Med surg test 2 part 6 Flashcards
Immobilization secures the injured extremity in order to:
Prevent further injury.
Promote healing/circulation.
Reduce pain.
Correct a deformity.
__ __ is when a pulling force (traction) is applied manually to realign the displaced fractured
bone fragments
Closed reduction
Once the fracture is reduced, immobilization is used to allow the
bone to heal
__ __ is when a surgical incision is made and the bone is manually aligned and kept in place
with plates and screws
open reduction
Open reduction is when a surgical incision is made and the bone is manually aligned and kept in place
with plates and screws. This is known as an
open reduction and internal fixation (ORIF) procedure.
Traction: Check the temperature of the affected extremity. The extremity should be
warm, not cool, to touch.
Traction: Cool skin may indicate decreased
arterial perfusion
Nail beds that are cyanotic may indicate
venous congestion
Casts are more effective than splints or immobilizers because they cannot be
removed by the client.
type of cast that is heavy, not water resistant, and can take 24 to 72 hr to dry
Plaster of Paris
___ __ casts are light, stronger, water resistant, and dry very quickly (in 30 min).
Synthetic fiberglass
If the swelling continues after cast application and causes unrelieved pain, the cast can be
split on one side (univalve) or on both sides (bivalved).
___ is used over any rough area of the cast that may rub against the client’s skin
Moleskin
Prior to casting, the area is cleaned and dried. ___ ___ __ roll is placed over the
affected area to maintain skin integrity
Tubular cotton web
After cast application, position the client so that warm, dry air circulates around and under the cast (support the casted area without \_\_\_\_\_\_\_\_\_\_\_)
pressure under or directly on the cast
Elevate the cast above the level of the heart during the first 24 to 48 hr to prevent
edema
If any drainage is seen on the cast, it should be
outlined, dated, and timed, so it can be
monitored for any additional drainage
Cast education: Clients are instructed not to place
any foreign objects under the cast to avoid trauma to the skin
___ ___ over the cast can be used to avoid soiling from urine or feces
Plastic coverings
Traction uses a pulling force to promote and maintain
alignment of the injured area
Goals of traction include: Prevent __ __ injury
soft tissue
Goals of traction include: ___ of bone fragments
Realignment
Goals of traction include: Decrease
muscle spasms and pain
Goals of traction include: Correct or prevent further
deformities
Traction prescriptions should include: amount of
weight
Traction prescriptions should include: whether
traction can be
removed for nursing care
Classification of Traction: Straight or running: The countertraction is provided by
the client’s body
Classification of Traction: The countertraction is provided by the client’s body by applying a
pulling force in a
straight line
Classification of Traction: Movement of the client’s body can alter the traction provided.
Straight or running
Classification of Traction: Balanced suspension: The countertraction is produced by
devices such as slings or splints
Classification of Traction: Balanced suspension: The client’s body can be moved without
altering the traction.
traction used preoperatively for hip fractures for
immobilization in adult clients
Bucks
Traction: Ensure that weights hang
freely and are not resting on the floor.
If the weights are accidentally displaced,
replace the weights. If the problem is not corrected,
notify the provider
Move the client in halo traction as a unit, without
applying pressure to the rods
to treat muscle spasms, use
heat/massage
Loosening of pins could indicate
infection
Crusting at the pin site
should not be removed as this provides a natural barrier to bacteria.
____ antibiotics prevent infection when fracture immobilization is achieved
Prophylactic
Splints are ___ and allow for monitoring of skin swelling or integrity
removable
Splints can be used to support fractured/injured areas until
casting occurs and swelling is
decreased
involves fracture immobilization using percutaneous pins and wires that are
attached to a rigid external frame
External fixation
Used to treat: Comminuted fracture
External Fixation
Used to treat: nonunion fractures with extensive soft tissue damage
External Fixation
Used to treat: Leg length discrepancies from congenital defects
External Fixation
Used to treat: Bone loss related to tumors or osteomyelitis
External Fixation
External Fixation advantages include: Minimal blood loss occurring in comparison with
internal fixation
External Fixation advantages include: Allowing for early
mobilization
External Fixation advantages include: Permitting
wound care with open fractures
Nursing Actions for external fixation
Provide antiembolism stockings and sequential compression device to prevent DVT
Open Reduction and Internal Fixation (ORIF) nursing actions: ensure that heels are
off the bed at all times
Open Reduction and Internal Fixation (ORIF) nursing actions: Position for comfort and with __ on the surgical site
ice
Open Reduction and Internal Fixation (ORIF) nursing actions: Have the client get out of bed from the ____ side
unaffected
Open Reduction and Internal Fixation (ORIF) nursing actions: ensure increased intake of __ and __
calories and calcium
Open Reduction and Internal Fixation (ORIF) nursing actions: meals should be
small, frequent meals with snacks
Open Reduction and Internal Fixation (ORIF) nursing actions: what do you monitor pertaining to the GI system
constipation
Compartment syndrome described in one sentence
pressure that disrupts circulation
Compartment syndrome (ACS) is assessed by using
the five P’s
Compartment syndrome: Increased pain unrelieved with
elevation or by pain medication
Compartment syndrome: Intense pain when ___ moved
passively
____ is a late sign of compartment syndrome
Pulselessness
Compartment syndrome: Palpated muscles are ___ and swollen from edema.
hard
Fat embolism: most common fractures are
hip and pelvis
in addition to hip and pelvis fracture, fat embolism can occur with long bone fractures or with
total joint arthroplasty
difference between PE and fat embolism
FE has petechiae
prevention of fat embolism is
immobilize the area so that the fat doesn’t get out of the bone
fat embolism Tx
O2
corticosteroids (for edema)
fluid replacement
pain/anxiety meds
Osteomyelitis: Bone pain that is constant, pulsating, localized, and worse with
movement
Who might not have a fever despite having osteomyelitis
older adults
A fracture that has not healed within 6 months of injury is considered to be experiencing
___ ___
“delayed union.”
Electrical bone stimulation and bone grafting can be used to treat
nonunion (which is when the bones havent healed in 6 months)
which of the 6 p’s is an early sign of compartment syndrome
Paresthesia
Buck’s traction is a temporary immobilization device applied to diminish muscle spasms and
immobilize the affected extremity until surgery is performed
