Ch. 27: Fractures Flashcards Preview

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Flashcards in Ch. 27: Fractures Deck (60)
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A fracture occurs when the resistance between a bone and an applied stress yields to the _____, resulting in a disruption to the integrity of the bone

Applied stress


Who is bone healing and remodeling in: children or adults? Why?

Children---thicker periosteum and good blood supply


What type of injuries may result in altered bone growth?

Epiphyseal plate injuries


What is plastic deformation (bend fracture)?

The bone is bent no more than 45 degrees


What is buckle (torus) fracture?

Compression of the bone resulting in a bulge or raised area at the fracture site


What is greenstick fracture?

Incomplete fracture of the bone


What is transverse fracture?

Break is straight across the bone


What is oblique fracture?

Break is diagonal across bone


What is spiral fracture?

Break spirals around the bone


What is growth plate fracture?

Injury to the end of the long bone on the growth plate


What is stress fracture?

Tiny cracks in the bone


What is complete fracture?

Bone fragments are separated


What is incomplete fracture?

Bone fragments are still attached


What is closed or simple fracture?

The fracture occurs w/o break in the skin


What is open or compound fracture?

The fracture occurs with an open wound and bone protruding


What is complicated fracture?

The fracture results in injury to other organs and tissues


Nursing care: What is first thing to do when providing emergency care at the time of injury?

Maintain ABC


Neuro assessment: What are parts of this?

-Skin temp
-Skin color
-Cap refill


What does loss of sensation indicate?

Nerve damage


If we give an opioid analgesia for pain, what do we monitor?

Resp. depression and constipation


What casts are heavy, not water resistant, and can take 10-72 hours to dry?

Plaster or paris casts


What casts are light, water resistant, and dry very quickly (5-20 min)?

Synthetic fiberglass


What should be done prior to casting?

Skin area should be observed for integrity, cleaned, and dry

Bony prominencies should be padded to prevent skin breakdown


How can we provide atruamatic care =?

Show procedure on doll or toy


Elevate the cast _______ during the first ____ to prevent ____

Elevate the cast ABOVE THE LEVEL OF THE HEART during the first 24-48 hours to prevent SWELLING


Apply ____ for the first 24 hours to decrease swelling



How often should we turn and position client?

Every 2 hours so that dry air circulates around and under the cast for faster drying---this will also prevent pressure from chaining the shape of the cast


How should affected extremitiy be supported when sitting?

With a sling or elevated


What could indicate infection on the cast?

Increased warmth or hot spots on the casts surface


Plaster casts: use palms of hands to avoid _____, expose the cast to air to promote drying



What should we use over any rough area of the cast that may rub against the clients skin?



What should client do after removal of cast?

Soak extremity in warm water and apply lotion


What is used to align, immobilize, and reduce muscle spasms associated with certain fractures?

Traction, countertraction, and friction


Traction care: Through the use of forward pulling force and a backward force adding or removing weight controls the degree of force applied to maintain ____ & ____

Traction and allignment


Uses a pulling force that is applied by weights (may be used intermittently)--using tape and straps applied to the skin along with boots and/or cuffs, weights are attached by a rope to the extremity (back, russell, bryant traction)

Skin traction


Uses a continuous pulling force that is applied directly to the skeletal structure and/or specific bone. A pin or rod is inserted through or into the bone. Force is applied through the use of weights attached by a rope. This traction allows the client to change positions w/o interfering with the pull of the traction and decreases complications associated with immobility and traction

Skeletal traction


Suspends the leg in a flexed position; the hip and hamstring muscles are relaxed

Balanced suspension traction


Uses a halo-type bar that encircles the head. Screws are inserted into the outer table of the skull. This attaches to either bed traction or rods that are secured to a vest worn by the client

Halo traction (cervical traction)


Nursing actions: What should we do with halo traction ---assure what?

Assure the wrench to release the rods is attached to the best when using halo traction in the event that CPR is necessary


Nursing actions: What do we assess pin sites for?



Nursing actions: How should the hardware be?

Tight and that bed is in correct position


Nursing actions: How should the weights and ropes be? What should we NOT do?

Weights to hang freely and the ropes are free of knots

Do NOT life or remove weights unless prescribed and supervised by the provider!!!


Nursing actions: How should we remove the sheets to be changed?

From the HOB to the foot of bed, and remake bed in same manner


What are the fractures that are the most common for requiring surgery?

Supracondylar fractures and fractures of the humerus and femur


After a surgery to fix a fracture, when should we encourage mobilization?

As soon as prescribed!


What are the 2 big complications of fractures?

1. Compartment syndrome
2. Osteomyelitis


Compression of nerves, blood vessels and muscle inside a confined place

Compartment syndrome


What happens if compartment syndrome gets untreated?

Tissue necrosis can result


What are some findings for compartment syndrome?

-Increased pain that is unrelieved with elevation or analgesics
-Intense pain when passively moved
-Paresthesia, numbness
-Pulselessness distal to the fracture
-Inability to move digits
-Warm digits with skin that is tight and shiny


What is prevention of compartment syndrome?

-Loosen the constrictive dressing or cut the bandage or tape
-Elevate the extremity and apply ice


Client education for compartment syndrome?

Tell client to report pain that is not relieved by analgesics, pain that continues to increase in intensity, numbness or tingling, or a change in color of the extremity


Infection w/in the bone secondary to a bacterial infection from an outside source, such as with an open fracture (endogenous) or from a blood borne bacterial source



What are the clinical manifestations of osteomyelitis?

-Appearing ill
-Not wanting to use affected extremity
-Site of infection is tender, and bone pain worsens with movement


What do we assist with in osteomyelitis?

-Assit with diagnostic procedures (obtaining skin, blood, and bone cultures)
-Assit with joint or bone biopsy
-Assit with proper positioning to promote comfort


What should we administer for patents who have osteomyelitis?

-Administer IV and oral antibiotic therapy
-Administer pain med as prescribed


A nurse is caring for a child who is in a plater spica cast. Which of the following is an appropriate action for the nurse to take?

A. Use a heat lamp to facilitate drying
B. Avoid turing child until cast is dry
C. Assist client with crutch walking after cast is dry
D. Apply moleskin to edges of cast



A nurse is teaching a group of parents about fractures. Which of the following should be included in the teaching?

A. Children need a longer time to heal from a fracture than an adult
B. Epiphyseal plate injuries may result in altered bone growth
C. A greenstick fracture is a complete break in the bone
D. Bones are unable to bend, so they break



A nurse is caring for a child who sustained a fracture. Which of the following are appropriate for the nurse to take (SATA)?

A. Place a heat pack on the site of injury
B. Elevate the affected limb
C. Assess neuromuscular status frequently
D. Encourage ROM of the affected limb
E. Stabilize the injury

B, C, E


A nurse is caring for a child who has a fracture. Which of the following are clinical manifestations of a fracture? (SATA)

A. Crepitus
B. Edema
C. Pain
D. Fever
E. Ecchymosis

A, B, C, E


A nurse is caring for a chid who is in a Russell traction. Which of the following are appropriate actions for the nurse to take? (SATA)

A. Remove the boots once a day for a bath
B. Assess the child's position frequently
C. Assess pin sites q4h
D. Ensure the weights are hanging freely
E. Ensure the buttocks is raised off the bed

B, E

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