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ABSN > fractures - 405 > Flashcards

fractures - 405 Flashcards

1
Q

3 phases of bone healing

A

1) inflammatory -> hematoma
2) reparative -> fibrous cartilage, callous, ossification
3) remodeling

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2
Q

transverse fracture

A

straight line horizontally through the bone

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3
Q

spiral fracture

A

bone is broken in a twisted motion

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4
Q

greenstick fracture

A

spilter break, doesn’t go fully through the bone
most often in children

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5
Q

comminuted fracture

A

bone shatters

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6
Q

oblique facture

A

diagonal line through the bone

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7
Q

pathologic fracture

A

a disease process precipitates the bone break like bone cancers or severe osteoporosis
fracture would not happen in a healthy individual

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8
Q

stress fractures

A

due to overuse / repetitive stress on the joints

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9
Q

fracture emergency care

A

1) assess airway, bleeding, head injury
2) splint fracture asap
-immobilization
-maintain body alignment
-elevate body part to promote venous return & dec swelling
-apply cold pack 1st 24hr for vasoconstriction

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10
Q

3 goals for fracture treatment

A

1) reduce
2) immobilize
3) restore function

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11
Q

fracture reduction

A

replacing bone fragments in the correct anatomic position
can be closed or open

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12
Q

closed reduction

A

preferred
-non surgical manual realignment of bone fragments
-no incision in the skins
-uses local anesthesia

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13
Q

open reduction

A

usually coupled w/ internal fixation
open the patient to reduce it and then add internal fixation devices in like nails or screws

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14
Q

what is the next step in fracture care after fracture is reduced

A

immobilize the bone to hold broken bones together until healing takes place

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15
Q

how is immobilization achieved

A

external: cast, splints, brace, traction, & external fixators

internal: metal plates, screws, nails, pins & possible bone graft

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16
Q

cast care for a plaster of paris cast

A

-heat is felt
-handle w/ palms while wet
-petal edges to avoid casts from digging into skin

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17
Q

cast care

A

-no covering to allow for ventilation
-reposition q1-2 hrs until set
-neurovascular distal to cast checks q1 for 24 hrs
- fit 1-2 fingers into the cast
-ice for the first 24-36 hrs

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18
Q

what are the 5 Ps

A

pain*
pallor **
puleslessness **
paresthesia
paralysis **
* = first sign PVS problem
** = late sign PVS problem

19
Q

cast complications

A

-infection r/t pressure necrosis
-circulation impairment
-peripheral nerve damage
-comps of immobility

20
Q

how would we know if there is injury happening inside the cast

A

listening to subjective queues from the pt

21
Q

benefits of a splint

A

removable

22
Q

traction

A

-applies pulling force on fractured extremity
-2 types: skin & skeletal
-pulling force must be continuous
-running vs countertraction

23
Q

skin traction

A

-short term
-5 to 10 lbs
-bucks & russels

24
Q

skeletal traction

A

-longer term & tolerated better
-5 to 45 lbs
-pins used to immobilize part
-disadv: impaired skin integrity & risk for osteomyelitis

25
Q

running traction

A

-pulling is unidirectional
-pt will slip in direction of traction

26
Q

counter traction

A

pulling force is going in both directions

27
Q

bucks traction

A

-simplest form
-provides straight pull on affected extremity (running)
-relieve muscle spasm or temporary immobilization before ORIF

28
Q

russels traction

A

-permits pt to move somewhat in bed d/t counter traction
-permits flexion of knee joint
-relieve muscle spasm/back pain

29
Q

balanced suspension traction benefits

A

for skin or skeletal
-provides counter traction
-prevents pt from sliding to end of bed
-pulling force of traction is not altered when bed or patient moves
-allows for increased pt movement & facilitates care
must maintain constant traction w/ no interruption in wts

30
Q

line of pull

A

should never be interrupted

31
Q

external fixators

A

screws are placed into the bone above and below the fracture and a device is attached to the screws from outside the skin, where it may be adjusted to realign the bone

32
Q

external fixators (pins) related nursing care

A

-assess for pin loosening
-assess for infection
-meticulous pin care: 1/2 & 1/2 solution and cleaning the pins w/ a sterile qtip
-do not put ointments around the pin
-avoid touching the area

33
Q

internal immobilization devices

A

-pins
-screws
-plate

34
Q

nursing care for internal immobilization devices

A

-assess 5 Ps
-elevate extremity above heart
-apply ice compresses
-notify HCP immediately if pain increases & it is unrelieved by meds
-teach signs of neurovascular dysfunction

35
Q

pain control w/ internal immobilization devices

A

-ACT medications
-use non drug measures to support
if pain is unrelieved, think compartment syndrome

36
Q

compartment syndrome

A

swelling within a compartment that has no where to go d/t fascia not budging, can cause major issues within hours

37
Q

what to do if person develops compartment syndrome

A

emergency fasciotomy

38
Q

nursing mgt related to infection control

A

-assess pins
-aseptic technique
-culture site prn
-administer abx
-monitor temp
-monitor WBC

39
Q

nursing mgt related to impaired skin integrity

A

-examine potential pressure areas q4
-petal cast edge if plaster of paris
-do not insert items into cast to scratch
-instruct pt to report warmth, inc pain and foul odor
-moisture contributes to breakdown
-turn if permissible (avoid friction/shearing)

40
Q

nursing mgt related to impaired physical mobility

A

-pain control before ROM
-AROM/PROM/physical therapy
-weight bearing or NWB
-instruct use in assistive devices

41
Q

fractures put pts at risk for what

A

venous thromboembolism &/or fat embolisms
monitor for chest pain, tachypnae, cyanosis, apprehensin, tachycardia, petechial ras & hypoxemia

42
Q

what reduces the likelihood of fat embolisms

A

promote surgical stabilization of fractures

43
Q

fat embolism s/s

A

neurological features occurs 6-12 hrs before pulmonary symptoms

44
Q

treatment for fat embolism

A

supportive care
oxygen
fluids

ABSN (150 decks)

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