Orthopedic Trauma / Surgery Flashcards
1
Q
Describe the classification of fractures (4)
A
- Skin intactness
- Type
- Location
- Alignment
2
Q
Describe an open / compound fracture (3)
A
- Bone is protruding
- Skin not intact
- External bleeding
3
Q
Describe a closed fracture (3)
A
- Bone not protruding
- Skin is intact
- No external bleeding
4
Q
What is a complete fracture?
A
Fracture across the entire width of the bone - 2 distinct sections
5
Q
What is an incomplete fracture?
A
Fracture through only part of the bone - does not divide into 2 distinct sections
6
Q
What is a comminuted fracture?
A
Fracture creating 3 or more fragments
7
Q
What are the possible fracture locations in an extremity? (3)
A
- Proximal
- Mid-shaft
- Distal
8
Q
What is non-displaced alignment of a fracture?
A
Bone fragments are aligned
9
Q
What is displaced alignment of a fracture?
A
Bone fragments are misaligned
10
Q
What is angulated alignment of a fracture?
A
Bone fragments are at angles to each other
11
Q
The extent of injury due to a fracture correlates to …
A
The amount of force that caused the fracture
12
Q
What are the manifestations of fractures? (9)
A
- Pain
- Shock
- Deformity
- Crepitus
- Edema
- Warmth
- Ecchymosis
- Muscle spams
- Numbness / tingling
13
Q
Describe pain associated with fractures (2)
A
- Immediate
- Aggravated by movement / pressure
14
Q
Describe muscle spasms associated with fractures (2)
A
- Occurs above / below fracture
- Shortening in long bones
15
Q
Immediately following a fracture, muscles are …
A
Flaccid for 10 - 40 minutes
16
Q
Describe crepitus associated with fractures
A
Grating sound upon movement due to broken bone ends rubbing together
17
Q
Where does numbness / tingling occur in the case of a fracture?
A
Distal to the injury - if nerve damage has occurred
18
Q
What are the principles of fracture treatment? (3)
A
- Reduction
- Immobilization
- Restoration of function
19
Q
Where does immobilization of the fracture occur?
A
Above and below the fracture site
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
21
Q
Describe monitoring associated with fractures (2)
A
- Neurovascular checks
- Monitor for signs of shock
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
23
Q
Describe neurovascular checks associated with fractures (5)
A
- Pain
- Pallor
- Paralysis
- Paresthesia
- Pulselessness
24
Q
Pain upon ______ indicates neurovascular impairment
A
Passive motion
25
What coloration surrounding a fracture indicates arterial insufficiency?
Pale
26
What coloration surrounding a fracture indicates venous insufficiency?
Dusky / cyanotic / mottled
27
What is paresthesia due to?
Excess fluid creating pressure on the nerve supply
28
Describe the nursing intervention used for paresthesia
Elevate the part above the level of the heart
29
______ may be one of the last findings in neurovascular deficit
Pulselessness
30
How often are neurovascular checks conducted after surgery?
Every hour for the first 24 - 48 hours after surgery
31
If there is a change in pulse / inability to locate pulse, the injured area must be ...
Immediately repositioned and reassessed for a pulse
32
Describe the difference between open and closed reduction
- Open reduction - surgical
- Closed reduction - not surgical
33
Once the fracture is reduced, the bones must be ______ for healing to occur
Held in place
34
What are the methods of immobilization? (4)
- Cast / splint
- Internal fixation
- External fixation
- Traction
35
Name an example of a condition where a cast / splint would be used for immobilization
Club foot
36
______ uses pins / plates / screws / wires implanted under the skin
Internal fixation
37
______ uses rods / pins surrounding the outside of the extremity
External fixation
38
When is external fixation used?
When there is too much swelling to realign the fracture
39
Describe the nursing interventions associated with external fixation (2)
- Clean around the pin site to prevent infection
- Elevate to prevent edema
40
______ is the use of direct / indirect force applied to a body part
Traction
41
Describe traction
Ropes, weights, and pulleys maintain constant force
42
What are the goals of traction? (6)
- Reduce the fracture
- Immobilization
- Maintain correct positioning
- Overcome muscle spams
- Stretch adhesions
- Correct deformities
43
With traction, ______ is encouraged to maintain the health of body tissues
Movement
44
______ is applied indirectly to bone
Skin traction
45
______ is applied directly to bone by a wire / pin through the distal bone fragment
Skeletal traction
46
Which type of traction has an increased risk of infection?
Skeletal traction
47
What areas can skeletal traction be applied to? (5)
- Skull
- Humerus
- Ulna
- Femur
- Tibia
48
Describe the risk of infection associated with skeletal traction
Hardware passing through the bone can cause osteomyelitis
49
Describe site care associated with skeletal traction
Clean with peroxide / saline
50
What signs of infections should be monitored when caring for a patient with skeletal traction? (4)
- Fever
- Redness
- Swelling
- Purulent drainage
51
Describe the characteristics of skin traction (4)
- Used for hours - 1 week
- 2 - 10 lbs
- Can be removed
- Used for mild injuries WITHOUT soft tissue trauma
52
Describe the characteristics of skeletal traction (4)
- Used for 1 - 10 weeks
- 10 - 30 + lbs
- Must be maintained continuously
- Used for severe injuries WITH soft tissue trauma
53
What happens if skeletal traction is removed prematurely? (2)
- Strong muscle contractions
- Disruption of bone fragments
54
Describe Bucks traction (2)
- Used for hip fractures
- Used prior to surgery
55
Describe Russells traction (2)
- Bucks traction with a sling extended under the knee
- Used for hip / femur fractures
56
Which type of traction is shown?
Buck's traction
57
Which type of traction is shown?
Russell's traction
58
Cervical traction provides relief from ______
Neck pain
59
Pelvic traction provides relief from ______
Back pain
60
Traction force must be applied in ______
2 directions
61
The lines of pull in traction are called ______
Vectors of force
62
Traction may ______ pain / spasms in acutely traumatized tissues
Temporarily increase
63
Describe positioning associated with traction
Intermittently place the bed in flat position to decrease hip flexion / contractures
64
What is the primary complication associated with traction?
Pressure on the head of the fibula causing peroneal nerve compression
65
What is the primary manifestation of peroneal nerve compression?
Inability to flex / extend toes
66
Describe the requirements for ropes during traction (2)
- Run straight through the middle of the pulley
- Taut / free of kinks
67
What orthopedic complications are associated with fractures? (6)
- Compartment syndrome
- Fat embolism
- DVT
- Infection
- Avascular necrosis
- Delayed union
68
Describe compartment syndrome
Pressure in a limited space causing compromised circulation
69
The ______ portion of an extremity contains the most compartments
Distal
70
What is internal pressure compartment syndrome?
Bleeding / fluid accumulation
71
What is external pressure compartment syndrome?
Bulky dressings / casts
72
What are the manifestations of compartment syndrome? (2)
- Diminished sensation
- Pain upon passive stretching
73
______ are not typically affected by compartment syndrome
Pulses
74
Describe the nursing interventions associated with compartment syndrome (3)
- Lower the extremity to the level of the heart
- Remove / loosen compression
- AVOID ice
75
What procedure is used for the treatment of compartment syndrome?
Decompression fasciotomy
76
Why is compartment syndrome considered an emergency? (2)
- Irreversible damage within 4 - 6 hours
- Extremity becomes useless within 24 - 48 hours
77
A fat embolism occurs within ______ of the fracture
48 hours
78
Describe the pathophysiology of a fat embolism (2)
- Fat globules are released from bone marrow
- Fat globules enter circulation and travel through pulmonary vasculature
79
What are the manifestations of a fat embolism? (4)
- Hypoxia
- Tachypnea
- Restlessness
- Petechial rash on chest
80
What diagnostic tests are used for diagnosis of a fat embolism? (2)
- ABGs
- Chest x-ray
81
Describe the pathophysiology of a DVT
Hypercoagulability causes venous stasis
82
What procedures are risk factors for DVTs? (4)
- THR
- TKR
- Hip fractures
- Knee reconstructions
83
______ is the most frequent fatal complication of orthopedic surgery
Venous thrombosis
84
Venous thrombosis can lead to ______
Pulmonary embolism
85
Pulmonary emboli are characterized by pleuritic chest pain that increases with ______
Inspiration
86
What are the manifestations of a DVT? (4)
- Deep tenderness
- Warmth
- Redness
- Swelling
87
What types of infection are associated with orthopedic trauma / surgery? (2)
- Wound infection
- Osteomyelitis
88
What is avascular necrosis?
Death of the bone
89
A fracture is considered delayed union if it has not healed within ______ of injury
6 months
90
What manifestation indicates improper fitting of crutches?
Numbness / tingling of hands
91
Describe the education associated with crutches (2)
- Walk erect
- Chin up - do not look at feet
92
Describe the education associated with walkers
Use chair arms for support when rising - do not use walker
93
The nurse should stand on the patient's ______ side when assisting with a walker
Weaker
94
The patient should turn towards the ______ side when using a walker
Stronger
95
The patient should advance the walker and the ______ leg simultaneously
Weaker
96
The patient should hold the cane on the ______ side
Stronger
97
The patient should advance the cane and the ______ leg simultaneously
Weaker
98
X-rays are used for diagnosing ______
Fractures / degenerative conditions
99
Bone scans are used for diagnosing ______
Malignancies / infections
100
During an MRI, the patient must lay still for ______
30 - 60 minutes
101
Which type of diagnostic tests require assessment of iodine allergies due to use of contrast dye? (2)
- Arthrogram
- CAT scan
102
Describe the post-op nursing interventions associated with musculoskeletal diagnostic tests (3)
- Neurovascular assessments
- Compression bandages
- Ice
103
What laboratory tests are associated with musculoskeletal diagnostic tests? (3)
- Serum calcium
- Serum phosphorus
- Erythrocyte sedimentation rate
