Fractures Flashcards
Soft tissue injuries
Soft tissue injuries is damage to the muscle, tendons and ligaments
-Contusions
-Sprains and strains
-Dislocations and subluxations
Contusions, sprains, and strains; treatment
-Rest
-Ice
-Compressikn
-Evelate
Joint dislocations; Collaborative management
-Confirm by x ray
-Reduction
-Pain management
Joint dislocations; nursing management
-Assess Nerovascular status
•CMS
-Protect joint
•immobilize
Neurovascular assessment
Circulation
-Assess the colour of the skin
-Assess temperature
-Assess capillary refill
-Assess peripheral pulse if accessible
Motor
-Assess movement of involved fingers and toes
•Radial, medial, ulnar
•Peroneal, tibial
-Assess for presence of pain with movement
Sensation
-Assess presence and abnormal sensation
-Pressure, pinprick and temperature discrimination
Fractures
-Disruption or break in continuity of the structure of bone
-Majority of fractures from traumatic injuries
-Some fractures secondary to disease process
•Cancer or osteoporosis-known as pathological
Avulsion fracture
A fracture in which a fragment of bone has been pulled away by a tendon and it’s attachment
Commiuted fracture
A fracture in which bone has splintered into several fragments
Compression fracture
A fracture in which bone has been compressed (seen in vertebral fractures)
Depressed fracture
A fracture in which fragments are driven inwards (see frequently in fractures of skull and facial bones)
Epiphyseal fracture
A fracture through the epiphysis
Greenstick fracture
A fracture in which one side of a bone is broken and the other side is bent
Impacted fracture
A fracture in which a bone fragment is driven into another bone fragment
Oblique fracture
A fracture occluding at an angle across the bone (less stable than transverse fracture)
Open fracture
A fracture in which also involves the skin or mucus membranes, also called a compound fracture
Pathological fracture
A fracture that occurs through an area of diseased bone (eg osteoporosis, bone cyst, pagers disease) can o occur without trauma or fall
Simple fracture
A fracture that remains contained, with no disruption of the skin integrity
Spiral fracture
A fracture that shifts around the shaft of the bone
Stress fracture
A fracture that results from repeated loading of bone and muscle
Transverse fracture
A fracture that is straight across the bone shaft
With fractures adjacent structures are damaged
-Soft tissue edema
-Bleed into muscles and joints
-Joint dislocations
-Ruptured tendons, severed nerves
-Damage to blood vessels
-Body organs may be damaged by force that causes the fracture
Fractures; clinical manifestations
-Pain
-Loss of function
-Guarding
-+- deformity
+- shortening of the extremity
-Crepitus
-Local swelling and discolouration
-Patient usually reports injury to the area
Fractures; initial management
-Stabilize limb and support above & below site
•assess neurovascular status before and after splinting
-Open fracture: cover with sterile dressing to prevent contamination
-Remove clothing from unaffected side first
Fractures; collaborative care
-Anatomical realignment of bone fragments
-Immobilization to maintain realignment
-Restoration of normal or near-normal function of injured parts
-Prevention of infection (open fractures)
Complete break
Completely through bone
Incomplete break
Bone is still in one piece but break occurs across the bone shaft
You are an RN in the ED. The triage note for Ms. k reads “75 y/o female, fell in her outstretched hand while out walking. Obvious deformity Rt wrist.
Assessment specific to this injury includes
-Edema and swelling
-Pain and tenderness
-Deformity
-Ecchymosis or contusion
-Loss of function
-Crepitation
-Muscle spasm
Immediate nursing interventions would include
-A,B,C
-Control bleeding with direct pressure
-Check neuromuscular status distal to the injury
-Elevate injured limb if possible
-Apply ice
-Splint fracture site, do not attempt to straighten fractured or dislocated joints, do not manipulate protruding bone ends
A colles’ fracture is a
Fracture of the distal radius
Most colles’ fractures occour in patients
> 50 years old with osteoporosis
The ED physician decides to reduce the fracture. A closed deduction is
A nonsurgical, Manual realignment of the bone to their previous position
One key intervention following the application of a cast is to check for…
circulation, sensation, and movement
What is traction
Traction is the application of a pulling force to an injured or diseased part of body or extremity, while countertraction pulls in opposite direction
-Prevent or reduce muscle spasm
-Immobilize joint or part of body
-Reduce a fracture of dislocation
-Treat a pathological joint condition
Traction is also indicated to
-Provide immobilization to prevent soft tissue damage
-Reduce muscle spasm associated with low back pain or cervical whiplash
-Expand a joint space before major joint reconstruction
Traction; pourpouse
-Prevent or decrease muscle spasm
-Immobilize joint or part of body
-Decrease a fracture or dislocation
-Treat a pathological joint condition
Two most common types of traction
Skin traction
Skeletal traction
Fractures; skin traction
-Used for short term treatment until skeletal traction or surgery is possible
-Tape, boots, or splints applied directly to skin to maintain alignment, assist in reduction, and help diminish muscle spasms in injured extremity
-Traction weighs 2.3-4.5Kg
Skeletal traction
-In place for longer periods
-Used to align injures bones and joints or to treat joint contractures and congenital hip dysplasia
-Provides a long-term pull that keeps injured bones and joints aligned
-Physician inserts pin or wire into bone, either partially or completely, to align and immobilize injured body part
-Skeletal traction weigh range 2-20kg
-Too much weight results in delayed nonunion
Traction; cont
-Countertraction commonly supplied by patients body weight or augmented by elevating end of bed
-Imperative that nurse maintains traction constantly and does not interrupt weight applied to traction
Overall goals of fracture treatment
-Anatomical realignment of bone fragments
-Immobilization to maintain realignment
-Restoration or normal or near-normal function of injured parts
Fracture healing
Not occour in the expected time
-Delayed union
Not occour at all
-Nonunion
-Healing time for fractures increases with age.
Casts
Restrict tendinoligamentous movement
-Assisting with joint stabilization while fracture heals
-Applicaiton incorporates joints above and below fracture
-Plaster sets in 15 minutes (not strong enough for weight bearing until 24-72 hours)
-Fresh plaster should never be covered with a blanket
-Once completely dry may need to be petalled to avoid skin irritation
What are 3 main complications of bone fracture
- Infection
- Compartment syndrome
- Fat Embolism
Infection (osteomyelitis)
-High incidence in open fractures and soft tissue injuries
-Massive or blunt soft tissue injury often has more serious consequences than fracture
-Deviated and contaminated tissue is an ideal medium for pathogens
-May manifest years later
-Must be treated aggressively with antibiotics
Compartment syndrome
Decreased compartment size
-Resulting from restrictive dressing, splints, casts, excessive traction, or premature closure of fascia
Increased compartment size
-Related to fracture, bleeding, edema, chemical response to snakebite, or IV filtration
The 6 Ps of compartment syndrome
Pain
Pressure
Pallor
Pulselessness
Paresthesia
Paralysis
Compartment syndrome; clinical manifestations
-Pain: distal to injury that is not relieved by opioid analgesics and pain on passive stretch of muscle travelling through compartment
-Paresthesia: numbness and tingling
-Urine output must be assessed because there is a possibility of muscle damage
-Myoglobin released from damaged muscle cells precipitates as a gel-like substance
-Causes obstruction in renal tubes
-EARLY RECOGNITION AND TREATMENT IS ESSENTIAL
-Ischemia can occour 4-8 hours after onset
-Regualr neurovascular assessments
-May occur initially or may be delayed for several days
Compartment syndrome; CM cont
-Large amount of myoglobin may result in acute tubular necrosis
-Acute tubular necrosis causes a tire renal failure
-Common signs of myoglobinuria
•Dark reddish brown urine
•CM associated with acute renal failure
Compartment syndrome; Collaborative care
-Prompt, accurate diagnosis
-Extremity should not be elevated above heart level
•elevation may raise blood pressure and slow arterial perfusion
-Application of cold compress may result in vasoconstriction and may exacerbate compartment syndrome
Compartment syndrome; collaborative care
-If at all suspicious - cut bandage, release Velcro straps on simmer splint or bivalve cast
-Reduction in traction weight may decrease external circumferential pressures
-Surgical decompression may be nessacary
Fat embolism syndrome
-Presence of systemic fat globules from fracture that are distributed into tissues and organs after a traumatic skeletal injury
-Contributory factor in many deaths associated with fracture
Fat embolism syndrome; Clinical manifestations
-Early recognition crucial in preventing potentially lethal course
-Most patients manifest symptoms 24-48 hours after injury
-Fat globules transported to lungs cause a hemorrhagic interstitial pneumonitis
-Clinical course of fat embolus may be rapid and acute
-Patient frequently expresses a feeling of impending disaster
-In short time skin colour changes from pallor to cyanosis
-Patient may become comatose
Fat embolisim syndrome; collaborative care
Treatment
-Fluid resuscitation
-Correction of acidosis
-Replacement of blood loss
-Encourage coughing and deep breathing
-Oxygen to treat hypoxia
-ICU-mechanical ventilation
Nutritional therapy
Patients dietary requirements must include:
-Ample protein (1G/1KG BW)
-Vitimans (B, C, D)
-Calcium
-Phosphorus
-Magnesium
Indications for joint replacement
-Relieve chronic pain
-Improve joint mobility
-Correct malalignment
-Remove intra-articular causes of erosion
Preoperative care hip replacement
-Typically elective surgery, unless in the case of traumatic injury (I.e. hip fracture)
-Pre-operative goal: having the patient in optimal health prior to the surgery
Pt pre op teaching
-No flexion of affected limb past 90°
-No crossing of legs
-No bending over to reach for objects
-No driving x 6/52
-No heavy lifting
-No NSAIDs or ETOH 48 hours Preoperative (risk of bleeding)
Postop nursing management
-Asses pain and administer analgesics
-Elevate affected leg (foot above heart)
-Monitor dressing
-Pillow between legs when Turing in bed
-Early ambulaiton
Discharge teaching
-Emphasize hip percautions
-Typically d/c on anticoagulation therapy (Fragmin)
-Ensure pt understands when and how to take medications
-Typically full weight bearing with crutches or walker
-Physio and ambulation - as per surgeon
-Signs of infection
-When and how to contact health care provider
-Dressing care
-Resources for patients
Post op care knee athroplasty
-Compression drsg to immobilize knee in extension x 24 hours
-Zimmer splint to maintain extension x 24/52
Complications joint surgery
-Infection
-Thromboembolism
-Fat embolism
