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NURS 220 > LEC 2: Fractures > Flashcards

LEC 2: Fractures Flashcards

1
Q

Fracture

A

Break in continuity of the bone; can be complete or incomplete

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2
Q

Pathological Fracture

A

May occur during normal activity or following minimal injury when a bone is weakened by a disease process

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3
Q

Fatigue or Stress Fracture

A

Normal bone subjected to repeated stress without bone and muscle recovery

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4
Q

How are fractures classified?

A

Classification by mechanism of the injury or the type of bone discontinuity

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5
Q

Closed (simple) Fracture

A

Skin over site is intact

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6
Q

Open (compound) Fracture

A

Skin over injury site is broken either by fracture fragments, piercing skin, or a penetrating outside force

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7
Q

What are clinical manifestations (signs and symptoms) of fractures?

A 
Edema
Pain and tenderness 
Muscle spasms
Deformity 
Ecchymosis 
Loss of function 
Crepitation
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8
Q

What are diagnostic and lab test done for fractures?

A 
History and physical exam
X-ray exam 
Computed tomography (TC) 
Magnetic resonance imaging (MRI) 
White blood cell count (WBC) 
Hemoglobin (HBG) 
Hematocrit (HCT)
Partial thromboplastin time (RR) 
International normalized ratio (INR)
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9
Q

What are the six phases that bones goes through for self-healing?

A
  1. Fracture hematoma
  2. Granulation tissue
  3. Callus formation
  4. Ossification
  5. Consolidation
  6. Remodelling
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10
Q

Fracture Hematoma

A

Semisolid clot

- Takes 72 hours

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11
Q

Granulation Tissue

A

Osteoid

- Takes 3 to 14 days

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12
Q

Callus Formation

A

Minerals deposited, strengthens bone

- Takes 14 days

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13
Q

Ossification

A

Strength by helping create new bone and clinical union

- Takes 3 to 6 weeks

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14
Q

Consolidation

A

Distance diminishes and radiological union

- Takes 6 months to a year

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15
Q

Remodelling

A

Pre-injury shape and strength

- Up to 1 year

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16
Q

What are the three goals of fracture management?

A
  1. Anatomical realignment of bone fragments (reduction)
  2. Immobilization to maintain alignment
  3. Restoration of normal or near formal function to the injured part
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17
Q

What are the three types of anatomical realignment?

A
  1. Close reduction
  2. Open reduction
  3. Traction
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18
Q

Anatomical Realignment: Close Reduction

A

Nonsurgical, manual realignment of bone fragments to previous anatomical position

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19
Q

Anatomical Realignment: Open Reduction

A

Correction of bin alignment through surgical incision

Includes internal fixation with use of wires, screws, pins, plates, intermedullary rods, or nails

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20
Q

Anatomical Realignment: Traction

A

Application of a pulling force to an injured or diseased part of body or extremity while counetrtraction pulls in opposite direction
Used for skeletal traction or skin traction

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21
Q

What are the four types of fracture immobilization items?

A
  1. Fixation
  2. Splint
  3. Cast
  4. Traction
22
Q

Fracture Immobilization: Fixation

A

Internal: pins, plates, rods, and screws
External: Metallic external device, is outside the body and still screwed into the bone

23
Q

What do you look for in a neurovascular assessment for patients with fractures?

A 
Colour 
Temperature 
Cap refill
Edema
Pulses
Movement 
Sensation 
Pain

*Check CSM

24
Q

What are the pre-operative nursing management for patients with fractures?

A

Maintain adequate CSM, alignment
Pain management
Assess for and prevent early complications
Maintain skin integrity, hydration, NPO
Ins and outs, IV therapy
Prepare for surgery; physical, psychosocial, lab & diagnostic test, blood work

25
Q

What are the post-operative nursing management for patients with fractures?

A 
Monitor vital signs 
Aseptic dressing changes 
Promoting ambulation 
Monitoring wound drainage, drains
Preventing complications 
Medications 
Pain assessment 
Neurocascular assessment; critical 
Oxygenation and respiratory status 
Hydration 
Urinary retention 
Bowles/ bladder 
Education 
Referrals 
Nutrition and diet
26
Q

What do you need to do for cast care, post-casting?

A

Elevate limb for the first 24 to 48 hours
Apply ice
Avoid handling, especially the first 24 hours
Neurovascular checks
Don’t get wet

27
Q

Promotive and Preventative Management: What condition do you want to prevent?

A 
Edema 
Compartment syndrome 
Infection 
Deep veins thrombosis 
Pressure injuries
28
Q

Edema

A
  • Commonly occurs after bone/ tissue injury
  • Prevention/ decrease in edema is key to preventing other dangerous conditions
  • Decreasing edema relieves pain
29
Q

Compartment Syndrome

A

Increased tissue pressure within a limited space

30
Q

What are signs and symptoms of compartment syndrome?

A
  • Pain (pain on passive motion also)
  • Poikilothermia
  • Pallor
  • Paresthesia
  • Paralysis
  • Pulselessness
31
Q

What are treatments for compartment syndrome?

A
  • Want to elevate and ice to prevent
  • Is continues, may get orders to cut the cast off
  • If symptoms keep showing, you do NOT want to keep elevation and icing due to circulation
32
Q

What are signs and symptoms of infection?

A
  • Tenderness
  • Pain
  • Redness
  • Swelling
  • Local warmth
  • Elevated temperature
  • Purulent drainage
  • Delayed union or non-union of surgical site
33
Q

How do you treat an infection?

A

Will give prophylactic antibiotics, three times

34
Q

What are signs and symptoms of DVT?

A

Swelling
Warmth
Tenderness to area

35
Q

How can you prevent DVT?

A 
Anti embolic stockings (AES) 
PCS 
Mobility 
Bed exercise
Prophylactic anticoagulants
36
Q

How do you diagnos a DVT?

A

Doppler ultrasound

37
Q

Pressure Injury

A

Prevention is key

  • Pressure relieving mattress
  • Early mobilization
  • Frequent turning and positioning
  • Keep body surface clean and dry
  • Use Braden Scale for risk assessment
38
Q

Supportive/ Rehabilitative Care

A
  • Prevent swelling m
  • Ambulate early
  • Maintain bowel function
  • Encourage self-care
  • Manage pain
  • Referrals to PT and OT
39
Q

What are signs and symptoms of hip fractures?

A
  • Leg is shortened and externally rotated
  • Pain
  • Unable to weight near
40
Q

What are the two types of hip fractures?

A
  1. Intracapsular hip fracture

2. Extracapsular hip fracture

41
Q

Intracapsular Hip Fracture

A

Femoral neck fracture
Inside joint capsule
Usually related to bone disease

42
Q

Extracapsular Hip Fracture

A

Outside joint capsule

Usually related to a fall or trauma

43
Q

What is the surgical management for intracapsular hip fractures?

A

Treated with insertion of a femoral head prothesis

44
Q

What is the surgical management for extrcapsular hip fractures?

A

Treated with scres

45
Q

When is a total hip arthroplasty done?

A

Severe trauma
Osteoarthritis
Failure of previous surgeries

46
Q

Osteoarthritis

A

Degenerative joint disease

47
Q

What is the post-operative nursing care?

A
  • Similar to general post-op nursing management
  • Dressing change as ordered
  • Hemovac drain for 24 to 48 hours
48
Q

In what position are patients in after a hip fracture surgery?

A

Patient in supine position or on their side with pillows between legs

49
Q

What are special precautions you need to take after hip fracture surgery?

A
  • Do not cross patients ankles or legs
  • Do not force hip inwards or outwards
  • Do not force hip into more than 90 degrees of flexion
  • Use abduction pillow or regular pillow between legs when turning
  • Sit patient in high seated chairs and toilet seats
50
Q

How long do patients stay in the hospital after a hip fracture surgery?

A

Length of stay is 3 to 7 days and staples are removed by general practitioner in 14 days

NURS 220 (41 decks)

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