MS - Fractures & Joint Replacement Flashcards
bone structure
- dense, irregular connective tissue
- osteoblasts
- osteocytes
- purpose: support & structure; assist the body in movement; protect vital organs
fracture
- when too much force place on bone it fractures
- young and elderly: porous bone & areas of weakness
- any disease process that weakens bones or decreases tolerance to force
- age 12-21yrs typically fractures result of high-energy trauma: MVA, contact sports, bicycle accidents
- age 65+ typically fractures result of low-energy trauma
complete fracture
break is completely through the bone
incomplete fracture
fracture is partially across the bone; no displacement of bone fragments
closed (simple) fracture
skin is not ruptured and remains intact
open (compound) fracture
skin is bone; exposing the bone and causing soft tissue injury
open grading fracture
grade I: puncture wound, no vascular involvement
grade II: puncture wound, fragments of bone, moderate skin & muscle contusion, significant wound contamination
grade III: severe damage to soft tissues, nerves, muscles, and vessels; extremely contaminated
patterns of fractures
- transverse
- oblique
- spiral
- comminuted
- avulsion
- impacted
- fissure
- greenstick
patterns of fractures
- compression: bone collapse on self; bone mass loss; high falls
- depressed: fragments inward; blunt force trauma; skull and facial fracture
patterns of fractures
- displaced fracture: two ends separated from each other; out of their normal position; usually comminuted or oblique
- non-displaced fracture: periosteum remains intact; bone is still in alignment; usually transverse, spiral, and greenstick fractures are non-displaced fractures
management of fractures
- dx with x-ray or CT
- treatment: pain management > narcotics, NSAIDs; abx if open contaminated fx
- nonsurgical management: closed reduction; cast or splint for immobilization
- surgical management: open reduction with internal fixation (ORIF); external fixation
- traction: can be with other treatment options; weight and force to reduce fx & relieve muscle spasms > skeletal traction, skin traction
compartment syndrome
- increased edema and hemorrhage
- increased swelling = compresses blood vessels, restricting blood flow and oxygenation of muscle and nerves leading to hypoxia
- hypoxia causes more blood and fluid to lead into restricted compartmental space
- symptoms: pain, pressure, paresthesia, pallor, paralysis, pulselessness; notify HCP immediately > remove cast and/or fasciotomy
fracture complications
- neurovascular compromise: bone fragments sever vessels and nerves; 6 P’s
- venous thromboemboli (VTI): large vessel clots in circulation; travel to pulmonary arteries (pulmonary emboli)
- fat embolism syndrome: long bone fractures
- hypovolemia
- blood loss: open and closed fractures, hematomas = internal bleeding; pelvis highly vascular > hypovolemic shock
- infection/osteomyelitis
- malunion and nonunion
nursing management for fractures
- assess: 6 P’s; VS; positioning; labs
- actions: admin meds; wound/pin care; ice/elevation; ROM & positioning
- teaching: treatment options; healing process; diet to promote healing; wound and pin care technique; exercise ambulation; use of assistive devices; self-care
joint replacement pathophysiology
osteoarthritis
- loss of cartilage strength and function
- erosion of cartilage and bone
- narrowing joint space
- bone spurs
- thinning cartilage
- inflammatory response
- joint replacement removes damaged area of bone & replaces with prosthesis
