Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Med-Surg > Mobility & Hip Fractures > Flashcards

Mobility & Hip Fractures Flashcards

1
Q

Why are fractures more common in childhood ?

A
  • bones are less dense and more porous in young children
  • children are more active than adults and they have limited gross motor coordination
  • fractures in infants needs to be questioned more for child abuse
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are some symptoms of fractures ?

A
  • edema
  • pain & tenderness (localized to point of injury)
  • muscle spasm
  • decreased or loss of function (inability to bear weight or use, guard against movement)
  • ecchymosis, confusion
  • may or may not have deformity
  • IMMOBILIZE if you suspect fracture
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How do we diagnose fractures ?

A
  • radiographs
  • history taking
  • suspicion of fracture in a young child who refuses to walk or bear weight
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the goals of fracture management ?

A
  • reduction (putting the bones together) & immobilization (to promote healing)
  • restoring function
  • preventing further injury and deformity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What do we assess in neurovascular checks ?

A
  • pain & point of tenderness
  • pulses: cap refill if you can’t access pulse point
  • pallor: pale, but want to see pink undertones
  • paresthesia: sensation distal to the fracture site
  • paralysis: movement distal to the fracture site
  • pressure: may be described as tight feeling, may look pinkish or feel wam
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How long does it take for bone healing in the neonatal period ?

A

2-3 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How long does it take for bone healing in early childhood ?

A

4 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How long does it take for bone healing in later childhood ?

A

6-8 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How long does it take for bone healing in adolescence ?

A

8-12 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are casts used for ?

A

used to immobilize the fracture until adequate callus formation
- in most cases the joint above and below the injury are casted to eliminate movement that may cause displacement at fracture site

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How long does it take for each type of cast to dry ?

A
  • plaster: 10-72 hrs to dry and not waterproof at all
  • synthetic: 5-20 mins and usually waterproof but still don’t want to get wet
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is some cast and brace care ?

A
  • ensure skin and neurovascular integrity
  • check the surrounding tissue every 1-2 hrs
  • neurovascular checks: check for compartment syndrome
  • keep extremity elevated (above level of heart) op help with swelling
  • keep cast/brace clean and dry (allow air circulation for plaster cast to dry) to avoid mold
  • mark any damage noted
  • do not put anything inside the cast (can cause injury)
  • keep non-casted joint mobile
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Why do we use traction for ?

A
  • to immobilize a joint or part of the body
  • prevent pain and muscle spasms associated with injury
  • reduce a fracture or dislocation
  • may help correct contractures (extremities that are bent/locked)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is Buck’s traction ?

A

temporary immobilization and stabilization of fractured hips or fractures of femoral shaft
- correct knee and hip joint contractures (not fractures)
- reduced muscle spasms
- weight is attached at the boot on the foot and is pulling and keeps the foot in perfect alignment
- can’t move pt side to side

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is skeletal traction ?

A

reduces fractures (holds the broken bones together)
- immobilizes/stabilizes fractures
- weights are attached to the pins in the bones
- we do this type of traction if it’s more unstable
- pin care q4 hrs
- wipe pins with CHG wipes
- infection in bone is osteomyelitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is a closed reduction ?

A
  • nonsurgical, manual realignment of bone fragments
  • usually with conscious sedation, sometimes anesthesia
  • Ex.) setting a cast
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is a open reduction ?

A
  • surgically usually with anesthesia
  • risk of infection
  • longer recovery
  • Ex.) surgical insertion of screws to re-attach pieces of ulna bone together
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is external fixation ?

A

devices (pins, rods, screws, etc.) are outside/external to the body
- used to apply traction
- immobilization
- holds fracture fragments together to promote healing

19
Q

What is internal fixation ?

A

devices (pins, rods, screws, etc.) are inside the body
- holds fractures fragments together to promote healing
- often permanent

20
Q

What is open reduction internal fixation (ORIF) ?

A

surgical procedure resulting in internal fixation
- the broken bone is reduced or put back into place
- an internal fixation device is placed on the bone (screws, plates, rods, pins)

21
Q

What is some care we do for a pt with surgery or traction ?

A
  • neurovascular checks (P’s)
  • circle any damage noted on cast or dressing
  • pain control
  • edema= ice to area for first 24 hrs after surgery
  • pulmonary function (turn, cough, deep breathe) & incentive spirometer to prevent pneumonia
  • positioning/alignment
  • teach/reinforce use of assistive devices
  • plan to minimize complications due to immobility
  • careful pin care
  • traction stays in place unless there is an emergency (like a code)
22
Q

How can infection affect fractures ?

A

delays healing and may result in chronic osteomyelitis
- infection more common in open fractures and soft tissue injuries

23
Q

What is some collaborative care for infections in fractures ?

A
  • open fractures require aggressive surgical debridement
  • IV antibiotics followed by course of oral antibiotics
  • meticulous pin care
24
Q

What is compartment syndrome ?

A

condition in which swelling & increased pressure within a compartment press on and compromise the function of blood vessels, nerves, and/or tendons that run through that compartment

25
Q

What are some causes of compartment ?

A
  • decreased compartment size
    • restrictive dressings
    • splints & casts (if too tight)
  • increased compartment content
    • edema
    • bleeding
    • inflammation
      this occurs within the first 48 hrs of injury, when edema is at its peak
26
Q

What are some clinical manifestations of compartment syndrome

A
  • PAIN
  • paresthesia
  • pressure
  • pallor: in the beginning it may be red/pinkish but if it persists it will get pale
  • paralysis
  • pulselessness
    patient may present with one or all of the six P’s
27
Q

How do we prevent compartment syndrome ?

A
  • regular assessment of extremity and cast/immobilization device
  • limit length of time that extremity is in a dependent position
  • elevate operative extremity if ordered and ice the extremity
28
Q

How do we treat compartment syndrome ?

A
  • prompt, accurate diagnosis is critical
  • early recognition is key
  • DO NOT apply ice or elevate above heart level (this decreases circulation so it causes blood flow issues)
  • remove/loosen the bandage and bivalve the cast
  • traction weight reduction
  • surgical decompression (fasciotomy)
29
Q

What are complications of compartment syndrome ?

A
  • infection from necrotic tissue
  • persistent motor weakness in the affected extremity is not reversible
  • contracture (Volkmann’s contracture of the forearm, can begin within 12 hrs of increased pressure)
  • myoglobinuric renal failure
  • amputation in extreme cases
30
Q

What is myoglobinuric renal failure ?

A

the injured muscle tissues release myoglobulin (muscle protein) into circulation
- this can clog the renal tubules and cause acute renal failure
- the damaged muscle cells release K+ which can’t be excreted because of the renal failure
- the hyperkalemia may cause dysrhythmias and cardiac arrest

31
Q

What is a fat embolism ?

A

presence of fat globules in tissues and organs after a traumatic skeletal injury
- usually occurs in fractures of long/big bones
- chunks of fat getting into the blood stream

32
Q

What is the mechanism theory for fat embolisms ?

A

release of fat globules from the bone marrow into the venous circulation

33
Q

What is the biochemical or metabolism theory for fat embolisms ?

A

hormones trigger release of fatty acids & neutral fats
- platelet aggregation & fat globule formation occurs

34
Q

What are clinical manifestations of fat embolisms ?

A
  • chest pain (usually think of a MI but once the EKG comes back normal we think a embolism)
  • tachypnea cyanosis
  • dyspnea
  • apprehension
  • confusion
  • changes in LOC
  • apprehension
  • tachycardia
  • decreased partial pressure of oxygen (PaO2)
  • diffuse crackles (late)
  • mental status changes
  • restlessness
  • HA
35
Q

How long does it take for a fat embolism to occur ?

A

24 to 48 hrs
- may be hours if extreme
- when emboli travel to the lungs, S/S are caused by poor O2 exchange

36
Q

How do you know if it’s fat embolism ?

A
  • rapid onset of symptoms with traumatic injury/surgery
  • petechiae (doesn’t happen in PE) to neck, anterior chest wall, axilla, buccal membrane and conjunctiva
  • chest x-ray showing white out
  • fat cells in blood/urine specimen (maybe)
37
Q

What is the treatment for fat embolism ?

A
  • immobilize fractures as soon as possible & maintain in
  • supplemental O2/respiratory support
  • correction of acidosis
  • IV fluids (to dilute system and hope clot gets excreted)
38
Q

What is a Venous Thromboembolism (VTE) ?

A

veins in the lower extremities and pelvis are highly susceptible to thrombus formation after fracture, especially hip fractures

39
Q

What are precipitating factors to VTEs ?

A
  • venous stasis caused by incorrectly applied casts or traction
  • local pressure on a vein
  • immobility
40
Q

What are some prevention strategies for VTE ?

A
  • ambulation as soon as possible/safe
  • prophylactic anticoagulant (Heparin, Coumadin, Lovenox)
  • SCDs (if you can’t do then do some ankle pumps to get blood circulating)
  • ankle pumps
41
Q

What are some clinical manifestations of fractures of the hip ?

A
  • external rotation (pointing outwards)
  • muscle spasm
  • shortening of the affected extremity
  • severe pain and tenderness in the region of the fracture site
42
Q

What are some surgical repairs of fractures of the hip ?

A

these permit early mobilization of the patient and decreases the risk of major complications
- internal fixation
- partial hip replacement (fix the ball or the socket_
- total hip replacement (you fix both the ball and the socket

43
Q

What are some do not’s for someone with a hip replacement ?

A
  • flex hip greater then 90 degrees
  • adduct the hip
  • internally rotate the hip
  • cross legs
  • put on own shoes or stockings until 8 wks after surgery
  • sit on chairs without arms to aid in rising to a standing position
44
Q

What are some things someone can do that had hip surgery ?

A
  • use elevated toilet seat
  • use a shower chair (NO BATHS)
  • use pillow between legs for first 8 wks after surgery when lying on “good” side or when supine
  • keep hip in neutral, straight position when sitting, walking, or lying
  • notify surgeon if severe pain, deformity, or loss of function occurs
  • inform dentist of presence of prosthesis before dental work so that prophylactic antibiotics can be given (since the bacteria loves to migrate into the implanted hardware, even if it was years ago)

Med-Surg (23 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions