fractures - 405 Flashcards
3 phases of bone healing
1) inflammatory -> hematoma
2) reparative -> fibrous cartilage, callous, ossification
3) remodeling
transverse fracture
straight line horizontally through the bone
spiral fracture
bone is broken in a twisted motion
greenstick fracture
spilter break, doesn’t go fully through the bone
most often in children
comminuted fracture
bone shatters
oblique facture
diagonal line through the bone
pathologic fracture
a disease process precipitates the bone break like bone cancers or severe osteoporosis
fracture would not happen in a healthy individual
stress fractures
due to overuse / repetitive stress on the joints
fracture emergency care
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
3 goals for fracture treatment
1) reduce
2) immobilize
3) restore function
fracture reduction
replacing bone fragments in the correct anatomic position
can be closed or open
closed reduction
preferred
-non surgical manual realignment of bone fragments
-no incision in the skins
-uses local anesthesia
open reduction
usually coupled w/ internal fixation
open the patient to reduce it and then add internal fixation devices in like nails or screws
what is the next step in fracture care after fracture is reduced
immobilize the bone to hold broken bones together until healing takes place
how is immobilization achieved
external: cast, splints, brace, traction, & external fixators
internal: metal plates, screws, nails, pins & possible bone graft
cast care for a plaster of paris cast
-heat is felt
-handle w/ palms while wet
-petal edges to avoid casts from digging into skin
cast care
-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
what are the 5 Ps
pain*
pallor **
puleslessness **
paresthesia
paralysis **
* = first sign PVS problem
** = late sign PVS problem
cast complications
-infection r/t pressure necrosis
-circulation impairment
-peripheral nerve damage
-comps of immobility
how would we know if there is injury happening inside the cast
listening to subjective queues from the pt
benefits of a splint
removable
traction
-applies pulling force on fractured extremity
-2 types: skin & skeletal
-pulling force must be continuous
-running vs countertraction
skin traction
-short term
-5 to 10 lbs
-bucks & russels
skeletal traction
-longer term & tolerated better
-5 to 45 lbs
-pins used to immobilize part
-disadv: impaired skin integrity & risk for osteomyelitis
running traction
-pulling is unidirectional
-pt will slip in direction of traction
counter traction
pulling force is going in both directions
bucks traction
-simplest form
-provides straight pull on affected extremity (running)
-relieve muscle spasm or temporary immobilization before ORIF
russels traction
-permits pt to move somewhat in bed d/t counter traction
-permits flexion of knee joint
-relieve muscle spasm/back pain
balanced suspension traction benefits
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
line of pull
should never be interrupted
external fixators
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
external fixators (pins) related nursing care
-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
internal immobilization devices
-pins
-screws
-plate
nursing care for internal immobilization devices
-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
pain control w/ internal immobilization devices
-ACT medications
-use non drug measures to support
if pain is unrelieved, think compartment syndrome
compartment syndrome
swelling within a compartment that has no where to go d/t fascia not budging, can cause major issues within hours
what to do if person develops compartment syndrome
emergency fasciotomy
nursing mgt related to infection control
-assess pins
-aseptic technique
-culture site prn
-administer abx
-monitor temp
-monitor WBC
nursing mgt related to impaired skin integrity
-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)
nursing mgt related to impaired physical mobility
-pain control before ROM
-AROM/PROM/physical therapy
-weight bearing or NWB
-instruct use in assistive devices
fractures put pts at risk for what
venous thromboembolism &/or fat embolisms
monitor for chest pain, tachypnae, cyanosis, apprehensin, tachycardia, petechial ras & hypoxemia
what reduces the likelihood of fat embolisms
promote surgical stabilization of fractures
fat embolism s/s
neurological features occurs 6-12 hrs before pulmonary symptoms
treatment for fat embolism
supportive care
oxygen
fluids
