Fractures/Ortho Surgery Flashcards
1
Q
4 classifications for fractures?
A
- Extent of break
- Extent of soft tissue damage
- Cause
- Type
2
Q
classifying fracture by extent
A
Complete versus Incomplete
Open vs Closed
3
Q
complete vs incomplete fracture
A
Complete = broken in two Incomplete = not broken into two pieces, still connected
4
Q
open versus closed fracture
A
closed = no bone sticking out of skin open = sticking out of bone - risk of infection and osteomyelitis!
5
Q
classifications of fracture by cause
A
Pathologic or Spontaneous = osteoporosis
Fatigue/Stress = running /jumping
Compression = fall and land on feet
6
Q
what is an example of a cause of pathologic fracture?
A
osteoporosis
7
Q
example of cause of fatigue or stress fracture?
A
running/jumping
8
Q
example of compression fracture cause?
A
fall and land on feet
9
Q
fracture where bone broke and not aligned well
A
displaced
10
Q
fracture that runs all the way around the bone
A
spiral
11
Q
fracture in kids that is like incomplete
A
greenstick
12
Q
fracture where there is still some connection b/w bone but also fragments
A
fragmented
13
Q
fracture where there is shattering of bone in many pieces
A
comminuted
14
Q
fracture runs up the bone length
A
oblique
15
Q
fracture where two bones pushed together and leads to comminuted fracture
A
impacted
16
Q
risk factors for fractures?
A
*Riding in cars -> car accident risk Falling Malnutrition -> over age on 30 need to take in enough Ca and Vit D Sports Osteoporosis
17
Q
where do adults, young/middle aged, and older adults have most of their fractures?
A
Adults: Ribs
Young and middle-aged: Femoral
Older adults: Femur
18
Q
health promotion education/interventions for fracture prevention
A
Seat belts Airbags Reducing driving while impaired Osteoporosis screening/ treatment Fall Prevention
19
Q
3 things to get in history when assessing fracture
A
Type of Injury
Alcohol and drug use
Disease states
20
Q
what do we prioritize with physical assessment of fracture
A
ABC!
21
Q
what is indicator that we need to get imaging for fracture
A
pain
22
Q
head to toe signs of fracture?
A
- Change in bone alignment
- Shortening
- Change in Shape
- Bruising & Swelling
23
Q
C in CMS assessment
A
Circulation Color Pulse Capillary refill Temperature (warm, cool?)
-compare to other extremity, focus on distal end
24
Q
M in CMS assessment for fracture
A
Motion : Movement distal to fracture?
25
S in CMS assessment for fracture
Sensation
Tingling? Pain? Numbness?
Check extremity distal to injury… Compare it to other extremity… Changes?
26
Change in CMS=
indication of compartment syndrome = priority assessment!
27
Diagnostics for fracture
```
H&H-bleeding
WBC- infection
ESR
X-Ray
CT-scan
Hip
Spine
MRI
```
28
When do we immobilize fracture?
immediately to prevent damage
29
types of immobilization
Bandage
Splint
Cast
Traction
30
interventions for fracture
- ABC
- Pain
- Immobilize
- Sterile Gauze
- Reduction
- Elevation
- Ice
31
can nurses reduce bones?
no
32
what is most common way to manage a simple fracture
closed reduction
33
what happens in closed reduction?
Utilization of traction on bone and moving ends to position of realignment
34
what do we use to confirm proper placement of bone after closed reduction?
xray
35
when do we want to do complete a closed reduction?
ASAP to prevent nerve damage/promote proper bone healing
36
nurse role in closed reduction?
Administer medications
| Monitor patient
37
when do we use splints? which is more goodly- splint or cast?
More commonly used on body parts that do not bear weight
| --> preferred over cast b/c can adjust if swelling !
38
what do we use to immobilize ankle and foot id weight bearing is allowed?
orthopedic boot or shoe
*also preferred over cast
39
when do we use a cast?
- Typically reserved for complex fractures and LE fractures
| - Also utilized for correction of deformities and when NWB
40
what material do we prefer to make casts out of
fiberglass!
41
can fiberglass cast get wet?
Can get wet (but padding underneath cannot)
42
can use _____ to waterproof but it cannot be fully submerged in water
gore-tex
43
fiberglass vs plaster cast
```
fiberglass = most common, dries quick, reduces skin breakdown, need stockinette and padding underneath
plaster = need stockinette and padding underneath, 24 hours to dry
```
44
when do we use bivalve in cast?
for swelling, whole top and bottom come off
45
why put a window on a cast?
if open wounds and need to do wound care
46
cast intervention assessment
Increased pain
Increased drainage
Fowl smell
Circulation
47
______ is risk for compartment syndrome
cast
48
running vs balanced traction
Balanced: Fractured extremity is suspended with two opposing forces
--> can move limb w/o changing the traction
Running: Force exerted in one plane only (fractured limp is the opposing force)
--> if move limb they change traction
49
if move limb they change traction: balanced or running
running
50
skin vs skeletal traction
Skin: Force is applied to the fractured limp with use of bandage or splint
Skeletal: Force is applied to fractured limp with use of pins inserted into bone
51
it is important to make sure the weights for traction are not ____ ____ _____
on the floor
52
who do we contact if changes in weight w/ traction?
provider
53
what is buck's traction? what kind of pain is it particularly helpful for?
Buck’s Traction
- Running, skin traction
- Used for pain reduction specifically - esp. for hip fracture until repaired surgically
54
what is halo traction used for?
- cervical fracture
| - used for pain reduction
55
Open Reduction with Internal Fixation (ORIF) uses what to reduce fracture?
- Metal pins, rods, prostheses or plates are used for fixation in open surgery
- Affected area is kept immobile during healing process
56
how quickly can you become mobile again after ORIF?
immediately! and no traction
57
do you need traction with ORIF!
no!
58
post op ORIF care
- Pain Management : need to be able to move, breathe, what pain goal can get you there?
- Ambulation right away
- Prevent Complications
- PT
- NV Compromise
59
benefits of external fixation?
Less Blood Loss
Early Ambulation
Promotes Healing
60
complications from fixation surgery
```
Acute Hypovolemic shock
Hypovolemic Shock
Fat Embolus Syndrome
VTE (PE)
Infection (Including osteomyelitis)
Avascular Necrosis
Delayed Union
```
61
what is acute compartment syndrome?
- muscles are in fascia compartments but with swelling the fascia prevents expansion and get compression in blood vessel and nerves
- --> ischemia of muscle
- ---> damage to vessel, nerves, septic, amputation
62
acute compartment syndrome prevention
>Avoid tight dressings and casts
>Perform frequent CMS assessments for EARLY detection
---6 P's changes
63
volkmann's contracture
- forearm fracture as a result of acute compartment syndrome
| - -> muscles necrosed and becomes misshapen
64
fat embolism syndrome --> what is it and when do you see it?
-Fat globules released with all long bone fractures
(also hip and knee arthroplasty)
-Small percentage of people will develop FES
-->24-72 hours after trauma
65
FES triad of sxs
- Lungs (low O2, Dyspnea, tachypnea)
- Brain (Confusion, headache, seizure, altered LOC)
- Skin (Petechia on neck, chest and arms)
66
FES treatment
- Prevention
- >Early fixation
- >Surgical technique
- Supportive
- Oxygen
- Fluids
- Albumin: bind to fatty acid
67
define surgical site infection
=If site becomes infected within 30 days of surgery
| =If hardware becomes infected in the 1st year
68
surgical site infection can lead to ....
osteomyelitis
69
systemic vs local signs of infection
| *consideration for elderly
```
systemic = fever, elderly have depressed immune response and may not have a fever with infected fracture
local= red, hot
```
70
upper extremity fracture interventions
* Remove jewelry ASAP!
- Perform NV assessment
- Immobilize
- Elevate
- Apply Ice
- Manage Pain
71
hip fracture interventions/risks (things to consider for elderly)
- High mortality rate
* *Osteoporosis is the biggest risk factor
- IV Morphine/ PCA
* Avoid Demerol can contribute to delirium
- Delirium
- Mobility important
72
biggest risk factor for hip fracture
osteoporosis + elderly
73
avoid ______ in elderly with fracture b/c it can contribute to delerium
demerol
74
chest and pelvis fracture interventions/assessment
- -Potential for heart and lung damage (and other organs)
* ABC First
-Pelvis Fractures can quickly lead to death (loss of blood)
Look for blood in the urine, stool
*****Abdominal rigidity????
Abdominal swelling
75
spine fractures
-Associated with osteoporosis, cancer, MM
Causes pain, deformity and Neuro compromise
Non-surgical
Surgical
Kyphoplasty
Vertebroblasty
