Fractures

Question 1

Stages of bone healing?

Answer 1

1- bleeding at broken ends of boen with hematoma formation, 72 hrs
2- organization of hematoma into fibrous network, 3-14 day
3- invasion of osteoblasts, lengthen collagen strands, deposits of calcium, 2 weeks
4- callus formation (new bone built as osteoclasts destroy dead bone, 3 weeks to 6 months)
5- remodelling (callus is reabsorbed/trabecular bone is laid down, can take up to a year)

Question 2

What is the neurovascular assessment for fractures?

Answer 2

C- colour (temperature, cap refill, peripheral pulses, edema)
M- movement
S- sensation (also suffering- pain)

Question 3

What are usual lab stuff for people with fractures?

Answer 3

Low hemoglobin, increased WBC/ESR

Question 4

What should we monitor for fractures?

Answer 4

Acute pain, decreased mobility, potential for neurovascular compromise, infection.

Question 5

Cast care?

Answer 5

Can cause neurovascular complications if too tight to check colour, sensation, temperature, movement (CMS). Ice and elevate within first 24-48 hrs. Don’t handle with hands. Don’t get cast wet, itchy means healing, don’t put stuff under cast, and foul odour is not normal.

Question 6

Traction care/what is it?

Answer 6

Pull ends of bones apart and reduces spasms. Ensure there’s no frayed ropes, loose knots, ropes are in pulley grooves, weight hangs freely, and body is aligned. Inspect skin around slings/pins.

Question 7

What are some immobility complication?

Answer 7

Pressure injury, osteoporosis, constipation, weight changes, muscle atrophy, atelectasis, VTE, depression, changes in sleep, sensory deprivation.

Question 8

What is bone non union complication?

Answer 8

Bones don’t heal together.

Question 9

Complications of fractures?

Answer 9

Bone non union, infection, venous thrombosis, FES, CS.

Question 10

What is a compound fracture?

Answer 10

Skin over broken bone is disrupted and causes external wound.

Question 11

What is a simple fracture?

Answer 11

Doesn’t extend through skin and there’s no visible wound.

Question 12

What is a displaced fracture?

Answer 12

Bone alignment is disrupted/altered and end of bone sections more likely to cause damage to surrounding tissues/nerves.

Question 13

What is fat embolism syndrome? S+S

Answer 13

Fat globules are release from bone marrow into bloodstream after an injury. Globules will clog blood vessels and impair organ perfusion (embolize to the lungs).

S+S: low O2, dyspnea, tachypnea, agitation, headache, decreased LOC, seizures, vision changes, rash develops

Question 14

What is fasciotomy?

Answer 14

Surgeon will cut through fascia to relieve pressure and tension on blood vessels and nerves for patients with acute CS.

Question 15

What is closed reduction?

Answer 15

Non surgical method for managing simple fractures- traction, immobilizing in splints/boot/cast

Question 16

What is closed reduction?

Answer 16

Non surgical method for managing simple fractures- traction, immobilizing in splints/boot/cast

Question 17

What is ACS?

Answer 17

Increased pressure in limited space will cause decreased circulation and perfusion to that area. Ischemia will develop (decreased blood flow), necrosis (death of tissue), colour ashens, pulses weak, acute pain, N&T.

Question 18

What are the 6 P of ACS? and bonus one

Answer 18

1. Parenthesis- feels N&T, pins and needles
2. Pain
3. Pressure
4. Pallor
5. Paralysis- loss of motor function
6. Pulselessness
   also poikiloothermia- differing temperature between limbs (affected side is cooler)

Question 19

What can CS cause eventually?

Answer 19

AKI- acute kidney injury, can have back pain/decreased urine output

Question 20

What do you do for CS?

Answer 20

Compare extremities, absent peripheral pulses, don’t apply ice or elevate, remove/loosen bandage, get doctor to split cast, reduce traction weight, could also have surgical decompression (fasciotomy).

Question 21

What is unrelieved pain and sign of/what should a nurse do first?

Answer 21

Compartment syndrome. Notify the doctor

Question 22

Cast care?

Answer 22

Don’t get wet, dont put things in it, can apply an ice pack for the first 24 hrs, move joints below and above cast.

Question 23

What do to when the patient is in a skeletal traction with foot and they report pain?

Answer 23

Call physician, ensure leg is not raised above heart level. You can’t release traction without an order.