Fractures Flashcards
What is a fracture?
Disruption or break in the continuity of bone
How do we classify a fracture? (6)
Open or closed
Complete or incomplete
Displaced or non displaced
What is open vs closed fracture?
Open is when the skin is broken and the bone is exposed
Closed is when the skin is intact and no bone is exposed
What is complete vs incomplete?
Complete
- break is completely through bone
Incomplete
- bone is still in one piece
What is displaced or nondisplaced
Displaced
- two ends separate from one another
Nondisplaced
- periosteum is intact and bone is aligned
Based on the direction of a fracture, it can be classified as
Think of all the types of locations (7)
Transverse
Spiral
Greenstick
Communitied
Oblique
Pathologic
Stress
What is transverse ?
Fracture in which the line of the fracture extends across the bone shaft at a right angle to the longitudinal axis
What is spiral fracture?
Fracture in which the line of the fracture extends in a spiral direction along the shaft of the bone
What is greenstick fracture?
Incomplete fracture with one side splintered and the other side bent
What is comminuted fracture?
Fracture with more than 2 fragments
( small fragments appear to be floating )
What is oblique fracture?
Fracture in which the line of the fracture extends in an oblique direction
( diagonal )
What is pathologic fracture?
Spontaneous fracture at the site of the bone disease
What is a stress fracture?
Repeated stress from jogging or running
What are clinical manifestations of a fracture? (7)
Localized pain
Swelling
Muscle spasm
Contusion
Decreased function
Inability to bear weight or use
Deformity
What are the 6 fracture healing stages?
Fracture hematoma
Granulation tissue
Callus formation
Ossification
Consolidation
Remodeling
Describe each fracture healing
Fracture hematoma (72hours)
Granulation tissue (3-14days)
Callus formation (3rd week)
Ossification (3week-6months)
Consolidation ( 1 year )
Remodeling
When a fracture occurs, bleeding creates a hematoma around the end of the bone
Active phagocytosis absorbs the products of local necrosis
( new tissues & blood vessels )
Minerals and new bone matrix
New bone matrix will stop moving and we may remove the cast
Distance between bone fragments decrease and will close
Union is completed & callus is reabsorbed
Many factors may influence healing if fracture, like?
Examples
Site of fracture
Smoking
Age
Infection
Blood supply
What is a closed reduction?
What is being applied?
This is usually done under what?
And after procedure we inform our patient to?
No surgical
Manual realignment of bone
Traction and countertraction applied
( manually moving it to reposition it)
General anesthesia
Being immbolized to promote healing
What is open reduction?
It includes what?
There is a high risk for?
We want to promote early ___ to prevent ___
And this helps facilitate early __
Correction of bone alignment through surgery
Internal fixation
( wires, screws, pins )
Infection
ROM to prevent adhesions
Ambulation
( which helps decrease the risk for complications related to immobility )
Sometimes we might have to use traction to help with fracture which is?
In which we do this for 4 things
Pulling forced to an injured part of the body
- Reduce pain
- Immobilize joint
- Reduce fracture
- Treat joint condition
What are the two types of traction?
Skin and skeletal
What is skin traction is short term?
What is bucks traction used for?
What are the equipment?
How much does it weight?
We want to do what assessment to prevent what?
Short term (48-72)
Bucks traction ( hip, knee)
Tapes,boots, splints
Traction weights 5-10pounfs
Skin assessment to prevent breakdown
Is skeletal traction long term?
What do we use?
Weights how much?
Risk for?
What are the complications?
This helps maintain continuous traction?
We want to keep what off the floor?
Yes to maintain alignment
Pins, wire into the bone
5-45pounds
Infection
Immobility
Yes
Weights
Traction nursing care
What do we want to inspect
Assess?
Monitor what sites?
Care for these sites?
Proper changes in?
ROM or PROM?
Inspect exposure skin
Assess pressure points
Monitor pin sites
Pin site care
Proper position
Exercise
Psychological needs
Do you normally get a cast after breakage?
No
What are the two types of cast?
Plaster of Paris
Synthetic
What is plaster of Paris?
How long do you set it for?
Given ever how many hours before weight bearing?
We don’t wanna over wet case because?
Why do we want to do no direct pressure?
The edges of the cast needs?
Material immersed in warm water and wrapped and molded
15mins
24-72
Risk for burn
Cause more injury & indentations if we use finger tips and cauze pressure points
Petaling in order to avoid the sharp edges
What is synthetic cast?
We can do early ?
It’s activated how?
Lightweight stronger and waterproofed
Weight bearing
By submersion in cool or tepid water then molded
Ambulatory and home care cast
Do! (6)
Frequent neeovascular assessment
Ice for 24 hours - swelling
Elevate the above heart
Exercise joints above and below
Hair dryer - cool setting for itching
Check health care provider
If the cast gets wet? What do we tell our patients ? (5)
DRRRR
Dry cast
Report increase pain
Report swelling
Report burning
Report sores
The biggest concern we have with fractures is compartment syndrome, which is?
Pain that increase or gets worse !
Ambulatory care
Cast care
Don’t!!!
(6)
Elevate if compartment syndrome
Get plaster cast wet
Remove padding
Insert objects
Bear weight 48 hours
Cover cast with plastic
What do we use to remove a cast?
Which does?
Osculating saw
Blades vibration cuts through a saw
When the cast comes off what do we see?
Skin is pale
( under a wet band-aid)
Atrophy of muscle
What can do we use for upper extremity immobilization?
Sling
Slings helps encourage moments of ?
Also very careful on pressure around?
Do we use a sling on a cast?
Fingers and nonimmbomized joints ( shoulders )
Posterior neck
Because we don’t want the arm to hang up ( instead down) and provides
Traction ; correction of arm
Notes
Upper extremity immbolization
Sling
- ensure axillary area is padded
- no undue pressure on neck
- encourage movement of fingers
- no sling use with long arm cast for upper humerus fracture - weight provided traction
What do you want to use for a vertebral injury?
Which helps?
Notes
- monitor for superior messenger if sterile syndrome
( cast syndrome )
- assess bowel sounds, abdominal pain and pressure, nausea and vomiting
- treat with gastric decompression (NGT&suction)
Assessing respiratory status, elimation, and pressure over bony areas
Body jacket brace
Immobilize and support for stable thoracic and lumbar spine injuried
With vertebral injuries, you can get something called cast syndrome, what is it?
Often the patient will feel?
When the brace is too tight, compressing the superior mesenteric artery against the duodenum
Nausea
Abdominal pressure
Vomit
For lower extremity immbolization
What do you use?
Notes
- assess for patient mesenteric artery syndrome
- nurse should instruct patient on positioning activities required to get on and off bedpan
- fracture bedpan usage
Elevate extremity above the heart
Do not place in dependent position
Observer signs of comparment syndrome and increased pressure
( pain, burning )
Hip spica cast
Notes
Preoperative care
- patient teaching
- monitor vs
- frequent neuro checks
- manage pain
- assess for bleeding or drainage
- pin care
- manage traction
What is an external fixation?
Often used for ___fractures with extensive ____damage
Notes
- applies traction
- compresses fracture fragments
- immbolized and hold in place
- asses for pin loosening
- patient teaching
- pin site care
Metal pins and roads inserted into bone and attached to external rods to stabilize fracture
Complex
Soft tissue damage
What is internal fixation?
Same thing as external with the mental rods, but instead of outside it’s inside
What is electric bone growth stimulation used for?
By doing.
Increase ___uptake
Activate intracellular ____ stores
Increase ____ factor production
Promote ___of new blood vessels
Non-invasive, semi invasive and invasive methods
Used to facilitate healing process
Calcium
Calcium
Growth factor
Growth
What are the medications to help treat fractures?(3)
Central and peripheral muscle relaxants
TDap vaccine
Bone penetrating antibotics
- cephalosporins
What is the nutritional therapy for fractures? (5)
Increase protein
Vitamins ( BCD )
Calcium, phosphorus and mag
Fluid (2000-3000)
Fiber
Patients who have body jacket and hip spica cast patients will need to eat what? To help avoid abdominal distention
6 small meals a day
Notes
Nursing assessments
Subjective data
- past medical history
- trauma
- bone or systemic disease
- immobility
- osteopenia
- osteroporsis
- corticosteroid use
- surgery
Functional health patterns
- level of activity
- hormone replacement
- menopause
- calcium intake
- loss of use
- chronic pain that increases with activity
What are the 6 ps of neurovascular assessment?
Pain
Paresthesia
Pulse
Pallor
Pressure
Paralysis
What are the 4 peripheral vascular assessment to do?
Explain each
Color and temperature
( artieral insufficiency& cyanotic means poor venous return )
Capillary refill
- poor arterial insufficient
Pulses
- decreased or absent
Edema
- pitting with severe injury
What is the 2 main peripheral neurologic assessment ?
( explain each )
Motor function
Upper extremities & lower extremities
Flex and extend
Sensory
Paresthesia or paralysis
- numbness or tingling
What is the 4 nursing diagsnosus?
Impaired physical mobility
Risk for peripheral neurovascular dysfunction
Acute pain
Readiness for enhanced self health management
What are the 3 outcomes?
Healing with no complications
Pain relief
Maximal rehabilitation
Notes
Other measures
- precent complications of immobility
Constpation
Renal calculi
Cardiopulmonary deconditioning
DVT/pulmonary emboli
Notes
Ambulatory
Prevent problems associated with MS
Dependence on ADL
Finances
Reinforce pt
Mobility training
Instruction to use aids
Pain management
Non weight bearing
Touch down ( toe touch )
Partial weight bearing (25-50)
Weight bearing as tolerated
Full weight bearing - ambulating
What are some assistive devices patients can use?
Cane
Walker
Crutches
Notes
Assitives devices
Consider stability, safety and lifestyle
Technique
Use transfer belt for stability
Discourage reaching for support
Upper arm strength
Evaluation of fracture (4)
Adequate pain relief
Appropriate care of cast or immbolized
No peripheral neurovascular dysfunction
Uncomplicated bone healing
