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OA Exam 2 > OA Fractures > Flashcards

OA Fractures Flashcards

1
Q

Fracture Risk Factors

A

Primary: age, bone disease, poor nutrition

Secondary: lifestyle habits

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2
Q

Types of Fractures

A
  • transverse
  • linear
  • oblique, nondisplaced
  • oblique, displaced
  • spiral
  • greenstick
  • comminuted
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3
Q

clinical manifestations of fractures

A
  • pain
  • deformity or misalignment
  • swelling
  • hypovolemia/shock or ecchymosis
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4
Q

Complications of fractures

A
  • compartment syndrome
  • DVT
  • Fat embolism syndrome
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5
Q

compartment syndrome

A

fascia surrounding muscles do not expand. When swelling occurs, muscle dies

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6
Q

S/S of compartment syndrome

A
  • severe pain
  • swelling
  • pallor
  • numbness
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7
Q

DVT

A

Deep Vein Thrombosis

-clot forms in one of the deep veins

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8
Q

S/S of DVT

A
  • redness
  • warmth of skin
  • leg pain cramping
  • swelling
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9
Q

Prevention of DVT

A
  • early surgery
  • anticoagulation
  • compression strategies
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10
Q

Treatment for DVT

A
  • bedrest
  • anticoagulants
  • vena caval filter
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11
Q

Complications of DVT

A
  • CVA

- Pulmonary embolism

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12
Q

Fat Embolism Syndrome

A

Fat emboli are released from closed long bone or pelvic fractures.

-These emboli enter the blood stream

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13
Q

The fat emboli entering the blood stream causes…

A
  • dyspnea that may progress to respiratory failure
  • petechial rash
  • neurological symptoms such as confusion, restlessness, seizures or come
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14
Q

There is an increased risk of infection with…

A
  • open fractures
  • external fixation devices
  • immunocompromised patients
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15
Q

Collaborative Treatment Strategies

A
  • Diagnostic Xrays
  • Surgery
  • Casting
  • Traction to align bones to heal
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16
Q

3 phases of fracture healing

A

Inflammatory

Reparative

Remodeling

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17
Q

Inflammatory phase

A

damage to bone, vessels, and tissue —–> hematoma —–>macrophages/neutrophils enter wound to degrade —–> lasts until osteoblasts and endothelial cells begin to proliferate at fracture site

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18
Q

Reparative phase

A

fibroblasts, osteoblasts, and chrondoblasts begin to secrete collagen to form fibrocartilage —-> soft callus joins fractured bone —->Endothelial cells begin to form vessels in damaged area —-> woven bone replaces soft callus (endochondral ossification) —–> hard callus —->lasts 6-8 wks for relatively simple fractures

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19
Q

Remodeling phase

A

woven bone is replaced by highly organized lamellar bone

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20
Q

lamellar bone

A

stronger and more compact with better blood circulation compared to woven bone.

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21
Q

Nonunion

A

fracture that shows no clinically significant progress toward complete healing for at least 3 months based on x-rays

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22
Q

Delayed union

A

occurs when healing process takes significantly longer than expected, usually more than 3-6 months

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23
Q

Malunion

A

occurs when the bone fragments join in a position that is not anatomically correct

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24
Q

Which unions may require surgical correction?

A

nonunions and malunions

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25
Q

Nursing Implementation

A
  • provide effective pain management
  • provide proper alignment
  • promote mobility
  • monitor neurovascular status
  • prevent infection
  • provide discharge instructions
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26
Q

Providing effective pain management

A
  • pain meds prn
  • elevation
  • ice
  • relaxation techniques
  • support above and below extremity
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27
Q

Providing proper alignment

A
  • teach cast and splint care

- if in traction, keep aligned in bed and ensure that weights are free hanging

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28
Q

Promoting mobility

A
  • reposition q 1-2 hours if not OOB yet
  • ambulate
  • teach to use crutches and walker
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29
Q

Monitoring neurovascular status

A

5Ps

  • Pain
  • Pulses
  • Pallor
  • Parasthesia
  • Paralysis/Paresis
30
Q

For Paresthesia assessment….

A

ask client about changes in sensation such as burning, tingling, or numbness

-presence of paresthesia indicates neural damage or involvement

31
Q

For Paralysis/Paresis assessment…

A

Assess the client’s ability to move body parts distal to the fracture such as fingers, and toes.

-inability to move indicates paralysis where as muscle weakness indicates paresis.

32
Q

Paralysis or paresis may indicate…

A

nerve or tendon damage

33
Q

Preventing infection

A
  • change dressings
  • provide pin care
  • monitor both sites for S/S of infection
34
Q

Proving discharge instructions

A
  • monitoring for complications
  • how to take meds
  • injury prevention
  • assess knowledge of use of cane/crutches/walker
  • assess for home care needs
35
Q

At 50 years of age, _________ women will experience a fracture of the vertebrae, forearm, or hip in their remaining years.

A

4 in 10

36
Q

Types of Hip Fractures

A
  • Intracapsular

- Extracapsular

37
Q

Intracapsular

A

within the joint capsule

38
Q

Extracapsular

A

below the capsule

39
Q

What gender are hip fractures more common?

A

women > 65 yo, secondary to osteoporosis

40
Q

Most common reason for hip fractures in woman?

A

falls

41
Q

Prevention Methods for Hip Fractures

A
  • weight bearing exercises
  • home safety inspection
  • collaboration with physician/pharmacist to assist how meds affect balance and bone density
  • avoidance of alcohol
  • attention to bone health
  • mobility assessment
42
Q

Clinical manifestations

A
  • external rotation
  • shortening of affected leg
  • muscle spasm
  • severe pain/tenderness
43
Q

Complications of Hip Fractures

A
  • DVT/PE
  • Dislocation
  • UTI/pneumonia
  • muscle atrophy
44
Q

Postoperative Complimentary Complications

A
  • infection
  • mental status change
  • avascular necrosis
  • nonunion or malunion of bone
45
Q

Collaborative interventions

A
  • diagnostic studies
  • bucks traction (until surgery)
  • surgical options
  • pain management
  • physical therapy after surgery
  • social services arranges rehab or alternative form of care after discharge
46
Q

Two main types of surgical repair

A
  1. external fixation

2. open reduction internal fixation

47
Q

external fixation

A

metal pins and screws are placed into the bone above and below the fracture.

  • pins and screws are then attached to a metal bar outside the skin
  • often performed if damage to soft tissues prevents internal fixation
48
Q

What is the nurse responsible for with external fixation?

A

monitoring the client for infection and neurovascular function

49
Q

Open reduction internal fixation

A

surgical procedure used to internally repair a bone fracture

50
Q

During reduction…

A
  • the bone is placed in correct alignment

- nails, screws, pins, wires, plates, or rods are then inserted into the bone to hold the bone in place

51
Q

What bones are typically repaired by ORIF

A

long bones

52
Q

Internal fixation allows…

A

shorter hospital stays, earlier return to full function, and fewer instances of nonunion and malunion

53
Q

Complications of fracture reduction

A

infection, neurovascular or vascular injury, and leg length discrepancy

54
Q

Nursing interventions for internal fixation

A
  • assess for drainage, infection, fluid, bowel sounds, lung sounds, pain, neuromuscular function
  • admin meds
  • encourage early ambulation
  • refer and arrange PT/OT
55
Q

Extracapsular fracture

A
  • variety of devices (screws, pins, nails)

- dislocation not an issue

56
Q

Intracapsular fracture

A
  • endoprosthesis replaces femoral head
  • slow to heal
  • dislocates easily
57
Q

Cast

A
  • post reduction
  • neurovascular checks
  • “hot spots”
58
Q

hot spots

A

indicate infection

59
Q

Splint

A

provides less support than a cast, but it can be easily adjusted to accommodate swelling and prevent compartment syndrome

60
Q

Medications

A
  • pain
  • antibiotics
  • anticoagulants
61
Q

Primary purpose of bucks traction

A

reduce muscle spasms and also aligns bone segments

62
Q

Pre & Post op assessment

A
  • neurovascular status
  • assess alignment
  • cognition
  • pain
  • vital signs
  • monitor incision site for evidence of infection/swelling
63
Q

Pre-op nursing interventions

A
  • address chronic health issues
  • manage muscle spasm and pain
  • analgesics/muscle relaxants
  • RICE
  • xray, MRI, CT
  • CBC, PT/INR
64
Q

RICE

A
  • rest
  • ice
  • compression
  • elevation
65
Q

Nursing implementation: Post-op

A
  • teach and assist with correct positioning of the hip
  • monitor for DVT
  • administer anticoagulants
  • assist with breathing exercises
  • monitor for penumonia
  • if limited mobility, turn q2 and monitor skin
  • good hygiene/sterile dressing changes
66
Q

Correct positioning of the hip

A

position using abduction pillow

67
Q

Hip Prosthesis Patient Education - Do nots!

A
  • No adduction
  • No sitting on chairs without arm rests
  • No low chairs
  • No internal rotation
  • No flexing hip more than 90 degrees
  • No putting on shoes and socks for 8 wks without device
  • No crossing legs or feet
68
Q

Hip Prosthesis Patient Education - Dos!

A
  • Use high-backed chair with arm rests
  • Use elevated toilet seats
  • Use chair in tub or shower
  • Use pillow or abductor brace between legs when lying or turning
  • Maintain hip in neutral position
  • Notify dentist before dental work
  • Notify MD if severe pain or loss of function
69
Q

Providing psychosocial support

A
  • OA may be very distressed by event
  • Create environment of trust which promotes patient and family discussion of feelings
  • Refer to homecare or rehab as needed
70
Q

Discharge planning essentials

A
  • be sure patient understands hip precautions
  • assess knowledge of ability to correctly use abduction pillow and walker/cane
  • review weight bearing restrictions
  • review meds
71
Q

Referral

A
  • Average hospital stay is 4 days
  • May need skilled nursing facility or rehab before going home
  • May need home health nursing
  • Recovery can take up to 1 year

OA Exam 2 (6 decks)

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