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NURS 3512 - Class 7-12 > Week 7 - Bone Fractures > Flashcards

Week 7 - Bone Fractures Flashcards

1
Q

what is a fracture

A
  • disruption or break in the continuity of the structure of bone
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2
Q

what 4 ways can fractures be classified and what do they mean

A
  • open = skin is broken, bone exposed, soft tissue injury
  • closed = skin not ruptures, skin intact
  • complete = break completely thru the bone
  • incomplete = occurs partly across the bone, bone still in one piece
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3
Q

what are symptoms of fractures (8)

A
  • immediate localized pain
  • decreased function
  • inability to bear weight
  • obvious bone deformity may be present
  • extremity immobilized in position it was found
  • swelling
  • bruising
  • crepitation
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4
Q

what is used to diagnose a fracture (3)

A
  • xray
  • ct
  • MRI
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5
Q

what are the overall goals of fracture treatment (3)

A
  • anatomical realignment of bone fragments = reduction
  • immobilization to maintain realignment
  • restoration of normal or near normal function of the injured extremity
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6
Q

what are the 2 types of fracture reduction

A
  • open

- closed

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7
Q

what is a closed reduction

A
  • nonsurgical, manual realignment of bone fragments to their previous anatomical position
  • often involves traction & countertraction
  • usually performed under local or general anasthesia
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8
Q

what is traction

A
  • process of slowly and gently pulling on a fractured or dislocated body part
  • application of a pulling force on a fractured extremitity to attain realignment
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9
Q

after closed reduction, what is done

A
  • traction, casting, external fixation, splints, or braces are used to immbolize the injury to maintain alignment until healing occurs
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10
Q

what are 2 types of traction

A
  • skin

- skeletal

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11
Q

what is skin traction

A
  • traction used for short term treatment (48-72 hr) until skeletal traction or surgery is possible
  • includes tape, boots, or splints directly applied to the skin
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12
Q

what is skeletal traction

A
  • traction generally in place for longer periods of time
  • provides a long term pull that keeps the injured bone and joints aligned
  • involves insertion of a pin or wire into the bone
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13
Q

what is a disadvantage associated w skeletal traction (2)

A
  • risk of infection

- prolonged immobility

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14
Q

what is open reduction

A
  • correction of bone alignment thru a surgical incision

- often includes internal fixation of the bone using wires, screws, plates, pins, rods, or nails

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15
Q

what are the disadvantages of open reduction

A
  • risk of infection

- use of anasthesia

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16
Q

what must be done after open reduction (2)

A
  • early initiation of ROM

- use of machines that provide continuous passive motion to joints

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17
Q

what is the benefit of open reduction with internal fixation

A
  • facilitates early ambulation

= decreased r/o complications r/t prolonged immobility

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18
Q

what is countertraction

A
  • pulls in the opposite direction of traction
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19
Q

for traction to be effective, what is required

A
  • countertraction
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20
Q

how is countertraction supplied

A
  • either by pt’s body weight

- pr weights pulling in the opposite direction and may be augmented by elevated the bed

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21
Q

what is imp r/t traction (3)

A
  • must be maintained continuously
  • keep weight off the floor
  • keep weight moving freely thru pulleys
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22
Q

what is the benefit of casts

A
  • allows the pt to perform many normal ADLs while still providing sufficient immobilization
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23
Q

what are the 2 types of casts

A
  • plaster

- fiberglass

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24
Q

describe how a plaster cast is applied (4)

A
  • pad bony prominences
  • plaster immersed in water then wrapped around affected joint
  • plaster sets within 15 min
  • 24 hr dry period
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25
Q

how long until a plaster cast is strong enough for weight bearing

A
  • 24-72 h
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26
Q

what is important to educate the pt & family about regarding a plaster cast (3)

A
  • do not cover w blanket –> air cannot circulate = heat builds up = risk of burn
  • during the drying period, cast should be kept dry, clean and direct pressure avoided
  • handle cast gently w open palm while drying to avoid a dent
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27
Q

what are the benefits to using a fiberglass cast (6)

A
  • lightweight
  • stronger
  • relatively waterproof
  • faster-drying than plaster
  • porous (less risk of skin problems)
  • allows for almost immediate mobilization)
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28
Q

what should be assessed / included in nursing care for casts (3)

A
  • frequent neurovascular assessments (can interfere w circulation & nerve fnxn if too tight)
  • pain assessment & management
  • assess for signs of complications
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29
Q

what should pts be taught regarding casts in general(12)

A
  • S&S of cast complication
  • do not insert any objects inside cast
  • do not cover cast w plastic for prolonged periods
  • do not bear weight on new cast for 48 h
  • when applying ice in first 24 hr, avoid getting cast wet by keeping ice in plastic bag & protecting cast w cloth)
  • exercise joints above & below cast
  • do not pull out cast padding
  • do not scratch inside the cast (risk of skin breakdown & infection)
  • apply ice for first 24 hr to reduce swelling
  • elevate above lvl of heart for first 48 h
  • dry cast thoroughly if exposure w water (blot w towel, hair dryer on low setting)
  • check w HCP before getting fiberglass cast wet
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30
Q

when should you not elevate the extremity above the heart

A
  • if compartment syndrome is suspected
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31
Q

if a pt with a cast is experiencing itchiness, what can they do

A
  • hair dryer set on cool setting can be directed under the cast
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32
Q

what are some S&S of cast complications the patient should report to the HCP (7)

A
  • increased pain
  • swelling
  • discoloration of distal extremity
  • pain during movement
  • burning or tingling under cast
  • sores
  • odour under cast
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33
Q

what should you do if a cast has to be removed in an emergency (3)

A
  • remove cast
  • maintain immobility
  • call dr
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34
Q

what is external fixation

A
  • use of a metallic device composed of metal pins that are inserted into the bone and attached to external rods to stabilize the fracture while it heals
  • long term process
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35
Q

what is external fixation used for (3)

A
  • traction
  • compress fracture fragments
  • immobolize reduced fragments when use of a cast or other traction is not available
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36
Q

what is included in care/assessment of external fixation (5)

A
  • assessment for pin loosening
  • pin site care & cleaning
  • assessment of infection
  • vascular assessment (if pin hits nerve)
  • pain should decrease w time
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37
Q

what is internal fixation

A
  • surgical insertion of internal fixation devices (pins, plates, rods, screws) at the time of realignment
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38
Q

what should be included in assessment/care for a pt using traction (9)

A
  • if slings used, inspect exposed skin areas regularly
  • skin assessment
  • skeletal traction pin site cleaning & S&S of infection
  • generally keep pt in center of bed in supine position
  • monitor for S&S of complications associated w immobility
  • frequent pstn changes
  • if exercise permitted, encourage participation in simple exercise regimen
  • ROM exercise of unaffected joints
  • DB&C
  • frequent exercise of the trunk
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39
Q

what does pin site care typically include in skeletal traction (3)

A
  • regular removal of exudates w half strength hydrogen peroxide
  • rinsing pin sites w normal saline
  • drying area w sterile gauze
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40
Q

what drug therapy is typically involved for a pt with fractures (5)

A

pts with fractures often experience pain associated w muscle spasms

  • central & peripheral muscle relaxants
  • NSAIDs
  • narcotics
  • baclofen
  • prophylaxis for complications from immobility (clots)
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41
Q

what is are 2 example of a central and peripgeral muscle relaxant

A
  • cyclobenzaprine

- methocarbamol (robaxin)

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42
Q

in an open fracture, there is risk of tetanus if they have not been previously immunized. what is done in this situation

A
  • use of prophylactic bone-penetrating anitbiotics

ex. cefazolin

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43
Q

why is nutrition imp for a pt with a fracture (3)

A
  • proper nutrition is imp for healing
  • promote muscle strength and tone
  • enhance ambulation
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44
Q

describe nutrition for a pt with a fracture (8)

A
  • ample protein
  • vitamins (esp B, C, D)
  • calcium
  • phosphorus
  • magnesium
  • 3 well-balanced meals a day
  • fluid intake of 2000-3000 mL/day for bowel and bladder function
  • high fibre
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45
Q

in what situation would 6 small meals be preferred over 3 large ones for a pt w fracture

A
  • if have skeletal traction, in body jacket, or hip spica bandage
  • prevent abdominal pressure & cramping
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46
Q

if a pt comes in w a fracture r/t trauma, what is the priority

A
  • neuro assessment
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47
Q

what assessment should be done in a pt with a fracture? why?

A
  • neurovascular

- the injury can cause nerve or vascular damage, usually distal to the injury

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48
Q

what does a neurovascular assessment include

A
  • peripheral vascular assessment

- peripheral neuro assessment

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49
Q

what is assessed during a neurovascular assessment

A
  • color
  • temp
  • cap refill
  • distal pulses
  • edema
  • sensation
  • motor function
  • pain

compare bilat!

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49
Q

what is assessed during a neurovascular assessment (8)

A
  • color
  • temp
  • cap refill
  • distal pulses
  • edema
  • sensation
  • motor function
  • pain

compare bilat!

50
Q

what is included in the intial interventions for a fracture (12)

A
  • treat life-threatening conditions first
  • ABCs
  • asses for & control external bleeding w pressure or sterile dressing & elevation of the limb
  • splint joints above and below injury
  • assess neurovascular status
  • elevate limb
  • apply ice
  • manage pain
  • obtain radiographs
  • admin tetanyus & diptheria prophlyaxis if skin integirty violated
  • mark location of pulses
  • splint fracture site
51
Q

what should you NOT do during the initial intervention of a fracture (2)

A
  • do not attempt to straighten out the joint

- do not manipulate the protruding bone ends

52
Q

what is included in ongoing monitoring of a fracture (6)

A
  • VS
  • LOC
  • O2 sats
  • peripheral pulses
  • pain
  • monitor for complications
53
Q

describe the alignment for a pt with a fracture

A
  • midline, neutral position
54
Q

what are the benefits of traction

A
  • promotes bone healing
  • decrease muscle spasm
  • prevent further soft tissue & vessel injury
55
Q

describe preop care if surgery is required to treat the fracture (3)

A
  • educate on immobilization
  • assure that pain meds will be available if needed
  • clean skin, remove debris & hair (to reduce risk of infection)
56
Q

describe post op care if surgery is required to treat fractures (5)

A
  • monitor VS
  • neurovascular assessment
  • proper alignment and positioning
  • pain mngmt
  • assess & change dressings for bleeding, S&S of infection
57
Q

what are some potential complications r/t immbolity in a pt with a fracture (5)

A
  • resp complications
  • constipation
  • renal calculi
  • deconditioning of the cardiopulmonary system
  • ulcers
58
Q

what nursing interventions can be done to prevent resp complication (4)

A
  • DB&C
  • spirometry
  • turning q2h
  • ROM exercises
59
Q

what nursing interventions can be done to prevent constipation in a pt with a fracture (6)

A
  • activity
  • high fluid intake (>2500 mL/day)
  • diet high in fiber & roughage
  • stool softeners
  • laxatives
  • maintain a regular time for elimination
60
Q

what nursing interventions can be done to prevent renal calculi r/t the bone demineralization (2)

A
  • fluid intake >2500 mL/day

- cranberry juice

61
Q

what nursing interventions can prevent or diminish deconditioning of the cardiopulmonary system r/t prolonged bed rest (3)

A
  • permit pt to sit on side of bed
  • dangle lower limbs over bedside
  • standing transfers
62
Q

what are potential complications of fractures (5)

A
  • infection (*open fractures)
  • compartment syndrome
  • pressure ulcers
  • clots
  • fat emboli
63
Q

what types of fractures are at high risk of infection

A
  • open & soft tissue injury
64
Q

what is included in collaborative care of infection (4)

A
  • aggressive treatment w antibiotics (IV, 3-7 days)
  • surgical debridement
  • irrigation
  • diligent wound care & assessments
65
Q

what is osteomylitis

A
  • severe infection of the bone, bone marrow, and surrounding soft tissue
  • requires long time for healing
66
Q

early infections usually occur when?

A
  • less than 2 weeks after surgery
67
Q

what are S&S of infection (10)

A
  • increasing local pain
  • redness
  • swelling
  • warmth
  • wound drainage
  • fever
  • disturbed wound healing
  • shiny, taut skin
  • odour
  • decreased sensation
68
Q

describe the typically infecting organisms

A
  • usually highly virulent

ex. staph, gram (-) bacilli, clostridial infection, tetanus

69
Q

what is compartment syndrome

A
  • condition in which elevated intracompartmental pressure within a confined myofascial compartment compromises the neurovascular function of tissues within that space
  • causes cap perfusion to be less than what is necessary for tissue viability
70
Q

what are 2 causes of compartment syndrome

A
  • decreased compartment size

- increased compartment contents

71
Q

what can cause decreased compartment size

A
  • restrictive dressings, splints, casts, excessive traction, premature closure of fascia
72
Q

what can caused increased compartment contents (3)

A
  • bleeding
  • edema
  • IV infiltration
73
Q

what is important r/t compartment syndrome

A
  • prompt, accurate diagnosis to prevent permanent damage to muscles and nerves
74
Q

what are the signs of compartment syndrome (6)

A
  • parasthesis
  • pain (distal to injury, not relieved by opioids)
  • poikolethermia (cold)
  • pallor, coolness, loss of normal color
  • paralysis or loss of function
  • pulselessness or diminished peripheral pulses
75
Q

what are the signs of compartment syndrome (6)

A
  • parasthesis
  • pain (distal to injury, not relieved by opioids)
  • poikolethermia (cold)
  • pallor, coolness, loss of normal color
  • paralysis or loss of function
  • pulselessness or diminished peripheral pulses
76
Q

what is usually the first indicator of compartment syndrome

A
  • pain
77
Q

what should you not do if you suspect compartment syndrome (2)

A
  • elevate above heart lvl (slows arterial perfusion)

- apply cold compress (causes vasoconstriction= exacerbates it)

78
Q

what should you do if you suspect compartment syndrome or note changes in pts condition (4)

A
  • notify HCP
  • may need to loosen or remove bandage, split cast in half
  • surgical decompression may be necessary = fasciotomy
  • if rlly severe, amputation may required
79
Q

what is a fasciotomy

A
  • incision between joints thru skin & fascia to immediately release pressure
80
Q

describe postop care for fasciotomy (2)

A
  • left open for several days to ensure adequate soft tissue decompression
    = monitor for infection
  • monitor healing
81
Q

what should be done to prevent compartment syndrome (2)

A
  • assess dressing

- neurovascular assessments

82
Q

describe the risk of venous thromboembolism in pts w fractures; what increases the risk (3)

A
  • veins of lower extremities and pelvis highly susceptible to thrombus formation
  • may occur after total hip or knee replacement surgery
  • also can occur r/t immobility
83
Q

what type of fracture causes increased risk of venous thromboembolism

A
  • hip
84
Q

how is a DVT diagnosed

A
  • US
85
Q

what should be assessed regarding r/o venous thromboembolism

A
  • legs: swelling, color, measure (Bilaterally)

- S&S of PE

86
Q

what is included in prevention of venous thromboembolsim in pts w fractures (6)

A

d/t high risk = prophylactic anticoagulants

  • heparin bolus followed by heparin infusion
  • warfarin
  • LMWH
  • fondaparinux
  • dalteparin
  • oral agents
87
Q

what oral agents can be used for prevention of DVTs and PE w fractures (3)

A
  • enoxaparin
  • apixaban
  • Xarelto
88
Q

what is fat embolism syndrome

A
  • the presence of systemic fat globules from fractures that are distributed into tissues and organs after a traumatic skeletal injury
89
Q

what are the highest risk fractures for fat emboli (4)

A
  • long bones
  • ribs
  • tibia
  • pelvis

( fat is released from marrow, these bones have high marrow content)

90
Q

what are symptoms of a fat emboli

A
  • respiratory distress symptoms
91
Q

what are some examples of resp distress symptoms seen w a fat emboli (11)

A
  • chest pain
  • tachypnea
  • cyanosis
  • dyspnea
  • apprehencsion
  • tachy
  • decreased PaO2
  • confusion
  • air hunger
  • petechiae around neck, chest wall, axilla, buccal membrane, conjuctiva of eye
  • changes in mental status
92
Q

what can be used to diagnose a fat emboli

A
  • xray
93
Q

what is the prevention of fat emboli (4)

A
  • assess LOC, petechia, resp
  • careful immobilization of long bone fracture **
  • DB&C
  • minimal repositioning before fracture immobilization or stabilization
94
Q

what is included in treatment of fat emboli (5)

A
  • fluid resus to prevent hypovolemic shock
  • correction of acidosis
  • replacement of blood loss
  • O2
  • intubation or positive pressure breathing if supplemental O2 not good enough
95
Q

describe the severity of pelvic fractures

A
  • ranges from benign to life-threatening depending on how the injury was sustained & the vasc. damage
96
Q

what risks are associated w pelvic fractures (4)

A
  • can cause serious intra-abdominal injury
  • can lacerate an organ (urethra, bladder, colon)
  • lacerate a vessel (hemorrhage)
  • paralytic ileus
97
Q

what are signs of a pelvic fracture (5)

A
  • local swelling
  • tenderness
  • deformity
  • unusual pelvic movement
  • ecchymosis on abdomen
98
Q

describe treatment for a stable, nondisplaced pelvic fracture (3)

A
  • may be on bedrest for weeks
  • limited intervention
  • early mobilization
99
Q

describe treatment for complex pelvic fractures (6)

A
  • pelvic sling traction
  • skeletal traction
  • hip spica casts
  • external fixation
  • open reduction
  • may need OR to stabilize pelvic bones
100
Q

describe care for a pt with a pelvic fracture (5)

A
  • extreme care in handling & moving
  • turn onlu when ordered
  • assess bowel & urinary function (bc can damage other organs)
  • assess distal neurovasc status
  • assess & manage pain
101
Q

what population are hip fractures common in

A
  • older adults
102
Q

what are signs of hip fractures (3)

A
  • external rotation muscle spasms
  • shortening of the affected extremity
  • severe pain and tenderness
103
Q

what is usually required for management of hip fractures

A
  • surgical repair
  • may be temporarily immobilized by Buck’s traction until the physician condition has stabilized and surgery can be performed
104
Q

what should be considered during treatment of a hip fracture

A
  • impact of immobility on their body system –> nutrition, resp, skin, turning
105
Q

what may be required for treatment of hip fractures

A
  • pinning

- replacement = prosthesis

106
Q

what is included in preop care for hip fractures (3)

A
  • analgesics
  • education on procedure
  • encourage use of overhead trapeze bar for position changes
107
Q

what is the postop care for hip fracture (8)

A
  • monitor VS
  • DB&C
  • pain meds
  • monitor I&O
  • monitor & change dressing
  • monitor for bleeding & infection
  • neurovasc assessment of extremity
  • ## ambulation POD 1
108
Q

what is there risk for after endoprosthesis

A
  • hip dislocation
109
Q

how can hip dislocation be prevented post- prosthesis

A
  • keep pillows or abductor splint between knees
110
Q

what is required for pt to be discharged home psotop for hip fractures (3)

A
  • pt must be able to safely demonstrate use of crutches or walker
  • ability to transfer in and out of bed
  • ability to ascend and descend stairs
111
Q

what should NOT be done to avoid hip dislocation for femoral head prosthesis (6)

A
  • force hip into greater than 90 degrees of flexion
  • force hip into abduction
  • force hip into internal rotation
  • cross legs at knees
  • put on own sheos or stockings until 8 weeks after surgery without adaptive device
  • sit on chairs without arms (needed to aid rising to standing position)
112
Q

what measures should be taken to avoid hip dislocation post femoral head prosthesis (6)

A
  • use an elevated toilet seat
  • place chair inside shower or tube & remain seated while washing
  • use pillow between legs for first 8 weeks after surgery when lying on the side allowed by surgeon or when supine
  • keep hip in neutral, straight pstn when sitting, walking, or lying
  • notify surgeon if severe pain, deformity, or loss of function
  • inform dentist of presence of prosthesis before dental work so prophylactic antibiotics can be given if indicated
112
Q

what measures should be taken to avoid hip dislocation post femoral head prosthesis (6)

A
  • use an elevated toilet seat
  • place chair inside shower or tube & remain seated while washing
  • use pillow between legs for first 8 weeks after surgery when lying on the side allowed by surgeon or when supine
  • keep hip in neutral, straight pstn when sitting, walking, or lying
  • notify surgeon if severe pain, deformity, or loss of function
  • inform dentist of presence of prosthesis before dental work so prophylactic antibiotics can be given if indicated
113
Q

a nursing diagnosis r/t fractures is impaired physical mobility. what nursing interventions should be done r/t splinting (5)

A
  • apply splint in position injured body part was found, using hands to support injury site, minimizing mvmt, and using assistance of another HCP
  • minimize movement
  • monitor for bleeding at injury site
  • monitor circulation
  • identify most approp splint material
114
Q

a nursing diagnosis r/t fracture is impaired physical mobility. what nursing interventions should be done r/t traction & immobilization care (6)

A
  • position in proper body alignment
  • maintain traction at all times
  • monitor neurovasc
  • provide trapeze for movement in bed
  • monitor skin & bony prominences
  • admin approp skin care at friction sites
115
Q

what nursing interventions should be implemented for cast care when it is wet (5)

A
  • handle w palms of hand until dry
  • support cast w pillows during drying period (avoid pillow under heel)
  • protect cast if close to groin ( prevent soiling)
  • mark the circumerence of any drainage
  • elevate casted extremity at or above lvl of heart
116
Q

a nursing diagnosis r.t fractures is risk for peripheral neurovascular dysfunction. what circulatory precautions should be taken (3)

A
  • perform neurovasc assessment
  • prevent infection in wounds to avoid further edema and inflamm.
  • maintain adequate hydration to prevent clots & increased blood viscosity
117
Q

what position should be done for a pt with a fracture

A
  • immobilize or supprot affected body part
  • maintain position & integirty of traction
  • elevate affected limb 20 degrees or greater above level of heart to reduce edema
118
Q

what peripheral sensation mngmt should be done for pts w fractures (2)

A
  • monitor for parasthesia

- monitor sharp/dull and hot/cold discrimination

119
Q

a nursing diagnosis r/t fractures is acute pain. what nursing interventions for pain mngmt can be done

A
  • perform assessment of pain
  • provide optimal pain relief
  • notify HCP or surgeon if pain-relief measures unsuccessful or pt complaining of increase in pain (sign of compartment syndrome)
  • teach use of nonpharmacological techniques
120
Q

what nursing interventions r/t cast care should be provided

A
  • instruct pt not to scratch skin under cast
  • offer alternatives to scratching
  • position cast on pillow to lessen strain on body parts
  • pad rough cast edges and traction connections to prevent skin irritation
  • apply ice for 24-36 hrs
  • address pain & symptoms of compromised circulation immediately
121
Q

what can cause pressure ulcers w fractures (4)

A
  • wet/macerated skin
  • immobility
  • wet chin pads on aspen collar
  • if weight not properly offloaded with traction

NURS 3512 - Class 7-12 (49 decks)

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