Fractures

Question 1

What is a fracture ?

Answer 1

Break / crack in bone
- either completely or partially

Question 2

What are the S&S of a fracture (BROKEN)

Answer 2

Bruising w pain and swelling
Reduced movement
Odd appearance
Krackling sound (bone frags rubbing together )
Edema + erythema @ site
Neuro vascular impairment

Question 3

Fractures can be

Answer 3

Closed fractures or open fractures

Question 4

What is a closed fracture ?

Answer 4

Broken bone does not penetrate through the skin- so overlying skin left intact

Question 5

What’s is an open fracture

Answer 5

Bone breaks through the skin
- bleeding/bruising
- exposed 2 external environment via traumatic violation of soft tissue and skin

Question 6

What is a complete fracture ?

Answer 6

When break separates bone into 2

Question 7

What is an incomplete fracture ?

Answer 7

When fracture does not break bone all the way through

Question 8

How can we diagnose a fracture ?

Answer 8

• x-ray : show above and below joint - at least 2 views to diagnose type of fracture
  -CT scan
• MRI ( not 4 diagnosis but to see tiny structural damage w head injury

Question 9

What is the nursing interventions for fractures?

Answer 9

• immobilise fx w a splint above and below it
  -stop bleeding by applying pressure w a clean cloth
• elevate extremity to reduce swelling
• apply ice to reduce swelling
• keep NPO until evaluated by MD
• get x-ray
• pain mgt w meds- document + monitor closely the relief (compartment syndrome)
• monitor 4 fat embolism

Question 10

What is compartment syndrome ?

Answer 10

Increased pressure in fascia squeezing and cutting of nerve and blood supply to muscle
- if not reverted within 6 hrs- pt will lose muscle

Question 11

What is the mgt of compartment syndrome /

Answer 11

• 6 P’s
• early sign is pain
• keep extremity @ heart lvl
• loosen n d remove restrictive clothing
• notify MD
• bivalve cast- reduces wgt on fx + relieves pressure
• severe - fascitomy

Question 12

What are the 6 P’s that we should assess and that will tell us if a pt is experiencing compartment syndrome ?

Answer 12

• Pain - early sign
• Paresthesia - tingling, pins + needles sensation in affected extremity
• Pallor- extremity will have a dusty pale colour- compare w other extremity
• Paralysis - check if pt has movement in fingers
• Poikilothermia- compare temps of both extremities- one colder than the other?
• Pulslessness- late sign

Question 13

What are the treatments for fractures

Answer 13

• bone reduction
• bone traction

Question 14

What is a bone reduction ?

Answer 14

Putting the bone back in its original position

Question 15

How is a bone reduction done in a closed fracture ?

Answer 15

Manually

Question 16

How is a bone reduction done in a an open fracture ?

Answer 16

Surgically
- internal - bone inside - pins, rods, plates
-external - outside skin- metal braces, + screws

Question 17

What is a traction ?

Answer 17

Aligning the bone w a steady pulling action
-wgts hang freely + not on the floor
- never remove wgts
- pin care- infection, skin integrity
- monitor 6 P’s
- overhead trapeze 2 help w movement

Question 18

What is the cast care ?

Answer 18

• monitor 6 P’s 4 compartment syndrome
• keep infection free
• elevate above heart lvl 2 reduce swelling and improve circulation
• ice for 2 days
• use palms to handle case when freshly applied- using fingers can leave dents which will stay and cause pressure ulcer
• turn every 2 hrs to make sure each side dries equally
• maintain skin integrity around the cast
• keep cast dry + dont get it wet
  -educate pt and family on these points

Question 19

What is the initial mgt of an open fracture ?

Answer 19

• inspect wound
• remove foreign bodies
• photo of wound
• cover area w saline
• antibiotics within 30 mins- prevent infection
• tetanus prophylaxis

Question 20

What is the definitive mgt for open fracture

Answer 20

Surgery ASAP
- clean out nd debride wound
- stop bleeding
- preserve as much as possible