Fractures, Hip, Surgery and Amputations Flashcards
Fracture causes?
primary tumor, pathological, steroids, chemotherapy causing osteopenia
Fracture Classifications?
- Closed or open (Simple or compound)
- Incomplete or complete
- Displaced or non-displaced
- Comminuted
Types of Fractures?
- Transverse
- Spiral
- Greenstick
- Comminuted
- Oblique
Fracture Healing stages?
- Hematoma formation (2-3 days)
- Granulation tissue - basis for new bone (3-14 days)
- Callus formation (2 weeks)
- Ossifies in 3 wks to 6 months
- Remodeling (up to 1 yr) complete healing
- gradual weight bearing over time
A patient presents with shortening and external rotation of the leg, what type of fracture do you suspect?
Hip, proximal femur
A patient presents with possible shortening and internal or external rotation of a leg. What type of fracture do you suspect?
Femur (mid-shaft, distal)
CMS (neurovascular) Checks after a fracture?
- Circulation (color)
- Distal pulses
- Temperature
- Capillary Refill Time
- Motion (mobility)
- ROM distal to fracture
- Muscle spasms
- Sensation (neurologic injury)
- Pain and/or acute tenderness
- Loss of sensation to body parts
5 P’s of fracture assessment?
- Pain
- Pulselessness
- Pallor
- Paresthesia
- Paralysis
Which electrolyte will be elevated with a fracture?
potassium due to muslce tissue necrosis
Management of a compound fracture?
sterile dressing on open wound or cleanest material available
Pharmacologic Therapy for fracture pain?
narcotics
Pharmacologic Therapy for muscle spasms with a fracture?
muscle relaxants (soma flexeril, robaxin)
Pharmacologic Therapy
for an open fracture?
- Antibiotics-cephalosporin (Kefzol, Ancef)
- Tetanus toxoid
Nutritional Therapy for a fracture?
- Protein
- Vitamins (B, C, D)
- calcium, phosphorus, magnesium
- Fluids and fiber (prevent constipation)
Types of fracture traction?
- skin
- skeletal
- balanced suspension
Types of skin traction?
1) Buck’s
2) Russell’s
Traction: Nursing Management?
- Maintain traction
- Monitor CMS of affected extremity
- Inspect skin frequently for skin breakdown
- Encourage movement of unaffected body areas
- Dietary considerations
Caring for plaster Casts?
- Keep uncovered until dry (24-72 hours)
- Handle wet cast with palms not fingertips
- Don’t place cast on plastic
Can a Synthetic Cast get wet?
yes
Fracture Management: After Cast Care?
- Wash skin gently with mild soap and pat dry; no lotions; avoid scratching
- Have patient move slowly until has re- adjusted to “life without cast”
- Resume activities gradually
- Frequent rest and elevation
Instructions for proper Crutch use?
- Crutches below axilla 2-3 fingers
- Elbow flexed 20-30 degrees when walking
- Nurse stand on affected side
- Patient to look up and out when walking, crutches 6-10 inches in front
- Do not rest on axillary bars-stop ambulation if develop numb/tingle in hands/arms
Instructions for proper Cane and Walker use?
- Handle at height of greater trochanter
- Stand on affected side with ambulation
Fracture Complications?
- Alterations in the fracture healing process (Direct)
- Nonunion
- Infection
- Avascular Necrosis
- Blood vessel and nerve damage (Indirect)
- Venous Thrombosis
- Traumatic or Hypovolemic Shock
- Compartment Syndrome
- Fat Emboli
Fracture Complications Infection?
- Description
- Bone-Osteomyelitis- Earliest sign-pain
- Assessment
- pain unrelieved with rest fever
- Interventions
- Bedrest, antibiotics
Fracture Complications: Avascular Necrosis?
- Description: bone death
- Assessment
- Pain
- ↓ sensation, ROM
- Interventions
- Notify MD, surgery
Fracture Complications Compartment Syndrome?
- Description
- pressure in muscle compartment
- Assessment
- Causes-internal or external
- Interventions
- Relieve pressure
Fracture Complications Fat emboli?
- Description
- fat globules
- Assessment
- respiratory symptoms
- chest pain
- petechiae
- chest x-ray-“snowstorm”
- Interventions
- oxygenation, immobilization, supportive care
Risk factors for Hip fractures?
- Elderly
- Female
- Hx of osteoporosis
Goal of Post-op Care for a Total Hip Replacement?
Avoid injury R/T hip dislocation, DVT, PE
Post-op Care for a Total Hip Replacement?
- abduction pillow (“A-frame” pillow)
- don’t sleep on the operative side
- don’t flex hip more than 90 degrees
- don’t elevate the HOB > 45 degrees
- fracture bedpan
- overhead trapeze
- DVT prophylaxis medication
- isometric exercises
Discharge Teaching: Total Hip Replacement?
- Maintain abduction
- Avoid stooping; internal rotation of the affected leg
- Do not sleep on the operated side until directed
- Flex hip only to ¼ circle
- Never cross legs
- Avoid the position of flexion during sexual activity
- Walking = excellent; avoid overexertion
- In 3 months will be able to resume ADLs except for strenuous sports
- Prophylactic antibiotics prior to dental visits
Positioning for a LE amputation?
- prevent edema and contractures
- keep stump from hanging over the side of the bed
- discourage long periods of sitting
- Prone - 20 min 3-4 times a day
- ROM and strengthening exercises
Initial Care of a Fracture?
- ABC’s
- Immobilize with cast or splint
- Neurovascular exam
Initial Care of a Compound Fracture?
- ABC’s
- sterile dressing or cleanest material on open wound
- neurovascular exam
Nursing care for a cast?
- mobilize patient as soon as possible
- isometric exercises
- weight bearing as instructed
- no scratching under the cast, no objects inside
- monitor circulation, infection (hot spots, foul odor and pain)
Causes of blood vessel and nerve damage in a fracture?
- venous thrombosis
- traumatic or hypovolemic shock
- compartment syndrome
- fat emboli
What is the earliest sign of osteomylelitis?
pain
Nursing assessment and treatment for osteomylelitis?
- Assessment: pain unrelieved with rest and fever
- Interventions: bedrest to reduce bloodflow and spread of infection and antibiotics
Fracture Complication - Fat emboli:
1) Description
2) Assessment
3) Interventions
1) fat globules
2) resp symptoms, chest pain, petechiae, chest x-ray for “snow storm”
3) O2, immobilization, supportive card
Fracture Complication - Compartment Syndrome:
1) Description
2) Assessment
3) Interventions
1) pressure in muscle compartment
2) bleeding/edema, cast is to tight
3) relieve the pressure
Fracture Complication - Avascular Necrosis:
1) Description
2) Assessment
3) Interventions
1) bone death
2) pain and decreased sensation and ROM
3) notify MD, surgery to remove the necrotic tissue
Risk factors for HIP fracture?
elderly, female and hx of osteoporosis
Signs/Symptoms of a hip fracture?
- pain, shortening & external rotation on the affected side
- abduction of affected leg
Surgical treatment for a HIp fracture?
ORIF, total hip replacement, hip resurfacing
Post-op care for a Total Hip Replacement?
- abduction pillow (“A-frame” pillow)
- don’t sleep on operative side
- don’t flex hip more than 90 degrees
- don’t elevate the HOB > 45 degrees
- fracture bedpan
- overhead trapeze
- DVT prophylaxis
- isometric exercises
Discharge teaching for a Tota Hip Replacement?
- maintain abduction
- avoid stooping: internal rotation of affected leg
- don’t sleep on operative side
- flex hip only 1/4 circle
- never cross legs
- avoid position of flexion during sexual activity
- walking = excellent; avoid overexertion
- Will be able to resume ADL except for sports in 3months
- prophylactic antibiotics prior to denatl visits
Indications for an amputation?
diabetes and necrosis
Post-op Amputee Care interventions?
- tourniquet at the bedside
- evaluate for phantom limb pain
- encourage verbalization regarding loss of body part
Postitioning for a lower extremity amputation?
- prevent edema and contractures
- keep stump from hanging over side of bed
- discourage long periods of sitting
- lay pt prone - 20 mins x 3-4 times a day
- ROM and strengthening exercises
- stump care
- fit for prosthetics
Can a patient remove a compression bandage on a stump?
yes, once daily for bathing
