Fractures Flashcards
A disruption or break in the continuity of bone
A Fracture
Fractures are most common in patients with what comorbidities?
- Cushings
- Osteoporosis
- Osteogenesis imperfecta
- cancers
- anorexia
- Paget’s disease
- A genetic disorder that prevents the body from building strong bones
- Also known as brittle bones
Osteogensis Imperfecta
Chronic Disorder that causes bones to grow larger and become weaker than normal
Paget’s disease
What kind of fracture is this?
Complete fracture
What kind of fracture is this?
Incomplete fracture
What kind of fracture is this?
Closed, Simple non-displaced
What type of fracture is this?
Closed simple displaced
What type of fracture is this?
Open Compound
What type of fracture is this?
Avulsion
What type of fracture is this?
Comminuted
What type of fracture is this?
Compression fracture
What type of fracture is this?
Depressed
What type of fracture is this?
Greenstick fracture
What type of fracture is this?
Oblique fracture
What type of fracture is this?
Spiral fracture
What type of fracture is this?
Impacted fracture
What type of fracture is this?
Disruption that spans across the width of the bone; causing bone fragments
Complete
What type of fracture is this?
Disruption occurs through part of the bone cortex; no displacement of bone fragments
Incomplete fracture
What type of fracture is this?
Fracture is contained within the skin
Closed simple
What type of fracture is this?
Fracture that is contained within the skin and the bone is still in proper alignment
Closed, simple, non-displaced
What type of fracture is this?
Fracture that is contained within the skin but the bone is not properly aligned
Closed, simple, displaced
What type of fracture is this?
Disruption where pieces of bone protrude through the skin, creating an external wound that exposes the fracture site. These fractures are graded based on severity
Open Compound
What Grade of compound fracture is this?
Presence of puncture wound, minimal soft tissue injury, vasculature remains intact
Grade I Compound fracture
Or Open
What grade of compound fracture is this
Puncture wound, fragments of broken bone, moderate skin and muscle contusions, significant wound contamination
Grade II compound fracture
Or Open
What grade of Compound fracture is this?
Severe damage to soft tissues, nerves, muscles, and blood vessels. Open fracture site is extremely contaminated. Contains numerous comminuted fractures
Grade III Compound Fracture
Or open
What type of fracture is this?
Caused by over stretching and tearing of a tendon or ligament, separating a small segment of bone at the insertion site
Avulsion Fracture
What type of fracture is this?
Shattered bone fragments at the site of disruption
Comminuted Fracture
What type of fracture is this?
Caused by excessive force along the axis of spongy bone, making the bone collapse on itself
Compression Fracture
What type of fracture is this?
Disruptions where bone fragments are forced inward, associated with blunt force trauma to facial and skull fractures
Depressed Fracture
What type of fracture is this?
Bone fragments not in proper alignment
Displaced fracture
What type of fracture is this?
- Incomplete disruption where one side of the bone is bent and the other is fractured
- Typical in children d/t bone flexibility
Greenstick fracture
What type of fracture is this?
- Bone fragments are well approximated at the site of disruption
- Bone pieces are lined up
Non-displaced fracture
What type of fracture is this?
Break occurs at a 45-degree angle across the bone
Oblique Fracture
What type of fracture is this?
Fracture wraps around the shaft of the bone
Spiral fracture
What type of fracture is this?
Segments of bone are wedged into eachother at the fracture line
Impacted fracture
Medications used to treat Fractures
- Opioids and NSAIDs - the manage and relieve pain
- ABX for open fractures with contaminated wounds to prevent OM and other infections
Name the 6 P’s
Neurovascular assessment
- Pain
- Pressure
- Paralysis
- Pallor
- Paresthesia
- Pulselessness
Nursing assessment of a fracture
- Inspect site of injury
- Palpate extremity noting 6 P’s
- Verify correct positioning, application, and stability of imobilization devices
- Assess vital signs - includes pain!
The presence of one or more of the 6 P’s can indicate what?
Neurovascular compromise
Neurovascular compromise can lead to what?
- Hemorrhage
- Compartment syndrome
- Infection
- Permanent loss of function
Absence of 6 P’s indicate what?
Proper treatment is being provided and there is no neurovascular compromise
The following vital signs can indicate what in fracture patients?
Low BP
Tachycardia
Tachypnea
Hemmoragic Shock d/t excessive bleeding
An elevated temperature can indicate what in a fracture patient?
Infection
The following vital signs indicate what in a fracture patient?
- Tachycardia
- Tachypnea
- Decreased O2
Pulmonary Embolus
The following are clinical manifestations of what?
- Pain
- Deformity
- Sometimes an open wound
Fractures
This is released from damaged muscle and may indicate the presence of rhabdomylosis, which may lead to renal compromise or failure
Myoglobin
This is released with any muscle breakdown, and with rhabdomyolysis the levels are very high.
Creatine Phosphokinase
or
CPK
Type of blood test
used to detect signs of infection (WBCs) and blood loss (Hgb & Hct)
Complete Blood Count
or
CBC
A type of blood test
checks for electrolyte imbalances, which can indicate renal failure
CMP
A type of blood test
checks for proper kidney functioning and can lead to renal failure
Renal panel
Hematuria or tea colored urine can indicate what?
Rhabdomylosis
Lab tests for fractures
- Myoglobin
- Creatine Phosphokinase
- CBC
- CMP
- Renal panel
- Urinalysis
Non-Surgical Treatment of fractures
- Closed reduction
- Traction
- Manual manipulation of bone fragments to put in proper alignment
- Uses anesthesia
- After realignment, bone is placed in cast or splint
A type if non-surgical treatment for a fracture
Closed reduction
Surgical Treatment of fractures
- Open Reduction External Fixation or OREF
- Open Reduction Internal Fixation or ORIF
Plates, screws rods into fracture
Surgical tx for fx
Open reduction Internal Fixation
Rods and pins around fracture to stabilize it
Open reduction external fixation
Types of anesthesia used on patients with a fracture
- Conscious sedation
- General Anesthesia
- Nerve block
- Spinal block
Non-ridgid immobilization to maintain alignment
Splint or sling
Rigid immobilization to maintain alignment; made of fiberglass or plaster for use on weight bearing extremities
Cast
- Pins, tongs, screws, and wires are surgically screwed to the bone weight is then applied to provide alignment
- i.e. Halo device
Skeletal traction
- Uses flexible harness, boot, or belt to secure the extremity while 5-10 lbs of weight is applied to relieve muscle spasms and maintain the length of the bone
- i.e. Bucks traction
Skin traction
External Fixator
Traction Device
Nursing dx for patients with a fx
- Acute pain r/t muscle spasms and trauma
- Activity intolerance r/t immobility
- Impaired mobility r/t limb immobilization
- Impaired skin integrity r/t presence of cast, splint, and traction
Patient teaching for fx patients to maintain pulmponary hygiene
- Incentive spirometry to prevent post-op PNA
- Coughing and deep breathing to promote expansion of aveoli
The following indicate what complication associated with a fx
- Decreased blood flow & oxygen to tissues
- Severed vessels or nerves by bone fragments
Neurovascular Compromise
How to correct NV compromise
- Elevation
- remove cast/splint
The following are all risk factors for what?
- Immobility
- trauma
- cardiac disease
- long surgery
- obesity
- smoking
- BCP use
VTE
How to prevent VTE in a fracture patient
- Early ambulation
- Anticoag therapy
The following indicate what complication associated with a fx
- Occurs in long bone fractures, very frequent in fx of the arms and legs (radius, ulnar, humerus, femur, tibia, fibula)
- Fatty bone marrow migrate into systemic circulation and clog smaller blood vessels
Fat Embolism
The following are S/S of what?
- Respiratory distress
- Acute confusion
- Generalized petechiae
- Restlessness potentially leading to respiratory failure and death
Fat Embolism
The following are S/S of what?
- Severe flank pain
- Dark, tea-colored urine
- Elevated serum myoglobin level
Rhabdomylosis
- Compression & tissue ischemia -> restricted blood flow to muscle -> myoglobin spills into circulation -> nephrons are clogged -> Renal failure
- Could also see multiple electrolyte imbalances
Rhabdomylosis
How to correct rhabdomylosis
IV fluids to flush kidneys
Complication associated with a fx
Fracture fails to heal in correct alignment, or fails to heal all together.
Malunion and nonunion
How to prevent malunion and nonunion
Frequently check the positioning of the immobilization device
Name this complication associated with a fx
- Increased edema and hemorrhage in the area of the fracture, causing compression of nerves and blood vessels
- Can be caused by a cast, immediate removal is necessary
Compartment syndrome
All of the following are S/S of what?
- Pain out of proportion to the injury
- Passive pain at rest of the affected limb, hurts worse when moved
- All of the 6 P’s are present
- Pallor, paralysis, and pulselessness are considered late findings
Compartment Syndrome
Late findings of compartment syndrome
- Pallor
- Paralysis
- Pulselessness
How to fix compartment syndrome
*Remove cast
* Immediate Fasciotomy – incisions are made through the fascia over the affected compartment to relieve pressure
* NOTIFY PROVIDER IMMEDIATELY!!
Blood clot that breaks off and travels through the heart into the lungs
A complication associated with a fracture
Pulmonary Embolus
The following are S/S of what?
Sudden, intense dyspnea
Pleuritic chest pain
Tachypnea
Tachycardia
Crackles
Cough
Hemoptysis
A complication associated with a fx
Pulmonary Embolism
Dietary teaching for patients with a fracture
Metabolic demands increase during bone and wound healing. Extra protein, carbohydrates, calcium, and vitamins A/D/C are needed for adequate bone repair. Vitamin D supplementation promotes bone healing. Extra fiber and fluids are needed to avoid constipation caused by narcotic analgesics.
To foster bone healing and minimize complications that can cause malunion or nonunion the nurse must teach what?
proper use of slings, splints, and traction devices
What technique should be used for wound care?
Aseptic
What before PT can help client get the most out of PT?
Pain meds
Complications associated with fractures
- PE
- Compartment Syndrome
- Rhabdomylosis
- Infection
- Malunion and nonunion
- Hypovolemia
- Fat Embolism
- VTE
- NV Compromise
If a crushing injury is suspected what should be avoided and why?
Elevation because it reduces arterial pressure
Nursing Interventions for a fracture
- Maintain pulmonary hygiene
- Administer pain meds as ordered
- Administer other meds as ordered
- Provide wound/pin care
- Elevation*
- Apply Ice
- Perform ROM exercises
- Reposition as needed
- Provide hydration and nutrition
- Give positive feedback and encouragement
