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Nursing > Nursing care for fractures and fracture healing/interprofessional care for fractures > Flashcards

Nursing care for fractures and fracture healing/interprofessional care for fractures Flashcards

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1
Q

What types of immobilization devices are there?

A
  • Casts (inculding air casts)
  • Braces
  • Splints
  • Fixation devices: external and internal
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2
Q

What are casts?

A
  • Are temporary circumferential immobilization device
  • Commonly used following closed reduction
  • Allow the patient to perform many normal acitvities of daily living (ADLs)
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3
Q

Where does the health care provider apply a cast?

A
  • To an extremity
  • Incorporating the joints above and below a fracture
  • Stockinette and padding are placed over the extremity
  • Extra padding placed over bony prominences
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4
Q

What type of materials can casts be made with?

A
  • Natural
  • Synthetic
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5
Q

What are the characteristics of Natural (plaster of paris) casts?

A
  • Is usually immersed in warm water
  • Then wrapped and moulded around the affected part
  • Sets up in 15 minutes
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6
Q

When are natural casts strong enough for weight bearing? Natural

A

After 24-72 hours

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7
Q

Who makes the decisions about if weight bearing is tolerated? Natural

A

The health care provider

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8
Q

What do you instruct the patient aboust casts? Natural

A

To never cover a fresh plaster cast because air cannot circulate, heat builds up in the cast and may cause burn, and drying is delayed

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9
Q

What should you avoid during the drying period?

A

Avoid direct pressure on the cast, handle it gently with an open palm to avoid denting

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10
Q

What do you do once the cast is dry of a natural cast?

A

The edges may need to be smoothed with strips of tape (petalling)

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11
Q

What do you need to ensure with the casts edge? Natural

A

Ensure a smooth cast edge to prevent skin irritation from rough edges

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12
Q

What do you need to prevent about plaster paris debris casts?

A

Debris from falling into the cast and causing irritation or pressure necrosis

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13
Q

What material are synthetic and hybrid material casts made of

A
  • Synthettic acrylic
  • Fibreglass-free
  • Latex-free polymer
  • Hybrid of materials
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14
Q

What do synthetic casting materials include?

A
  • Thermolabile plastic
  • Thermoplastic resins
  • Polyurethane
  • Fibreglass
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15
Q

How are synthetic casting materials activated?

A

By submersion in cool or tepid water then moulded to fit the torso or the extremity

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16
Q

Why are fibreglass casts being used for often?

A
  • Lightweight
  • Relatively waterproof
  • Stronger
  • Faster-drying
  • Porous
    - Less risk of skin problems
  • Allow for almost immediate mobilization
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17
Q

How are fractures of the upper body including vertebral injuries immobilized?

A

Immobilization of an acute fracture or soft tissue injury of the upper extremity is often accomplished by use of a
- sugar-tong splint
- posterior splint
- short arm cast
- long arm cast.

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18
Q

When would you use a Sugar-Tong Splint?

A
  • Acute wrist injuries
  • Injuries that may result in significant swelling
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19
Q

Where are plaster splints applied?

A

Over a well-padded forearm
- Beginning at the phalangeal joints of the hand, extending up the dorsal aspect of the forearm around the distal humerus
- Then extending down the volar aspect of the forearm to the distal palmar crease

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20
Q

How is the splinting material wrapped for a sugar-tong splint?

A

with either elastic bandage or bias stockinette

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21
Q

When would you used a Posterior splint?

A
  • A sugar-tong posterior splint accomodates for postinjury swelling in the fractured extremity
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22
Q

When would you use a Short Arm Cast?

A
  • Treatment of stable wrist or metacarpal fractures.
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23
Q

How is a short arm cast arranged?

A

Circular cast extending from the distal palmar area to the proximal forearm

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24
Q

What kind of immobilization does a short arm cast provide and what motion does it permit?

A

Wrist immobilization and permits unrestricted elbow motion

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25
Q

What does an aluminium finger split added to a short arm cast do?

A

For treatment of phalangeal injuries

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26
Q

What are long arm cast used for?

A

Commonly used for stable forearm or elbow fractures and unstable wrist fractures

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27
Q

Where does the long arm cast extend to?

A

its like the short arm cast but extends to the
- Proximal humerus

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28
Q

What kinda motion does the long arm cast restrict?

A

Wrist and elbow

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29
Q

What are the nursing measures for casts of the upper body including the vertebral injuries immobilized?

A
  • Supporting the extremity
  • Reducing the effects of edema
  • Maintining extremity elevation with sling
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30
Q

Why do we have the ensure the axillary area of sling is well padded?

A

To prevent skin exocriation and maceration associated with direct skin-to-skin contact

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31
Q

Should the placement of the sling be put undue pressure on the posterior neck?

A

No it should not

32
Q

Should movement of finger be encouraged when wearing a cast?

A

yes unless contraindicated

33
Q

What are the benefits of moving your fingers when you have a cast?

A
  • Enhance the pumping action of vascular and soft tissure structures
  • Decrease edema
34
Q

Should you encourage the patient to actively move nonimmobilzed joints of the upper extremity of the body? (yes or no) and why?

A

Yes to prevent stiffness and contractures

35
Q

Should you used a hanging arm cast for a proximal humerus fracture with elevation or a supporting sling?

A

No, Hanging provides traction and maintains fracture alignment.

36
Q

What is the body jacket brace used for?

A
  • Immobilization and support for stable spine injuries of the thoracic or lumbar spine
37
Q

How does the body jacket brace go on the person?

A

Around the chest and abdomen and extends from above the nipple line to the pubis

38
Q

What is superior mesenteric artery syndrome? (cast syndrome)

A
  • After application of the cast, assess the patient for the development of superior mesenteric artery syndrome (cast syndrome).
  • Occurs if the body cast is applied too tightly and compresses the superior mesenteric artery against the duodenum
39
Q

What does the patient experience with superior mesentric artery syndrome? (cast syndrome)?

A
  • Abdominal pain
  • Abdominal pressure
  • Nausea
  • Vomiting
40
Q

What should you asses when someone has cast syndrome?

A
  • Assess the abdomen for decreased bowel sounds
  • A window in the brace may be left over the umbilicus
41
Q

What are the treatments for cast syndrom?

A
  • Gastric decompression with a nasogastric tube
  • NG suction
42
Q

What are ongoing nurse assessments with someone that has a vertebral injury?

A
  • Respiratory status
  • Bowel and bladder function
  • Areas of pressure over the bony prominences (espacially the iliax crest)
43
Q

Should you adjust or remove the brace?

A

Yes if any complication occur

44
Q

How are fractures of the lower extremities immobilized?

A
  • Long leg cast
  • Short leg cast
  • Cylinder cast
  • Jones dressing
  • Prefabricated splint or immobilizer
  • Hip spica cast
45
Q

When should you use the immobilization device such as the Long leg cast?

A
  • Unstable fracture
  • Soft tissure injuries
  • Fractured tibia
  • Knee injuries
46
Q

Where does the long leg cast occupy on the body?

A

Extends from the base of the toes to the groin and the gluteal crease

47
Q

When should you use a short leg cast?

A
  • Stable ankle and foot injuries
48
Q

When should you use a cylinder cast?

A
  • Knee injuries or fractures
49
Q

Where on the body does the cylinder cast occupy?

A

Extends from the groin to the malleoli of the ankle

50
Q

What is a jones dressing composed of?

A
  • Bulky padding materials (absorption dressing and cooton sheet wadding)
  • Splints
  • Elastic wrap bias-cut stockinette
51
Q

Splint/immobilizer are used for which location?

A

Knee and ankle
Easy to apply and remove
Permits close obeservation of the affected joint for signs of swlling and skin breakdown
Removal of the splint or immobilizer facilitates ROM of the affected joint
Enables faster return to function

52
Q

Where does the hip spica cast occupy on the body?

A
  • Femur fractures in children
  • The cast extends from above the nipple line to the base of the foot (single spica).
  • May include the opposite extremity up to an area above the knee (spica and a half) or both extremities (double spica)
53
Q

Whats the prupose of the hip spica cast?

A

Immobilize the affected extremity and the trunk

54
Q

What should you assess in a patient with a Hip Spica cast?

A

The same conditions that are associated with the body jacket brace

55
Q

What should you do after an application of a lower extremity cast or dressing?

A
  • Extremity should be elevated on pillows above the heart level for the first 24 hours
  • The casted extremity should not be places in a dependant position because of the possibility of excessive edema
56
Q

What is the post cast nursing assessment for lower extremity casts?

A
  • Observe patient for signs of compartement syndrome
  • Observe increased pressure in the Heel, anterior tibia, head of the fibula, and the malleoli.
    (Increased pressure is manifested by pain and a burning feeling)
57
Q

What are internal and exteral fixation devices?

A

Fracture immobilization can be done using external and internal fixation devices

58
Q

what are external fixators used for?

A
  • Used to stabilize the fracture while it heals
  • Apply traction or to compress fracture fragments and to ommobilize reduced fragments when the use of a cast or other traction is not appropriate
  • Hold fracture fragments in a manner similar to a surgically implanted internal device
59
Q

What are external fixators composed of?

A
  • a metallic device composed of metal pins that are inserted into the bone and attached to external rods to stabilize the fracture while it heals
60
Q

Where is the external fixators attached to?

A

Directly to the bones by percutaneous transfixing pins or wires

61
Q

What are the indications and when should we use external fixators?

A
  • Closed fractures
  • Comples fractures with extensive soft tissue damage
  • Correction of bony defects (congential)
  • Nonunion or malunion
  • Limb lengthening
  • Used to salvage extremities that otherwise might require amputation
62
Q

What are the nursing assessment of external fixators?

A
  • Pin loosening
  • Pin site infection
  • Exudate
    • Erythema
    • Tenderness
    • Pain
  • Infection may necessitate removal of the device
63
Q

What are the patient teachings for external fixators?

A
  • Teach the patient and caregivers about meticulous pin care
  • Each health care provider has a protocol for pin care cleaning
    • Chlorhexidine is often used
64
Q

What are the internal fixation devices?

A
  • Pins
  • Plates
  • Intramedullary rods
  • Metal and bioabsoarbable screws
  • Surgically inserted at the tie of realignment
  • Biologically inert
65
Q

What are internal fixation devices made of?

A
  • Stainless steel
  • Vitallium
  • Titanium
66
Q

How are internal fixation devices evaluated to know if proper alignment was done?

A

Radiographs at regular intervals

67
Q

What adjunct therapies are used to support fracture healing?

A

Pharmacologic and nutritional therapy are key aspects of interprofessional care.

Electrical bone growth stimulation and methods, pharmacological management, and nutritional therapy are presented.

68
Q

What is electrical growth stimulation?

A

Used to facilitate the healing process for certain types of fractures, especially those with nonunion or delayed healing
The mechanism of action of electrical bone growth stimulation may include:
Increasing the calcium uptake of bone
Activating intracellular calcium stores
Increasing the production of bone growth factors (Khalifeh et al., 2018)

69
Q

What are the methods of bone growth stimulation?

A
  • Noninvasice
  • Semi-inavasive
  • Invasive
70
Q

What pharmacologic management can you use to support fracture healing?

A

Pain management
Infection prevention and management

71
Q

What central and peripheral muscle relaxant may be prescribed for people who have involuntary reflexes such as muscle spasms caused by edema?

A
  • Central and peripheral muscle relaxants may be prescribed
  • Cyclobenzaprine
  • Methocarbamol (Robaxin)
72
Q

How do we prevent and manage infection related to fracture healing?

A
  • Tetanus and diphteria toxoid
  • Tetanus immunoglobulin (for patient who has not been previously immunized)
  • Bone-penetrating antibiotics are used prophylactically before surgery.
73
Q

What does 3 well balanced meals a day provide with the necessary nutrients?

A
  • Promote muscle strength and tone
  • Build endurance
  • Enhance ambulation
  • Allow gait training skills
74
Q

To ensure optimal soft tissue and bone healing what must the dietary include?

A
  • Protein (e.g., 1 g/kg of body weight)
  • Vitamins (especially B, C, and D)
  • Calcium
  • Phosphorus
  • Magnesium
  • Low serum protein levels and vitamin C deficiencies interfere with tissue healing
  • Immobility and callus formation increase calcium needs
  • Fluid intake of 2 000 to 3 000 mL/day promotes optimal bladder and bowel function
75
Q

How can we make the client avoid constipation?

A
  • Adequate fluid
  • A high-fibre diet with fruits and vegetables
76
Q

If the patient is in bed with a skeletal traction or in a body jacket brace what should you instruct the patient?

A
  • To eat six small meals to avoid overeating and this abdominal pressure and cramping
77
Q
A

Nursing (6 decks)

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