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Exam 3 > Fractures > Flashcards

Fractures Flashcards

1
Q

What are the types of fractures a patient can have in their hips?

A

Intracapsular and extracapsular

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2
Q

Where do fractures occur on an intracapsular fracture?

A

At the ball joint and is the most severe

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3
Q

Where do fractures occur on an extracapsular fracture?

A

On the top of the femur

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4
Q

What does hip fractures usually result from?

A

Trauma- fall or motor vehicle crash

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5
Q

Children and teen hip fractures result from what?

A

Car and bike crashes or sports injuries.

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6
Q

What types of nutritional inadequacies are a risk factor for hip fractures?

A
  • Calcium
  • Vitamin D
  • Protein
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7
Q

what are the risk factors for hip fractures?

A
  • Older age
  • Problems with gait and balance
  • Neurological and musculoskeletal impairment
  • Dementia
  • Psychoactive medications
  • Visual impairments
  • Cancer metastases
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8
Q

What are the five ways to prevent falls?

A
  • Weight bearing and balancing exercises
  • Assessing home for hazards
  • Medications that may affect balance
  • Bone density
  • Muscle strength
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9
Q

What are the three ways to prevent hip fractures?

A
  • Preventing falls
  • Exercise and healthy diet
  • Adequate intake of calcium and vitamin D
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10
Q

A home health nurse is visiting an older client who lives with family members to evaluate the progress of the client’s hip pain after a fall. Which of the following would the nurse include when teaching the family about prevention of hip fractures from falls in the home?

  1. Remove all wall to wall carpeting from the home.
  2. Keep bare wood floors well polished.
  3. Use lampshades and frosted bulbs to reduce glare.
  4. Move items on the stairs to one side.
A
  1. Use lamp shades and frosted bulbs to reduce glare
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11
Q

What are the clinical manifestations of a hip fracture?

A
  • Adduction and shortening of affected limb
  • Possible external rotation
  • Acute pain in hip, groin, or medial side of knee.
  • Ecchymosis and swelling
  • May be unable to walk, stand, bear weight
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12
Q

Major loss of mobility due to a hip fracture may cause what complications?

A
  • DVT
  • Pressure ulcers
  • Pneumonia
  • UTI
  • Muscle atrophy
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13
Q

Other than major loss of mobility what are the other complications that can occur due to hip fracture?

A
  • Infection
  • Avascular necrosis
  • Death
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14
Q

What are the surgical goals after a hip fracture?

A
  • Stabilize fracture
  • Increase mobility
  • Decrease pain
  • Prevent complications
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15
Q

What are the medical managements used for hip fractures?

A
  • Immobilize to prevent further damage

- Surgery: reduction with fixation or replacement with prosthesis.

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16
Q

What are the three types of surgeries for hip fractures?

A
  • Repair with hardware
  • Partial hip replacement
  • Total hip replacement
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17
Q

What should you screen for after a patient has a hip fracture?

A

Osteoporosis

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18
Q

What do you need to assist the patient with after a hip fracture?

A

Repositioning the patient to keep the leg in abduction and to educate and assist with mobility and nutrition.

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19
Q

What are the four nursing managements that are needed for a patient with a hip fracture?

A
  • Relieve pain
  • Monitor for bleeding and fat emboli
  • Neurovascular assessment
  • Prevention of complications
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20
Q

After a hip surgery the patient should avoid hip dislocation. What are the three thing the patient should not do?

A
  • Affected leg should not cross the center of the body
  • Hip should not bend more than 90 degrees
  • Affected leg should not turn inward.
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21
Q

What four types of pharmacologic therapies can be done in a patient who has had a hip fracture?

A
  • Pain medications
  • Antibiotics
  • Anticoagulants
  • Bone density enhancers
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22
Q

ALWAYS assess for what in a patient who has fractured something?

A

the 5 P’s

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23
Q

What types of health history should you assess for in a patient with a hip fracture?

A
  • Age
  • History of traumatic event
  • Chronic illness
  • Medications
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24
Q

What types of physical assessment should you do for a patient with a hip fracture?

A
  • Pain
  • Inability to walk
  • Shortening of affected limb
  • 5 Ps
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25
Q

What are the Nursing Diagnoses for a patient with a hip fracture?

A
  • Impaired Physical mobility
  • Acute Pain
  • Risk for infection
  • Risk for falls
  • Impaired skin integrity
  • Anxiety
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26
Q

How often should you assess for the 5 P’s after a patient had a hip fracture?

A

1-2 hours

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27
Q

What type of pain should you assess for when panning effective pre and postoperative care?

A

Deep, throbbing, unrelenting pain

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28
Q

What should you monitor for when planning effective pre and post operative care?

A

Edema

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29
Q

What do you need to teach the patient after a hip surgery?

A
  • Proper range of motion
  • Isometric exercises
  • Observe use of assistive devices
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30
Q

How often should you turn a patient after having surgery to correct a fracture?

A

Every 2 hours

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31
Q

When looking at the surgical wound of a hip fracture patient- what should you asses for?

A

Wound size, color, and drainage

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32
Q

A serial fracture is usually due to what?

A

Abuse

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33
Q

How is a fracture described?

A

Break in continuity of bone

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34
Q

What are the 5 ways a fracture occurs?

A
  • Direct blow
  • Crushing force
  • Sudden twisting motion
  • Severe muscle contraction
  • Disease that has weakened bone
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35
Q

What does RICE stand for?

A
  • Rest
  • Ice
  • Compression
  • Elevation
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36
Q

When elevating a sprain or strain how high do you hold it?

A

Typically just above the heart

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37
Q

If a patient has a strain or sprain- other than RICE what do you do?

A

Immobilize and anti-inflammatory medications (NSAIDs)

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38
Q

What are the two ways fractures are classified?

A
  • Closed (simple)

- Open (compound)

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39
Q

A transverse fracture can be described as?

A

A break in a straight line across the bone- perpendicular to the shaft of the bone

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40
Q

An oblique fracture can be described as?

A

A break on an oblique angle (diagonal)

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41
Q

A spiral fracture can be described as?

A

A spiral shaped fracture of the bone

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42
Q

A communicated fracture can be described as?

A

A crushing of the bone resulting in crepedists

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43
Q

A segmental fracture can be described as?

A

At least two fracture line of the bone like isolates a portion of the bone.

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44
Q

An avulsed fracture can be described as?

A

A tendon or ligament attached to the bone pulls off a portion of the bone.

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45
Q

An impacted fracture can be described as?

A

One fragment of the bone gets pushed into another part of the bone.

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46
Q

A torus fracture can be described as?

A

Known as a buckle fracture resulting in a bulging of the bone.

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47
Q

A greenstick fracture can be described as?

A

A young or soft bone bends or breaks- typically in infancy and childhood.

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48
Q

What are the three phases of fracture healing?

A
  • inflammatory
  • reparative
  • remodeling
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49
Q

What are the risk factors for bone fractures?

A
  • Bone cancer
  • Osteoporosis
  • Lack of vitamin D, calcium, phosphorus
  • Aging
  • Lifestyle choices
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50
Q

What are the three ways to prevent fractures?

A
  • Education about safety equipment
  • Good lifestyle habits to increase bone strength
  • Safe living environment
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51
Q

What are the diagnostic tests used for a suspected fracture?

A
  • History
  • Initial assessment
  • X-rays
  • Blood chemistries, CBC, coagulation studies
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52
Q

Fractures are typically accompanied by what other injury?

A

Soft tissue injury

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53
Q

What are the manifestations of a fracture?

A
  • Deformity - loss of function
  • Pain/tenderness
  • Guarding
  • Hypovolemic shock
  • Eccymosis
  • Swelling
  • Numbness
  • Crepitus
  • Muscle spasm
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54
Q

What does crepitus feel like?

A

Rice crispies under the skin

55
Q

If a patient has an open fracture what should you do to prevent contamination?

A

Cover with sterile dressings

56
Q

What should you not attempt to do to a fracture?

A

Reduce it

57
Q

What are the three things emergency management will do for a fracture?

A
  • Immobilize the body part
  • Sprinting
  • Assess neurovascular status before and after splinting
58
Q

What must be done to the distal and proximal joints to the suspected fracture site?

A

They must be support and immobilized through splinting.

59
Q

In terms of rehabilitation related to clavicle fractures: what is done?

A
  • Use of clavicular strap or sling
  • Clavicle specific exercises
  • Limitation of activity
  • DO NOT elevate arm above shoulder for approximately 6 weeks
60
Q

What are the two things you do to rehab a humeral neck and shaft fractures?

A
  • Slings and bracings

- Activity limitations and pendulum exercises.

61
Q

In terms of pelvic fractures- management depends on what?

A

Type and extent of fracture and the associated injuries

62
Q

What is typically done to reduce and fixate a hip fracture?

A

Surgery

63
Q

What is care similar to in a patient with a hip fracture?

A

It is similar to a patient undergoing other orthopedic surgery or hip replacement surgery.

64
Q

What are the four types of stable pelvis fractures?

A
  • Pelvic wing (Duvemey’s) fracture
  • Sacral fracture
  • Simple pubic ramus fracture
  • ipsilateral fractures of pubic and ischial rami
65
Q

Unstable pelvic fractures are located where?

A

At the synthesis pubis

66
Q

A person who experiences an unstable pelvic fracture is at a huge risk of damaging this that will lead to 10% of patients dying from internal bleeding.

A

Femoral artery

67
Q

This is placed around the pelvis to keep everything from moving.

A

Pelvic girdle

68
Q

A stable fracture can be described as.

A

A fracture of the pelvis that is well approximates with bone to bone touching.

69
Q

What are the hardest bone to break?

A

Femur

70
Q

These are the two reasons a patient will have a femoral fracture.

A

Car accident or falling from heights

71
Q

How many types of femoral fractures are there?

A

6

72
Q

What are the 6 types of femoral fractures?

A
  • Fracture of neck of femur
  • Fracture of trochanteric region
  • Proximal fracture
  • Midshaft fracture
  • Supracondylar fracture
  • Condylar fracture
73
Q

Along with vital signs and pain assessment what other bodily assessments needs to be done on a patient with a hip fracture?

A
  • Respiratory status
  • Level of consciousness
  • signs and symptoms of shock
  • Frequent neurovascular assessment of affected extremity
  • Bowel and bladder elimination
  • Skin condition
74
Q

Fat embolisms are typically a complication of what types of fractures?

A

-Long bone fracture especially the femur.

75
Q

Aside from hemorrhage and shock what are the complications of fractures?

A
  • DVT, pressure ulcer, respiratory issues
  • Compartment syndrome
  • Delayed union and nonunion
  • Avascular necrosis
  • Reaction to internal fixation devices (pins)_
76
Q

What causes compartment syndrome?

A

Increasing pressure compromises circulation and the function of soft tissues, nerves, and vessels leading to anoxia and necrosis

77
Q

What are the five P’s?

A

-Pain, pallor, paresthesia, pulselessness, paralysis

78
Q

What are the 5 P’s?

A
  • Pain
  • Pallor
  • Paresthesia
  • Pulselessness
  • Paralysis
79
Q

Once you begin to notice compartment syndrome: necrosis and muscle death can occur in how many hours?

A

4

80
Q

What is used to monitor compartment pressure?

A

A wick catheter

81
Q

The nurse is caring for a 65 year old who fell and suffered a right femur fracture. The client is complaining of pain in the leg. The nurse determines that the right foot is pale and without a pedal pulse. The nurse take which of the following actions?

  1. Reassures the client that the finding is normal for older adults.
  2. Administers half of the pain medication ordered as pain perception may be lower in older adults.
  3. Monitors the foot for additional symptoms
  4. Notifies the physician
A
  1. Notifies the physician
82
Q

Why would a patient who has experience a fracture be at risk for DVT?

A

Due to immobility

83
Q

How do you prevent a DVT in a fracture patient?

A

Early immobilization of fracture and early ambulation

84
Q

Manifestations of fat embolism syndrome develop within…

A

Hours to a week

85
Q

Early stabilization of a long bone fracture will help prevent what?

A

A fat embolism

86
Q

What are the two risk factors for a fat embolism?

A

Long bone fracture and major trauma

87
Q

What are the triad of symptoms for a fat embolism?

A
  1. Respiratory failure (tachypnea and hypoxia)
  2. Neurological dysfunction
  3. Petechial rash
88
Q

What type of treatment is administered for a fat embolism?

A

Supportive

89
Q

What is paresthesias?

A

Numbness and tingling

90
Q

The pain associated with compartment syndrome is much greater than what?

A

The actual injury

91
Q

How long does a child tend to be in a cast after a fracture?

A

3-4 weeks

92
Q

How long does an adult tend to be in a caster after a fracture?

A

6-8 weeks

93
Q

Children typically experience what type of fractures from sports and play.

A

Long bone fractures

94
Q

Athletes and adults tend to experience what types of fractures and what happens to their recovery time?

A

-Stress fractures and the have a lengthened recovery time

95
Q

Why do older adults tend to experience fractures?

A

Due to osteoporosis

96
Q

Why do children tend to get fractures?

A

Due to their porous bones

97
Q

Open fractures require what?

A

Treatment to prevent infection

98
Q

What are the ways of treatment to prevent infection of an open fracture?

A
  • Tetanus prophylaxis
  • Antibiotics
  • Cleaning and debridement of the wound.
99
Q

Why would closure of the primary wound in an open fracture be delayed?

A
  • Permit edema
  • Wound drainage
  • Further assessment
  • Debridement if needed
100
Q

What are the three main goals in caring of a fracture?

A
  • Immobilize
  • Maintain perfusion
  • Prevent infection
101
Q

What are external fixation devices used for?

A

To manage open fractures with soft tissue damage and to provide support for complicated or comminuted fractures

102
Q

Why would a patient need reassurance if they are in an external fixation device?

A

Due to the appearance of the device

103
Q

What type of discomfort would a patient in an external fixation device experience?

A

Mild discomfort at the pin sites

104
Q

What does the nurse need to do for a patient in an external fixation device?

A
  • Elevate to reduce edema
  • Monitor for signs and symptoms of complications including infection
  • Pin care
  • Patient education about the device
105
Q

True or false:

The nurse never adjusts the clamps on the external fixation frame.

A

True- do not touch it. The doctor should do any adjusting

106
Q

True or false:

Testing for crepitus can produce further tissue damage and should be avoided.

A

False- you need to test for it but then leave it be once you find out if they have it or not.

107
Q

How are casts and splits described?

A

Rigid device to immobilize injured bones

108
Q

What two types of casts are there?

A

Plaster and fiberglass

109
Q

When would you use a fiberglass cast?

A

For easy fractures because they are difficult to mold

110
Q

When would you use a plaster cast?

A

For more difficult features because they are easy to mold

111
Q

What do you need to teach a patient with a cast?

A
  • Expectations during casting process
  • Do not scratch or stick anything under cast
  • Cushion rough edges
  • Exercises, activity and mobility, and elevation of extremity
  • Required follow up care- cast removal
112
Q

For a patient with a brace, splint, or cast: what are the ways to relieve pain?

A
  • Administer analgesic
  • Positioning changes
  • Intermittent application of ice or cold
  • Elevation to reduce
113
Q

Unrelieved pain of a patient which a fracture my indicate what?

A

Compartment syndrome

114
Q

You should encourage movement of digits distal to the fracture how often?

A

Every hour

115
Q

What is traction?

A

The application of a pulling force to a part of the body

116
Q

What are the four purposes of traction?

A
  • Reduce muscle spasms
  • Reduce, align, and immobilize fractures
  • Reduce deformity
  • Increase space between opposing forces
117
Q

What are the three types of skin traction?

A
  • Buck’s extension traction
  • Cervical head halter
  • Pelvic traction
118
Q

What are the two types of traction?

A

Skin and skeletal traction

119
Q

What type of traction is never interrupted?

A

Skeletal traction

120
Q

Why must traction be continuous?

A

To reduce and immobilize fractions

121
Q

What are the principles of effective traction?

A
  • Whenever traction is applied a counterforce must be applied
  • Frequently the patient body weight and positioning in bed supply the counter force.
122
Q

When would you remove the weights for a patient who is required to have traction

A

When intermittent traction is prescribed

123
Q

What types of factors must me eliminated if a patient is on traction?

A

Any thing that reduces the pull

124
Q

What must you make sure about the ropes and weights of a traction?

A

Ropes are free of knots and unobstructed. Weights must hang freely

125
Q

How many directions do all tractions need to be applied in?

A

2

126
Q

True or false:

The nurse must never remove weights from skeletal traction unless a life-threatening situation occurs.

A

true

127
Q

How many times a day should a patients skin be checked if they are on traction?

A

3 times a day

128
Q

What do you need to assess for when a patient is on traction?

A
  • Sensation and movement
  • Pulses, color, capillary refil, and temperature of fingers or toes
  • Indicators of DVT
  • Indicators of infection
129
Q

What do you need to palpate when a patient is on traction?

A

-Traction tapes to assess for tenderness

130
Q

What types of pharmacologic therapies are used in a patient with a fracture?

A
  • Analgesics for pain (opioids and NSAIDs)
  • Antibiotics
  • Anticoagulants
131
Q

A client wearing a right arm cast for a fractured humerus states, “I have not been able to extend my fingers on my right hand since this morning.” Which action is the priory for the nurse?

  1. Assess neurovascular status
  2. As the client to massage the fingers
  3. Encourage the client to take the prescribed analgesics as ordered.
  4. Elevate the right arm on a pillow to reduce edema.
A
  1. Assess neurovascular status
132
Q

What should you assess for in compartment syndrome?

A 
the 5 P's:
Pain
Pulses
Pallor
Paralysis
Paresthesia
133
Q

How often should you assess for the 5 Ps?

A

every 1-2 hours

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