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NURS 301 - Exam 4 > Orthopedic Trauma / Surgery > Flashcards

Orthopedic Trauma / Surgery Flashcards

1
Q

Describe the classification of fractures (4)

A
  • Skin intactness
  • Type
  • Location
  • Alignment
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2
Q

Describe an open / compound fracture (3)

A
  • Bone is protruding
  • Skin not intact
  • External bleeding
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3
Q

Describe a closed fracture (3)

A
  • Bone not protruding
  • Skin is intact
  • No external bleeding
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4
Q

What is a complete fracture?

A

Fracture across the entire width of the bone - 2 distinct sections

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5
Q

What is an incomplete fracture?

A

Fracture through only part of the bone - does not divide into 2 distinct sections

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6
Q

What is a comminuted fracture?

A

Fracture creating 3 or more fragments

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7
Q

What are the possible fracture locations in an extremity? (3)

A
  • Proximal
  • Mid-shaft
  • Distal
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8
Q

What is non-displaced alignment of a fracture?

A

Bone fragments are aligned

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9
Q

What is displaced alignment of a fracture?

A

Bone fragments are misaligned

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10
Q

What is angulated alignment of a fracture?

A

Bone fragments are at angles to each other

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11
Q

The extent of injury due to a fracture correlates to …

A

The amount of force that caused the fracture

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12
Q

What are the manifestations of fractures? (9)

A
  • Pain
  • Shock
  • Deformity
  • Crepitus
  • Edema
  • Warmth
  • Ecchymosis
  • Muscle spams
  • Numbness / tingling
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13
Q

Describe pain associated with fractures (2)

A
  • Immediate
  • Aggravated by movement / pressure
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14
Q

Describe muscle spasms associated with fractures (2)

A
  • Occurs above / below fracture
  • Shortening in long bones
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15
Q

Immediately following a fracture, muscles are …

A

Flaccid for 10 - 40 minutes

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16
Q

Describe crepitus associated with fractures

A

Grating sound upon movement due to broken bone ends rubbing together

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17
Q

Where does numbness / tingling occur in the case of a fracture?

A

Distal to the injury - if nerve damage has occurred

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18
Q

What are the principles of fracture treatment? (3)

A
  • Reduction
  • Immobilization
  • Restoration of function
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19
Q

Where does immobilization of the fracture occur?

A

Above and below the fracture site

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20
Q

Describe immediate medical management of fractures (6)

A
  • Splinting
  • Elevation
  • Analgesics
  • Ice for first 24 hours
  • DO NOT push the bone back into place
  • ALWAYS compare the affected extremity with the unaffected extremity
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21
Q

Describe monitoring associated with fractures (2)

A
  • Neurovascular checks
  • Monitor for signs of shock
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22
Q

What are the goals of applying ice for the first 24 hours of a fracture? (3)

A
  • Decreases pain
  • Decreases edema
  • Decreases hemorrhage
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23
Q

Describe neurovascular checks associated with fractures (5)

A
  • Pain
  • Pallor
  • Paralysis
  • Paresthesia
  • Pulselessness
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24
Q

Pain upon ______ indicates neurovascular impairment

A

Passive motion

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25
Q

What coloration surrounding a fracture indicates arterial insufficiency?

A

Pale

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26
Q

What coloration surrounding a fracture indicates venous insufficiency?

A

Dusky / cyanotic / mottled

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27
Q

What is paresthesia due to?

A

Excess fluid creating pressure on the nerve supply

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28
Q

Describe the nursing intervention used for paresthesia

A

Elevate the part above the level of the heart

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29
Q

______ may be one of the last findings in neurovascular deficit

A

Pulselessness

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30
Q

How often are neurovascular checks conducted after surgery?

A

Every hour for the first 24 - 48 hours after surgery

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31
Q

If there is a change in pulse / inability to locate pulse, the injured area must be …

A

Immediately repositioned and reassessed for a pulse

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32
Q

Describe the difference between open and closed reduction

A
  • Open reduction - surgical
  • Closed reduction - not surgical
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33
Q

Once the fracture is reduced, the bones must be ______ for healing to occur

A

Held in place

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34
Q

What are the methods of immobilization? (4)

A
  • Cast / splint
  • Internal fixation
  • External fixation
  • Traction
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35
Q

Name an example of a condition where a cast / splint would be used for immobilization

A

Club foot

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36
Q

______ uses pins / plates / screws / wires implanted under the skin

A

Internal fixation

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37
Q

______ uses rods / pins surrounding the outside of the extremity

A

External fixation

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38
Q

When is external fixation used?

A

When there is too much swelling to realign the fracture

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39
Q

Describe the nursing interventions associated with external fixation (2)

A
  • Clean around the pin site to prevent infection
  • Elevate to prevent edema
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40
Q

______ is the use of direct / indirect force applied to a body part

A

Traction

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41
Q

Describe traction

A

Ropes, weights, and pulleys maintain constant force

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42
Q

What are the goals of traction? (6)

A
  • Reduce the fracture
  • Immobilization
  • Maintain correct positioning
  • Overcome muscle spams
  • Stretch adhesions
  • Correct deformities
43
Q

With traction, ______ is encouraged to maintain the health of body tissues

A

Movement

44
Q

______ is applied indirectly to bone

A

Skin traction

45
Q

______ is applied directly to bone by a wire / pin through the distal bone fragment

A

Skeletal traction

46
Q

Which type of traction has an increased risk of infection?

A

Skeletal traction

47
Q

What areas can skeletal traction be applied to? (5)

A
  • Skull
  • Humerus
  • Ulna
  • Femur
  • Tibia
48
Q

Describe the risk of infection associated with skeletal traction

A

Hardware passing through the bone can cause osteomyelitis

49
Q

Describe site care associated with skeletal traction

A

Clean with peroxide / saline

50
Q

What signs of infections should be monitored when caring for a patient with skeletal traction? (4)

A
  • Fever
  • Redness
  • Swelling
  • Purulent drainage
51
Q

Describe the characteristics of skin traction (4)

A
  • Used for hours - 1 week
  • 2 - 10 lbs
  • Can be removed
  • Used for mild injuries WITHOUT soft tissue trauma
52
Q

Describe the characteristics of skeletal traction (4)

A
  • Used for 1 - 10 weeks
  • 10 - 30 + lbs
  • Must be maintained continuously
  • Used for severe injuries WITH soft tissue trauma
53
Q

What happens if skeletal traction is removed prematurely? (2)

A
  • Strong muscle contractions
  • Disruption of bone fragments
54
Q

Describe Bucks traction (2)

A
  • Used for hip fractures
  • Used prior to surgery
55
Q

Describe Russells traction (2)

A
  • Bucks traction with a sling extended under the knee
  • Used for hip / femur fractures
56
Q

Which type of traction is shown?

A

Buck’s traction

57
Q

Which type of traction is shown?

A

Russell’s traction

58
Q

Cervical traction provides relief from ______

A

Neck pain

59
Q

Pelvic traction provides relief from ______

A

Back pain

60
Q

Traction force must be applied in ______

A

2 directions

61
Q

The lines of pull in traction are called ______

A

Vectors of force

62
Q

Traction may ______ pain / spasms in acutely traumatized tissues

A

Temporarily increase

63
Q

Describe positioning associated with traction

A

Intermittently place the bed in flat position to decrease hip flexion / contractures

64
Q

What is the primary complication associated with traction?

A

Pressure on the head of the fibula causing peroneal nerve compression

65
Q

What is the primary manifestation of peroneal nerve compression?

A

Inability to flex / extend toes

66
Q

Describe the requirements for ropes during traction (2)

A
  • Run straight through the middle of the pulley
  • Taut / free of kinks
67
Q

What orthopedic complications are associated with fractures? (6)

A
  • Compartment syndrome
  • Fat embolism
  • DVT
  • Infection
  • Avascular necrosis
  • Delayed union
68
Q

Describe compartment syndrome

A

Pressure in a limited space causing compromised circulation

69
Q

The ______ portion of an extremity contains the most compartments

A

Distal

70
Q

What is internal pressure compartment syndrome?

A

Bleeding / fluid accumulation

71
Q

What is external pressure compartment syndrome?

A

Bulky dressings / casts

72
Q

What are the manifestations of compartment syndrome? (2)

A
  • Diminished sensation
  • Pain upon passive stretching
73
Q

______ are not typically affected by compartment syndrome

A

Pulses

74
Q

Describe the nursing interventions associated with compartment syndrome (3)

A
  • Lower the extremity to the level of the heart
  • Remove / loosen compression
  • AVOID ice
75
Q

What procedure is used for the treatment of compartment syndrome?

A

Decompression fasciotomy

76
Q

Why is compartment syndrome considered an emergency? (2)

A
  • Irreversible damage within 4 - 6 hours
  • Extremity becomes useless within 24 - 48 hours
77
Q

A fat embolism occurs within ______ of the fracture

A

48 hours

78
Q

Describe the pathophysiology of a fat embolism (2)

A
  • Fat globules are released from bone marrow
  • Fat globules enter circulation and travel through pulmonary vasculature
79
Q

What are the manifestations of a fat embolism? (4)

A
  • Hypoxia
  • Tachypnea
  • Restlessness
  • Petechial rash on chest
80
Q

What diagnostic tests are used for diagnosis of a fat embolism? (2)

A
  • ABGs
  • Chest x-ray
81
Q

Describe the pathophysiology of a DVT

A

Hypercoagulability causes venous stasis

82
Q

What procedures are risk factors for DVTs? (4)

A
  • THR
  • TKR
  • Hip fractures
  • Knee reconstructions
83
Q

______ is the most frequent fatal complication of orthopedic surgery

A

Venous thrombosis

84
Q

Venous thrombosis can lead to ______

A

Pulmonary embolism

85
Q

Pulmonary emboli are characterized by pleuritic chest pain that increases with ______

A

Inspiration

86
Q

What are the manifestations of a DVT? (4)

A
  • Deep tenderness
  • Warmth
  • Redness
  • Swelling
87
Q

What types of infection are associated with orthopedic trauma / surgery? (2)

A
  • Wound infection
  • Osteomyelitis
88
Q

What is avascular necrosis?

A

Death of the bone

89
Q

A fracture is considered delayed union if it has not healed within ______ of injury

A

6 months

90
Q

What manifestation indicates improper fitting of crutches?

A

Numbness / tingling of hands

91
Q

Describe the education associated with crutches (2)

A
  • Walk erect
  • Chin up - do not look at feet
92
Q

Describe the education associated with walkers

A

Use chair arms for support when rising - do not use walker

93
Q

The nurse should stand on the patient’s ______ side when assisting with a walker

A

Weaker

94
Q

The patient should turn towards the ______ side when using a walker

A

Stronger

95
Q

The patient should advance the walker and the ______ leg simultaneously

A

Weaker

96
Q

The patient should hold the cane on the ______ side

A

Stronger

97
Q

The patient should advance the cane and the ______ leg simultaneously

A

Weaker

98
Q

X-rays are used for diagnosing ______

A

Fractures / degenerative conditions

99
Q

Bone scans are used for diagnosing ______

A

Malignancies / infections

100
Q

During an MRI, the patient must lay still for ______

A

30 - 60 minutes

101
Q

Which type of diagnostic tests require assessment of iodine allergies due to use of contrast dye? (2)

A
  • Arthrogram
  • CAT scan
102
Q

Describe the post-op nursing interventions associated with musculoskeletal diagnostic tests (3)

A
  • Neurovascular assessments
  • Compression bandages
  • Ice
103
Q

What laboratory tests are associated with musculoskeletal diagnostic tests? (3)

A
  • Serum calcium
  • Serum phosphorus
  • Erythrocyte sedimentation rate

NURS 301 - Exam 4 (5 decks)

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