Fractures Flashcards by Brina Quintanilla Reyes

What is a fracture?

Disruption or break in the continuity of bone

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How do we classify a fracture? (6)

Open or closed
Complete or incomplete
Displaced or non displaced

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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

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What is complete vs incomplete?

Complete
- break is completely through bone

Incomplete
- bone is still in one piece

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What is displaced or nondisplaced

Displaced
- two ends separate from one another

Nondisplaced
- periosteum is intact and bone is aligned

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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

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What is transverse ?

Fracture in which the line of the fracture extends across the bone shaft at a right angle to the longitudinal axis

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What is spiral fracture?

Fracture in which the line of the fracture extends in a spiral direction along the shaft of the bone

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What is greenstick fracture?

Incomplete fracture with one side splintered and the other side bent

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What is comminuted fracture?

Fracture with more than 2 fragments
( small fragments appear to be floating )

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What is oblique fracture?

Fracture in which the line of the fracture extends in an oblique direction
( diagonal )

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What is pathologic fracture?

Spontaneous fracture at the site of the bone disease

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What is a stress fracture?

Repeated stress from jogging or running

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What are clinical manifestations of a fracture? (7)

Localized pain
Swelling
Muscle spasm
Contusion
Decreased function
Inability to bear weight or use
Deformity

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What are the 6 fracture healing stages?

Fracture hematoma
Granulation tissue
Callus formation
Ossification
Consolidation
Remodeling

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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

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Many factors may influence healing if fracture, like?
Examples

Site of fracture
Smoking
Age
Infection
Blood supply

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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

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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 )

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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

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What are the two types of traction?

Skin and skeletal

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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

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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

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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?

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