UNIT 7 FRACTURES, CARPAL TUNNEL SYNDROME, AMPUTATIONS CHAPTER 47

Question 1

What is a fracture

Answer 1

a break in a bone

A fracture is a break or disruption in the continuity of a bone that often affects mobility and causes pain . It can occur anywhere in the body and at any age. All fractures have the same basic pathophysiologic mechanism and require similar patient-centered, interprofessional collaborative care, regardless of fracture type or location.

Break in the continuity of the bone
Trauma, twisting, or bone disease
Fragments may be displaced, soft tissue
can be damaged and leads to
inflammation

Question 2

What are the different types of fractures

Answer 2

Closed
* Comminuted
* Complete
* Compression
* Depressed
* Greenstick
* Impacted
* Incomplete
* Open
* Spiral (sign of abuse)

Question 3

Does a compound fracture create a wound?

A. No
B. Yes

Answer 3

A fracture can also be described by the extent of associated soft-tissue damage: open (or compound) or closed (or simple) (Fig. 47.1). The skin surface over the broken bone is disrupted in a compound fracture, which causes an external wound.

These fractures are often graded to define the extent of tissue damage. A simple fracture does not extend through the skin and therefore has no visible wound.

Question 4

What type of pain does an amputee go through?
A. Localized
B. Referred pain
C. Phantom limb pain
D. Radiating pain

Answer 4

C. Phantom limb pain

Question 5

Complication of Amputations

Answer 5

• Hemorrhage leading to hypovolemic shock
• Infection
• Phantom limb pain
• Neuroma (A neuroma is a benign tumor of nerve tissue)
• Flexion contractures

Question 6

What type of positioning is appropriate for post op amputee patient?

A. trensdelendurg
B. prone position
C. supine position
D. sims position

Answer 6

B. prone position

A firm ma ttress is essential for preventing contractures with a leg amputation. Assist the patient into a prone position every 3 to 4 hours for 20- to 30-minute periods if tolerated and not contraindicated. This position may be uncomfortable initially but helps prevent hip flexion contractures

Elevation of a lower-leg residual limb on a pillow while the patient is in a supine position is controversial. Some practitioners advocate avoiding this practice at all times because it promotes hip or knee flexion contracture. Others allow elevation for the first 24 to 48 hours to reduce swelling and subsequent pain. Inspect the residual limb daily to ensure that it lies completely flat on the bed.

Question 7

Risk factor for amputations

Answer 7

Amputation

Removal of body part by trauma or
surgery

Above the knee or below the knee, upper
extremity amputation

Lower Extremities amputations greater in black
populations with diabetes, heart failure,
or renal failure. Veterans have increased
in amputations

Question 8

What is Carpal Tunnel Syndrome?

Answer 8

Carpal tunnel syndrome (CTS) is a common condition in which the median nerve in the wrist becomes compressed, causing pain and numbness.

Question 9

What are the risk factors for Carpal Tunnel?

Answer 9

Continuous pressure on the median nerve , typing.

Question 10

Fat Emboli

Answer 10

S/s of fat emboli (fat blocking blood flow BY fat particles )

• [ ] Altered mental status (Earliest sign)
• [ ] Petechae
• [ ] Tachycardia
• [ ] Hypoxemia( fat particles dislodged in brain and lungs
• [ ] Dyspnea
• [ ] chest pain
• [ ] Tachycardia
• [ ] Crackles
• [ ] Decreased SaO2
• [ ] Mild thrombocytopenia under 100,000platlet count ( 150,000-400,000)
• [ ] OXYGEN SAT IS MOST IMPORTANT
• [ ]
  TREATMENT FOR FAT EMBOLISM
  *oxygen
  *bed rest
  *gentle handling
  *hydration IV fluids
  *possibly steroid therapy
  *fracture immbolization

Risk factor of Fat Embolism
- fractures from long bones( FEMUR) ; occurs usually within 48 hrs of injury

Question 11

What medication is most appropriate for a or with neuropathic pain?

A. Acetiminophen
B.Pregabalin
C. Zofran
D. Zocar

Answer 11

B.Pregabalin

Question 12

What is the proper way to manage a plaster cast?

A. With elbow
B. With palm of hand
C with finger tips
D . With thumb to prevent indentations and compartment syndrome

Answer 12

B. With palm of hand

Question 13

What’s are the signs and symptoms of Carpal Tunnel Syndrome

Answer 13

Median nerve in wrist is compressed
Repetitive activities

S/S numbness, paresthesia, decreased fine movements

Question 14

Patient teaching to relieve carpal tunnel syndrome pain

Answer 14

Elevate for swelling, no heavy lifting 4-6 weeks, report increased pain

dx test- Tinel’s test

Question 15

A nurse is caring for a client with fat embolism syndrome. Which treatment is most appropriate for this client?
A. Remove any constrictive casts or dressings
B. Elevate affected extremity on a pillow
C. Place client on oxygen to keep saturations >95%
D. Administer intravenous pain medication

Answer 15

C

Question 16

A nurse is caring for a client with acute compartment syndrome. Which treatment is most appropriate and first action for this client?
A. Remove any constrictive casts or dressings
B. Elevate affected extremity on a pillow
C. Place client on oxygen to keep saturations >95%
D. Administer intravenous pain medication

Answer 16

A. Remove any constrictive casts or dressings