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6200 Adult /Older Adult II > Fractures, Hip, Surgery and Amputations > Flashcards

Fractures, Hip, Surgery and Amputations Flashcards

1
Q

Fracture causes?

A

primary tumor, pathological, steroids, chemotherapy causing osteopenia

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2
Q

Fracture Classifications?

A
  • Closed or open (Simple or compound)
  • Incomplete or complete
  • Displaced or non-displaced
  • Comminuted
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3
Q

Types of Fractures?

A
  • Transverse
  • Spiral
  • Greenstick
  • Comminuted
  • Oblique
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4
Q

Fracture Healing stages?

A
  • 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
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5
Q

A patient presents with shortening and external rotation of the leg, what type of fracture do you suspect?

A

Hip, proximal femur

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6
Q

A patient presents with possible shortening and internal or external rotation of a leg. What type of fracture do you suspect?

A

Femur (mid-shaft, distal)

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7
Q

CMS (neurovascular) Checks after a fracture?

A
  • 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
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8
Q

5 P’s of fracture assessment?

A
  • Pain
  • Pulselessness
  • Pallor
  • Paresthesia
  • Paralysis
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9
Q

Which electrolyte will be elevated with a fracture?

A

potassium due to muslce tissue necrosis

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10
Q

Management of a compound fracture?

A

sterile dressing on open wound or cleanest material available

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11
Q

Pharmacologic Therapy for fracture pain?

A

narcotics

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12
Q

Pharmacologic Therapy for muscle spasms with a fracture?

A

muscle relaxants (soma flexeril, robaxin)

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13
Q

Pharmacologic Therapy

for an open fracture?

A
  • Antibiotics-cephalosporin (Kefzol, Ancef)

- Tetanus toxoid

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14
Q

Nutritional Therapy for a fracture?

A
  • Protein
  • Vitamins (B, C, D)
  • calcium, phosphorus, magnesium
  • Fluids and fiber (prevent constipation)
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15
Q

Types of fracture traction?

A
  • skin
  • skeletal
  • balanced suspension
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16
Q

Types of skin traction?

A

1) Buck’s

2) Russell’s

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17
Q

Traction: Nursing Management?

A
  • Maintain traction
  • Monitor CMS of affected extremity
  • Inspect skin frequently for skin breakdown
  • Encourage movement of unaffected body areas
  • Dietary considerations
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18
Q

Caring for plaster Casts?

A
  • Keep uncovered until dry (24-72 hours)
  • Handle wet cast with palms not fingertips
  • Don’t place cast on plastic
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19
Q

Can a Synthetic Cast get wet?

A

yes

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20
Q

Fracture Management: After Cast Care?

A
  • 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
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21
Q

Instructions for proper Crutch use?

A
  • 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
22
Q

Instructions for proper Cane and Walker use?

A
  • Handle at height of greater trochanter

- Stand on affected side with ambulation

23
Q

Fracture Complications?

A
  • 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
24
Q

Fracture Complications Infection?

A
  • Description
    • Bone-Osteomyelitis- Earliest sign-pain
  • Assessment
    • pain unrelieved with rest fever
  • Interventions
    • Bedrest, antibiotics
25
Q

Fracture Complications: Avascular Necrosis?

A
  • Description: bone death
  • Assessment
    • Pain
    • ↓ sensation, ROM
  • Interventions
    • Notify MD, surgery
26
Q

Fracture Complications Compartment Syndrome?

A
  • Description
    • pressure in muscle compartment
  • Assessment
    • Causes-internal or external
  • Interventions
    • Relieve pressure
27
Q

Fracture Complications Fat emboli?

A
  • Description
    • fat globules
  • Assessment
    • respiratory symptoms
    • chest pain
    • petechiae
    • chest x-ray-“snowstorm”
  • Interventions
    • oxygenation, immobilization, supportive care
28
Q

Risk factors for Hip fractures?

A
  • Elderly
  • Female
  • Hx of osteoporosis
29
Q

Goal of Post-op Care for a Total Hip Replacement?

A

Avoid injury R/T hip dislocation, DVT, PE

30
Q

Post-op Care for a Total Hip Replacement?

A
  • 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
31
Q

Discharge Teaching: Total Hip Replacement?

A
  • 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
32
Q

Positioning for a LE amputation?

A
  • 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
33
Q

Initial Care of a Fracture?

A
  • ABC’s
  • Immobilize with cast or splint
  • Neurovascular exam
34
Q

Initial Care of a Compound Fracture?

A
  • ABC’s
  • sterile dressing or cleanest material on open wound
  • neurovascular exam
35
Q

Nursing care for a cast?

A
  • 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)
36
Q

Causes of blood vessel and nerve damage in a fracture?

A
  • venous thrombosis
  • traumatic or hypovolemic shock
  • compartment syndrome
  • fat emboli
37
Q

What is the earliest sign of osteomylelitis?

A

pain

38
Q

Nursing assessment and treatment for osteomylelitis?

A
  • Assessment: pain unrelieved with rest and fever

- Interventions: bedrest to reduce bloodflow and spread of infection and antibiotics

39
Q

Fracture Complication - Fat emboli:

1) Description
2) Assessment
3) Interventions

A

1) fat globules
2) resp symptoms, chest pain, petechiae, chest x-ray for “snow storm”
3) O2, immobilization, supportive card

40
Q

Fracture Complication - Compartment Syndrome:

1) Description
2) Assessment
3) Interventions

A

1) pressure in muscle compartment
2) bleeding/edema, cast is to tight
3) relieve the pressure

41
Q

Fracture Complication - Avascular Necrosis:

1) Description
2) Assessment
3) Interventions

A

1) bone death
2) pain and decreased sensation and ROM
3) notify MD, surgery to remove the necrotic tissue

42
Q

Risk factors for HIP fracture?

A

elderly, female and hx of osteoporosis

43
Q

Signs/Symptoms of a hip fracture?

A
  • pain, shortening & external rotation on the affected side
  • abduction of affected leg
44
Q

Surgical treatment for a HIp fracture?

A

ORIF, total hip replacement, hip resurfacing

45
Q

Post-op care for a Total Hip Replacement?

A
  • 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
46
Q

Discharge teaching for a Tota Hip Replacement?

A
  • 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
47
Q

Indications for an amputation?

A

diabetes and necrosis

48
Q

Post-op Amputee Care interventions?

A
  • tourniquet at the bedside
  • evaluate for phantom limb pain
  • encourage verbalization regarding loss of body part
49
Q

Postitioning for a lower extremity amputation?

A
  • 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
50
Q

Can a patient remove a compression bandage on a stump?

A

yes, once daily for bathing

6200 Adult /Older Adult II (17 decks)

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