lewis ch 62 fractures and amputation Flashcards
7 types fractures
- avulsion
- overriding
- comminuted
- oblique
- transverse
- green stick
- spiral
3 locations fractures
distal
medial
proximal
possible complications fractures (7)
- delayed / nonunion
- angulation
- infection
- acute compartmental syndrome
- venous stasis
- thrombus
- fat embolism
2 risk factors fractures
trauma
pathological
examples pathological risk factors for fractures (4)
- osteoporosis
- multiple myeloma
- osteogenic sarcoma
- metabolic diseases
S+S fractures (7)
- pain
- edema
- deformity
- decreased function
- false movement
- crepitation
- decreased sensation
5 Ps
pain pulse pallor paresthesia paralysis
musculoskeletal side efect corticosteroids
osteoporotic ractures
expected S+S fractures (7)
- pain
- guarding
- skin lacerations
- hematoma, edema
- restricted function
- crepitation
- muscle weakness
concerning S+S fractures (4)
- decreased/absent pulse, decreased skin temp
- delayed capillary refill
- paresthesias
- absent, decreased or increased sensation
peripheral vascular assessment (4)
- color and temp
- cap refill
- pulses
- edema
peripheral neurologic assessment (3)
- motor function
- sensory function
- paresthesia
S+S local infection (3)
- REEDA
- pain
- decreased function
S+S systemic infection (6)
- increased WBC
- increased HR, RR, temp
- malaise
- shivering
- nausea
- anorexia
REEDA
redness edema ecchymosis drainage approximation
6 Ps compartment syndrome
- pain
- pressure
- paresthesia
- pallor
- paralysis
- pulselessness
s+s venous thromboembolism
warm, red extremity
S+S fat embolism (3)
- tachypnea, SOB
- petechiae
- pt report of “impending doom”
common places fat embolism (4)
- femur
- fib
- tibia
- pelvis
recommended fluid intake post-op
2500 mL/day
cast care (3)
- frequent neurovascular assessments
- ice over cast for first 24 hours
- elevate for first 48 hours
what should you report with a cast (4)
- increasing pain
- swelling associated with pain, discoloration, movement
- burning or tingling
- sores or foul odor
what could a warm cyanotic limb indicate
poor venous return
6 cast care do nots
- elevate if compartment syndrome is suspected
- get plaster cast wet
- remove padding
- insert objects into cast
- bear weight for 48 hours
- cover cast with plastic for prolonged period
4 purposes fracture immobilization through traction
- prevent or decrease pain and muscle spasm
- immobilize joint
- reduce fracture or dislocation
- treat pathologic joint condition
2 most common types traction
skin
skeletal
when is balanced traction (skeletal traction) most commonly used (3)
fracture of:
- femur
- hip
- lower leg
when is buck’s traction (skin traction) most commonly used (2)
fracture of:
- hip
- femur
care of client in traction (TRACTION)
Temperature Ropes hang freely Alignment Circulation check (5 Ps) Type + location fracture Increased fluid intake Overhead trapeze No weights on bed or floor
what can be delegated to UAP with pt in traction (3)
- ensure ropes are hanging freely
- assisting pt to use overhead trapeze for position changes
- ensuring weights are hanging freely
how do you walk up the stairs with crutches
“good (foot) goes to heaven (up)”
“bad (foot) goes to hell (down)”
5 degrees of weight-bearing
- non weight bearing
- touch down/toe touch weight bearing
- partial weight bearing
- weight bearing as tolerated
- full weight bearing ambulation
complications post-op hip fractures (6)
- DBT
- neurovascular complications
- pulmonary complications
- skin breakdown
- urinary retention
- delayed complications
risk factors hip fracture (5)
- increased age
- female
- history osteoporosis
- decreased estrogen
- increased falls
2 options treatment for hip fracture
- buck’s traction
- surgery (internal fixation with hardware)
S+S hip fracture (5)
- pain
- affected leg shortened
- external rotation
- possible deformity
- ecchymosis
complications hip fracture (8)
- circulatory compromise
- immobility complications
- delayed/nonunion
- fat embolism
- nerve and vascular injury
- infection
- emboli
- avascular necrosis
stump wound care (3)
- elevate first 24 hours
- compression dressing
- discourage semi-fowlers position
stump care after wound has healed (4)
- assess skin breakdown
- wash and dry stump daily
- don’t apply anything to stump
- wear prosthesis
4 possible reasons for amputation
- peripheral arterial disease
- atherosclerosis
- diabetes: impaired circulation
- trauma
how long should pt wait after amputation to put full weight on it
3 months
how long should pt use prosthetic limb for during day
all day to avoid limb swelling
flexion contracture prevention for amputation (2)
- avoid chair > 1 hour
- lay prone 30 min 3-4xday
how often should amputee pt change limb sock and do ROM
daily
