Fractures Flashcards
What are the types of fractures?
Transverse, Spiral, Greenstick, Comminuted, Oblique, Pathologic, Stress
Fractures: Emergency care
Assess: Airway, Breathing, Head injury Splint fracture Immobilization Maintain body alignment Elevate body part Apply cold pack 1st 24 hours
What are the three goals of fracture treatment?
Reduce
Immobilize
Restore function
What does it mean to reduce a fracture?
Replace bone fragments in the correct anatomical position
What are the two types of reduction
Closed reduction and Open reduction
What is a closed reduction?
Non surgical, manual realignment of bone fragments
Local anesthesia is used
What is open reduction?
Surgical reduction. Nails, screws and plates often used
Also called “Open reduction with internal fixation”
What is the purpose of immobilization?
To hold broken bones together until healing takes place.
What are the different types of external immobilization devices?
Cast Splint Brace Traction External Fixators
What are the different types in internal immobilization devices?
Metal plates Pins Screws Nails With or without bone grafts
What are casts?
Temporary circumferential immobilization device
Common treatment after closed reduction
What are common cast materials?
Most common = fiberglass
Plaster of Paris not used much anymore
What are the different types of casts?
Arm
Leg
Body/Spica
Cast care (Plaster of Paris)
1- heat is felt. 2 - Handle with palms while wet. 3 - petal edges
No covering (blankets)
Reposition q 1-2 hours until set
Neurovascular checks q 1 hours X 24 hours
Be able to stick a finger or two inside the cast to make sure there is room
Ice first 24 - 36 hours to reduce swelling
Peripheral neurovascular assessment
Assess for 5 Ps Pain Pallor Pulselessness Paresthesia Paralysis
First sign is Pain
Late signs are Pallor, Pulselessness, Paralysis
Complications of casts
Infection r/t pressure necrosis
Circulation Impairment
Peripheral nerve damage
Complications of immobility
Splints and Immobilizers are?
Removable
Braces are?
Adjustable
Traction
Applies pulling force on fractured extremity
Pulling force must be continuous (unless ordered intermittent)
Skin traction
Short term (skin cant tolerate very long) 5-10 lbs
Skeletal traction
5 - 45 lbs
Pins used to immobilize part
Running vs Countertraction
Running - pulling force goes one way. Unidirectional. If on leg pt will be slipping down toward foot of bed.
Countertraction - pulling force in different directions
What is bucks traction?
Simplest form of skin traction
Provides straight pull on affected extremity (running)
Used: Relieve muscle spasm or temporary immobilization before ORIF (surgery)
What is Russell traction?
Skin traction
Permits pt to move, somewhat, in bed. (due to countertraction)
Permits flexion of knee joint
Used: Relieve muscle spasm/ back pain
Balanced Suspension traction (skin or skeletal)
Provides countertraction
Prevents pt from sliding to end of bed
Pulling force of traction is not altered when bed or pt is moved
Allows for increased pt movement and facilitates care
Nurse must maintain constant traction, no interruption in weights
The line of pull
Must never be interrupted
External fixators
Screws are placed above and below the fractures and a device is attached to the screws on the outside of the skin
Pins: Nursing implications
Assess for pin loosening
Assess for infection
Meticulous pin care
- 1/2 and 1/2 (peroxide and saline) followed by normal saline
- Avoid ointments
Teach to avoid touching
Internal devices: Types
Pins
Screws
Plates
Related nursing problem: Risk for peripheral neurovascular dysfunction
Elevate extremity above heart level
Apply ice compress
Notify provider immediately if increase of pain unrelieved by meds
Teach signs of NV dysfunction
Related nursing problem: Acute pain
ATC medication
Non-drug measures
Sudden inability of pain medication to relieve pain? Compartment syndrome
Compartment syndrome
Swelling out of control in only a few hours
Fasciotomy procedure done to relieve
Related nursing problem: Risk for infection
Assess pin insertion sites for indicators of infection Aseptic technique Culture site PRN Administer antibiotics Monitor temp Monitor WBCs
Related nursing problem: Risk for impaired skin integrity
Examine potential pressure areas q4 hours (Braden scale daily)
Petal cast edges (if plaster of paris)
Do not insert items into cast to scratch
Instruct pt to report increased pain, warmth, or foul odor
Moisture contributes to breakdown
Turn if permissible. avoid friction/shearing
Related nursing problem: Impaired Physical mobility
Pain control before ROM
AROM/PROM physical therapy
Weight bearing or non weight bearing (are they allowed to bear weight)
Instruct use in assistive devices
These patients are at increased risk for what?
Venous thromboembolism Fat embolism (Long bone fracture)
Monitor for CP, tachypnea, cyanosis, apprehension, tachycardia, hypoxemia
