.
First intervention in compartment syndrome…
Notify the PHCP.
Elevate the extremity.
May need to do a fasciotomy (wound remains open).
Osteomyelitis symptoms…
tachycardia
fever above 101
leukocytosis and elevated erythrocyte sedimentation rate
Confirmed with plain radiographs, MRI, bone scan.
Avascular necrosis…
bone death.
Pain, decreased sensation.
Confirmed with plain radiographs, MRI, bone scans.
Complication of hip fractures.
Watch for pain/numbness and notify the PCP.
Remove necrotic tissue.
FES earliest symptoms.
hypoxemia, dyspnea, tachypnea. Altered mental status is earliest sign.
Occurs within 48 hours.
Increased ESR. Decreased serum calcium. Decreased RBCs and platelets. Increased serum level of lipids. Tachycardia, crackles, increased temp.
Give oxygen, hydration, immobilization, and maybe steroid therapy.
Patients on long term corticosteroid therapy…
high risk for ischemic necrosis.
Delayed union…
fracture that hasn’t healed in six months.
CRPS…
from fractures or other musculoskeletal injury. often in the feet or hands.
Motor symptoms such as paresis, muscle spasms, loss of function.
Intense burning unrelenting pain.
Assess adults of all ages for…
opioid use for persistent pain before the fracture.
Assess all major body systems first for…
life-threatening complications.
For pelvic fractures assess…
vital signs, skin color, and LOC just in case of hypovolemic shock.
Pts with fractured hip…
may have groin pain or pain referred to back of knee or lower back from muscle spasm or edema.
Take care of…
pain FIRST.
Give IV Ketorolac in the PACU…
to reduce inflammation and pain.
Assess pin sites every how many hours?
8 to 12
Clear fluid drainage from pin sites is expected
within the first 48 to 72 hours.
Place cane on…
unaffected side.
Primary nursing assessment…
assessment and prevention of neurovascular dysfunction or compromise.
Assess neurovascular status…
every hour for the first 24 and every 1-4 hours after.
Elevate higher than the
heart.
Apply ice for how long?
first 24 to 48 hours