OA Fractures Flashcards
Fracture Risk Factors
Primary: age, bone disease, poor nutrition
Secondary: lifestyle habits
Types of Fractures
- transverse
- linear
- oblique, nondisplaced
- oblique, displaced
- spiral
- greenstick
- comminuted
clinical manifestations of fractures
- pain
- deformity or misalignment
- swelling
- hypovolemia/shock or ecchymosis
Complications of fractures
- compartment syndrome
- DVT
- Fat embolism syndrome
compartment syndrome
fascia surrounding muscles do not expand. When swelling occurs, muscle dies
S/S of compartment syndrome
- severe pain
- swelling
- pallor
- numbness
DVT
Deep Vein Thrombosis
-clot forms in one of the deep veins
S/S of DVT
- redness
- warmth of skin
- leg pain cramping
- swelling
Prevention of DVT
- early surgery
- anticoagulation
- compression strategies
Treatment for DVT
- bedrest
- anticoagulants
- vena caval filter
Complications of DVT
- CVA
- Pulmonary embolism
Fat Embolism Syndrome
Fat emboli are released from closed long bone or pelvic fractures.
-These emboli enter the blood stream
The fat emboli entering the blood stream causes…
- dyspnea that may progress to respiratory failure
- petechial rash
- neurological symptoms such as confusion, restlessness, seizures or come
There is an increased risk of infection with…
- open fractures
- external fixation devices
- immunocompromised patients
Collaborative Treatment Strategies
- Diagnostic Xrays
- Surgery
- Casting
- Traction to align bones to heal
3 phases of fracture healing
Inflammatory
Reparative
Remodeling
Inflammatory phase
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
Reparative phase
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
Remodeling phase
woven bone is replaced by highly organized lamellar bone
lamellar bone
stronger and more compact with better blood circulation compared to woven bone.
Nonunion
fracture that shows no clinically significant progress toward complete healing for at least 3 months based on x-rays
Delayed union
occurs when healing process takes significantly longer than expected, usually more than 3-6 months
Malunion
occurs when the bone fragments join in a position that is not anatomically correct
Which unions may require surgical correction?
nonunions and malunions
Nursing Implementation
- provide effective pain management
- provide proper alignment
- promote mobility
- monitor neurovascular status
- prevent infection
- provide discharge instructions
Providing effective pain management
- pain meds prn
- elevation
- ice
- relaxation techniques
- support above and below extremity
Providing proper alignment
- teach cast and splint care
- if in traction, keep aligned in bed and ensure that weights are free hanging
Promoting mobility
- reposition q 1-2 hours if not OOB yet
- ambulate
- teach to use crutches and walker
Monitoring neurovascular status
5Ps
- Pain
- Pulses
- Pallor
- Parasthesia
- Paralysis/Paresis
For Paresthesia assessment….
ask client about changes in sensation such as burning, tingling, or numbness
-presence of paresthesia indicates neural damage or involvement
For Paralysis/Paresis assessment…
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.
Paralysis or paresis may indicate…
nerve or tendon damage
Preventing infection
- change dressings
- provide pin care
- monitor both sites for S/S of infection
Proving discharge instructions
- monitoring for complications
- how to take meds
- injury prevention
- assess knowledge of use of cane/crutches/walker
- assess for home care needs
At 50 years of age, _________ women will experience a fracture of the vertebrae, forearm, or hip in their remaining years.
4 in 10
Types of Hip Fractures
- Intracapsular
- Extracapsular
Intracapsular
within the joint capsule
Extracapsular
below the capsule
What gender are hip fractures more common?
women > 65 yo, secondary to osteoporosis
Most common reason for hip fractures in woman?
falls
Prevention Methods for Hip Fractures
- 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
Clinical manifestations
- external rotation
- shortening of affected leg
- muscle spasm
- severe pain/tenderness
Complications of Hip Fractures
- DVT/PE
- Dislocation
- UTI/pneumonia
- muscle atrophy
Postoperative Complimentary Complications
- infection
- mental status change
- avascular necrosis
- nonunion or malunion of bone
Collaborative interventions
- 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
Two main types of surgical repair
- external fixation
2. open reduction internal fixation
external fixation
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
What is the nurse responsible for with external fixation?
monitoring the client for infection and neurovascular function
Open reduction internal fixation
surgical procedure used to internally repair a bone fracture
During reduction…
- 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
What bones are typically repaired by ORIF
long bones
Internal fixation allows…
shorter hospital stays, earlier return to full function, and fewer instances of nonunion and malunion
Complications of fracture reduction
infection, neurovascular or vascular injury, and leg length discrepancy
Nursing interventions for internal fixation
- assess for drainage, infection, fluid, bowel sounds, lung sounds, pain, neuromuscular function
- admin meds
- encourage early ambulation
- refer and arrange PT/OT
Extracapsular fracture
- variety of devices (screws, pins, nails)
- dislocation not an issue
Intracapsular fracture
- endoprosthesis replaces femoral head
- slow to heal
- dislocates easily
Cast
- post reduction
- neurovascular checks
- “hot spots”
hot spots
indicate infection
Splint
provides less support than a cast, but it can be easily adjusted to accommodate swelling and prevent compartment syndrome
Medications
- pain
- antibiotics
- anticoagulants
Primary purpose of bucks traction
reduce muscle spasms and also aligns bone segments
Pre & Post op assessment
- neurovascular status
- assess alignment
- cognition
- pain
- vital signs
- monitor incision site for evidence of infection/swelling
Pre-op nursing interventions
- address chronic health issues
- manage muscle spasm and pain
- analgesics/muscle relaxants
- RICE
- xray, MRI, CT
- CBC, PT/INR
RICE
- rest
- ice
- compression
- elevation
Nursing implementation: Post-op
- 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
Correct positioning of the hip
position using abduction pillow
Hip Prosthesis Patient Education - Do nots!
- 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
Hip Prosthesis Patient Education - Dos!
- 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
Providing psychosocial support
- 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
Discharge planning essentials
- be sure patient understands hip precautions
- assess knowledge of ability to correctly use abduction pillow and walker/cane
- review weight bearing restrictions
- review meds
Referral
- 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
