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NUR 200-Exam 2 > Fractures > Flashcards

Fractures Flashcards

1
Q

Nursing care for pt’s w/ a fracture?

A

ABC’s, Head-to-toe, Hx, Mechanism of injury,
Direct pressure of bleeding sites,
Immobilization of extremity,
Cover any open areas w/ a dressing (sterile)

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2
Q

What’s a skin traction?

A

Force applied to soft tissues w/ a weight/pulley system to maintain alignment using splints, bandages or boots (wt. 5-7lb)

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3
Q

What’s a skeletal traction?

A

Pins, wires, screws are surgically implanted to the bone and weights are attached to hardware pulling in diff directions to maintain alignment (wt. 25lb)

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4
Q

Why is skin traction used?

A

To keep alignment and decrease muscle spasms

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5
Q

Why is skeletal traction used?

A

If pt has soft tissue damage or when greater force is needed

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6
Q

What are 2 important things to assess for skin tractions?

A

Skin integrity and perfusion

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7
Q

What is important to assess for skeletal tractions?

A

Skin integrity and infection

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8
Q

What are 2 important things to assess for if a pt has a cast?

A

Hot spots (infection) neurovascular check

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9
Q

What is open reduction and internal fixation (ORIF)?

A

Surgery used to internally repair a bone fracture into correct alignment, use pins, screws, plates, nails, wires or rods to keep bone in place

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10
Q

What is external fixation?

A

Screws and pins are placed into bone above/below fracture then attached to metal bar outside of skin

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11
Q

What is electrical bone stimulation?

A

An electrical current is sent to fracture site, used if site won’t heal properly

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12
Q

Why would electrical bone stimulation be contraindicated?

A

Upper extremity fracture or pt has a pacemake

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13
Q

What is a intracapsular fracture?

A

Fracture across head or neck of the femur

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14
Q

What is a extracapsular hip fracture?

A

Fracture w/in the trochanter region

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15
Q

How will a fracture site appear?

A

Bruised, externally rotated and shortened

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16
Q

How will a dislocated extremity look?

A

Internally rotated and shortened

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17
Q

What are the pts biggest complaints in a fracture?

A

Pain, uncomfortable to sit (most comfortable when flat) muscle spasms

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18
Q

What are the 5 P’s for a neurovascular check?

A 
Pain
Pallor
Paresthesia
Pulses
Paralysis
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19
Q

How often do you do a neurovascular check?

A

Every Time you check VS, in post op more often then q4h when stable

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20
Q

Pre op management for hip fractures?

A

NPO, IVF (NS, D5 1/2) to prevent dehydration
Pain control intermittent in ED, PCA on unit (bolus of dilaudid)
Xrays, Stabilize extremity (Buck’s traction),
Lab studies (CBC, H/H, BUN/CRT, PT/PTT/INR)

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21
Q

What is general anesthesia?

A

When pt is knocked out and intubated

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22
Q

What is an epidural used for?

A

If pt is a high risk pt and unable to handle general anesthesia, is shorter/not intubated

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23
Q

What do you expect in PACU?

A

Stable VS, consciousness, pain controlled, no N/V

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24
Q

What are some open reduction internal fixation procedures for a hip fracture?

A 
Intramedullary rods (IM rods)
Intramedullary nails (IM nails)
Plates and screws
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25
Q

What is an arthroplasty?

A

Prosthesis

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26
Q

What is a hemiarthroplasty?

A

Replacement of head of femur

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27
Q

Post op care?

A

Positioning (alignment) w/ legs abducted (V shape)
Wt bearing status (partial)
Ambulation and PT

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28
Q

Complications to monitor for?

A

Pressure ulcers, atelectasis, dislocation, VTE, PE, compartment syndrome, fat embolism syndrome, infection, bleeding, malunion

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29
Q

What is a Pulmonary embolism?

A

Obstruction of the pulmonary artery by a blood clot; can occur @ anytime

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30
Q

Name this complication: altered mental status (earliest sign), tachycardia, slight fever, tachypnea, chest pain, dyspnea, crackles, decreased O2 sat, mild thrombocytopenia?

A

Pulmonary embolism

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31
Q

Whats a clue in a pts history for a pulmonary embolism?

A

Recent surgery

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32
Q

How do you treat a pulmonary embolism?

A

Bed rest, O2, anticoagulants, possible thrombolytic therapy, mechanical ventilation, PLT monitoring

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33
Q

What’s a normal aptt in a pt who isn’t receiving an anticoagulant?

A

25-39

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34
Q

What is the goal of anticoagulation?

A

1.5-2 times of normal

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35
Q

How often is aptt measures? and what should be done based on those results?

A

Daily; heparin drip adjusted per orders

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36
Q

What do you measure in a pt taking Coumadin?

A

INR

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37
Q

Explain compartment syndrome.

A

Swelling to the extremity prevents circulation of an extremity, histamine is released causing increase in blood flow thats trapped causing nerve tissue death which releases myoglobin that clogs the renal tubules causing renal failure

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38
Q

How long does it take for the loss of a limb to occur in compartment syndrome?

A

6hrs

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39
Q

What is the treatment for compartment syndrome?

A

Faciotomy- long incision to release pressure

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40
Q

What is the key sign to compartment syndrome? And a late sign?

A

Pain out of proportion to extremity; paralysis of limb or pulselessness

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41
Q

How will a pt w/ compartment syndrome present?

A

Swelling, pressure, cool extremity, decrease to absent pulses, change in sensation/motion

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42
Q

Explain fat embolism syndrome?

A

Fat globules are released from bone marrow, enter the bloodstream, travel to the pulmonary vascular bed and obstruct

43
Q

Why doesn’t fat embolism syndrome respond to anticoagulants?

A

Bc its fat…..duhh!

44
Q

How long will it take fat embolism syndrome to occur?

A

12-48hrs

45
Q

What is the earliest sign of fat embolism syndrome?

A

Altered mental status due to hypoxia/hypoxemia

46
Q

What are some key features to fat embolism syndrome?

A

Hypovolemia, pulmonary edema, capillary permeability, and a “snowstorm” effect on the xray

47
Q

How will a pt w/ fat embolism syndrome present?

A

Petechiae rash to upper extremity, cough/bloody frothy sputum, same s/s as PE

48
Q

True or false. Fat embolism syndrome is curative?

A

False

49
Q

What the key nursing actions of fat embolism syndrome?

A 
Gentle handling of extremity, early immobilization, 
100%O2 w/ non-rebreather mask
Possible mechanical ventilation, 
Hydration, fluid resuscitation, 
Possible transfusion/steroids
50
Q

A low grade temp is expected post op, what temp should ring “infection” and after what time period?

A

38.5+; 48hrs+ (also have increase HR/decrease BP)

51
Q

Infection in an elderly pt will appear as what?

A

A change in mental status

52
Q

When should you check the dressing postop?

A

Immediately on arrival to unit from PACU then q4h

53
Q

Management of bleeding and anemia?

A

Assessment of hip dressing, measure drainage from surgical drain, BP lower than baseline, autologous transfusion, monitor H/H

54
Q

What is the average amount of drainage from a surgical drain postop?

A

50mls/8hrs

55
Q

What is delayed healing?

A

Prolonged healing

56
Q

What is malunion?

A

Incorrect healing

57
Q

What is nonunion?

A

Failure to heal

58
Q

How are the unions diagnosed and how are they treated?

A

Xray; surgical intervention and/or electrical stimulation

59
Q

What are factors that influence functional status after surgery?

A

Age, balance, cognitive ability, gender, fatigue, pain and complications

60
Q

What are the best indicators of recovery?

A

Balance and cognitive ability

61
Q

What are major risk factors for total hip arthroplasty?

A

Osteoarthritis (degenerative joint disease)

62
Q

Decisions to have total hip arthroplasty?

A

Pain (drugs don’t work) interrupts sleep,
Unable to maintain desired quality of life/ADLs
Pt capable of participating in posop rehab

63
Q

If a pt has cemented total hip arthroplasty what are the advantages/disadvantages?

A

Can resume activity faster; can loosen and may need revision surgery

64
Q

If a pt has noncemented total hip arthroplasty what are the advantages/disadvantages?

A

Lasts longer (10-15yrs); limits activity for 6wks

65
Q

What is significant about dental work when considering a total hip arthroplasty?

A

Can cause infection that can lead to heart damage or complications to prosthetic so get done before

66
Q

What should a pt receive preop for several wks if a pt is anemic?

A

Epoetin Alpha to stimulate RBC production to decrease need for transfusion

67
Q

What hgb level alerts the surgeon for a blood transfusion?

A

8

68
Q

What is given preoperatively to have ready that may be needed during surgery?

A

Autologous blood donation

69
Q

What is the assessments to check for risk factors of a VTE in preop?

A

Hx, immobile, underlying clotting disorders, increased age, smoking

70
Q

What are the 3 rules to teach about exercises and transfers in postop?

A

No stooping/flexing
No bending at a 90 degree angle
No crossing legs (could cause dislocation)

71
Q

When should you stop anticoagulants before surgery?

A

1wk

72
Q

What kind of soap should a pt shower w/ morning of surgery and what should they not do?

A

Antibacterial soap/do not shave legs bc could cut self and cause an infection during surgery

73
Q

Whats another name for an epidural?

A

Neuroaxial

74
Q

What are some disadvantages/advantages to a longitudinal incision at the anterolateral thigh?

A

8-10cm on hip, has more muscle loss, decreases risk of dislocation but has longer recovery

75
Q

What are some advantages/disadvantages to posterolateral into thigh/buttock?

A

20-24cm, less muscle involved, higher risk of dislocation

76
Q

What types of drains are usually used in post op?

A

Jackson-Pratt/Hemovac

77
Q

How should a pt be positioned postoperatively?

A

Supine, head slightly elevated, may have over bed trapeze

78
Q

A pt should not sit how postoperatively?

A

No crossing legs or sitting @ 90 degree angle

79
Q

What could be assessed in post op?

A

Pain, skin breakdown, 5 P’s, assess for any complications, compare operative leg w/ inoperative leg

80
Q

What are some low molecular weight heparins used in postop that are all XA inhibitors (clotting factors), cause fewer bleeding complications, and don’t affect PT or aPTT significantly?

A

Enoxaparin (Lovenox)
Dalteparin (Fragmin)
Tinzoparin (Innohep)

81
Q

What can low molecular weight heparins cause? So what should you monitor?

A

Thrombocytopenia; platelets

82
Q

What should you assess for in a pt taking heparin?

A

Bleeding to IV site, gums, stools and neuro status

83
Q

What med should be given 72hrs before discharge? What Heparin antidote is used as well?

A

Coumadin

Protamine Sulfate

84
Q

To monitor postop pain what how long may NSAIDs be used for?

A

Up to 14days

85
Q

To help w/ progression of activity in postop when should a pt get out of bed?

A

Day 1

86
Q

What should be started right away after surgery?

A

PT eval and PT

87
Q

How should you assist a pt OOB in postop that prevents hip hyper flexion?

A

Stand on pt’s affected leg side, pt sits on side of bed (not @ 90degree/no bending @ waist) stand up, pivot on unaffected leg to chair

88
Q

If pt has cemented implants what should their weight bearing status be?

A

Usually PWB right away

89
Q

If a pt has non-cemented implants what should their wt bearing status be?

A

PWB 1st few wks until bony ingrowth occurs per xray

90
Q

What special devices should be ordered for a pt post op to help w/ progression of activity and prevent hip hyper flexion?

A

Elevated toilet seats, firm seat high back wheelchair

91
Q

How long of a stay will a pt usually stay in postop?

A

3days

92
Q

How long does acute rehab usually take? And completion of rehab

A

Approx. 1-2wks; about 6wks

93
Q

Safety @ home for pt after surgery?

A

No clutter/throw rugs! Secure electric/extension cords,
Adequate lighting, accessibility,
Shower chair, elevated toilet seats

94
Q

What is it called when a spinal disc ruptures allowing the fluid in the disc to leak out and irritate nearby nerves?

A

Herniated disc

95
Q

Excess wt, regular heavy lifting, bending and twisting, previous back probs, tall height and bone disorders are risk factors for what?

A

Herniated discs

96
Q

Name this type of herniated disc: not compressing a nerve is asymptomatic, if compressing nerve then pain in lower back, buttocks, thigh and leg, numbness/tingling and muscle weakness and may cause sciatica?

A

Lumbar discs

97
Q

Name this type of herniated disc: numbness/tingling, muscle spasms, weakness in areas serviced by affected leg, stiff neck, neck and shoulder pain shooting into arm or fingers?

A

Cervical discs

98
Q

Treatment for herniated discs?

A

Pain meds or surgery

99
Q

What are the 4 classic symptoms of Parkinson’s?

A

Tremor, rigidity, bradykinesia and postural instability

100
Q

Where do tremors usually occur in Parkinson’s?

A

Hand, foot, jaw, legs or pill rolling

101
Q

What occurs in rigidity in a pt w/ Parkinson’s?

A

Resistance to move bc of contraction of all skeletal muscles

102
Q

What occurs in bradykinesia in a pt w/ Parkinson’s?

A

Slow movements, shorter steps (shuffling gait), no arm swing, decrease blink rate, difficulty swallowing, chewing or w/ speech

103
Q

What are some nonmotor skills that appear in Parkinson’s?

A

Fatigue, loss of sense of smell, confusion, memory loss, dementia, slowed thinking

104
Q

Osteoporosis, osteogenesis imperfecta, Bone CA, inadequate intake of vit D, Ca and phosphate, aging, and trauma are all what?

A

Risk factors for fractures

NUR 200-Exam 2 (11 decks)

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