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ATI Pediatrics-MJ > Ch. 27: Fractures > Flashcards

Ch. 27: Fractures Flashcards

1
Q

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

A

Applied stress

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2
Q

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

A

Children—thicker periosteum and good blood supply

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3
Q

What type of injuries may result in altered bone growth?

A

Epiphyseal plate injuries

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4
Q

What is plastic deformation (bend fracture)?

A

The bone is bent no more than 45 degrees

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5
Q

What is buckle (torus) fracture?

A

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

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6
Q

What is greenstick fracture?

A

Incomplete fracture of the bone

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7
Q

What is transverse fracture?

A

Break is straight across the bone

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8
Q

What is oblique fracture?

A

Break is diagonal across bone

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9
Q

What is spiral fracture?

A

Break spirals around the bone

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10
Q

What is growth plate fracture?

A

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

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11
Q

What is stress fracture?

A

Tiny cracks in the bone

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12
Q

What is complete fracture?

A

Bone fragments are separated

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13
Q

What is incomplete fracture?

A

Bone fragments are still attached

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14
Q

What is closed or simple fracture?

A

The fracture occurs w/o break in the skin

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15
Q

What is open or compound fracture?

A

The fracture occurs with an open wound and bone protruding

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16
Q

What is complicated fracture?

A

The fracture results in injury to other organs and tissues

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17
Q

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

A

Maintain ABC

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18
Q

Neuro assessment: What are parts of this?

A
  • Sensation
  • Skin temp
  • Skin color
  • Cap refill
  • Pulses
  • Movementh
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19
Q

What does loss of sensation indicate?

A

Nerve damage

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20
Q

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

A

Resp. depression and constipation

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21
Q

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

A

Plaster or paris casts

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22
Q

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

A

Synthetic fiberglass

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23
Q

What should be done prior to casting?

A

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

Bony prominencies should be padded to prevent skin breakdown

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24
Q

How can we provide atruamatic care =?

A

Show procedure on doll or toy

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25
Q

Elevate the cast _______ during the first ____ to prevent ____

A

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

26
Q

Apply ____ for the first 24 hours to decrease swelling

A

Ice

27
Q

How often should we turn and position client?

A

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

28
Q

How should affected extremitiy be supported when sitting?

A

With a sling or elevated

29
Q

What could indicate infection on the cast?

A

Increased warmth or hot spots on the casts surface

30
Q

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

A

Denting

31
Q

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

A

Moleskin

32
Q

What should client do after removal of cast?

A

Soak extremity in warm water and apply lotion

33
Q

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

A

Traction, countertraction, and friction

34
Q

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 ____ & ____

A

Traction and allignment

35
Q

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)

A

Skin traction

36
Q

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

A

Skeletal traction

37
Q

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

A

Balanced suspension traction

38
Q

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

A

Halo traction (cervical traction)

39
Q

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

A

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

40
Q

Nursing actions: What do we assess pin sites for?

A 
Pain
Redness
Swelling
Drainage
Odor
41
Q

Nursing actions: How should the hardware be?

A

Tight and that bed is in correct position

42
Q

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

A

Weights to hang freely and the ropes are free of knots

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

43
Q

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

A

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

44
Q

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

A

Supracondylar fractures and fractures of the humerus and femur

45
Q

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

A

As soon as prescribed!

46
Q

What are the 2 big complications of fractures?

A
  1. Compartment syndrome

2. Osteomyelitis

47
Q

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

A

Compartment syndrome

48
Q

What happens if compartment syndrome gets untreated?

A

Tissue necrosis can result

49
Q

What are some findings for compartment syndrome?

A
  • 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
  • Pallor
50
Q

What is prevention of compartment syndrome?

A
  • Loosen the constrictive dressing or cut the bandage or tape
  • Elevate the extremity and apply ice
51
Q

Client education for compartment syndrome?

A

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

52
Q

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

A

Osteomyelitis

53
Q

What are the clinical manifestations of osteomyelitis?

A
  • Appearing ill
  • Irritability
  • Fever
  • Tachycardia
  • Edema
  • Pain
  • Not wanting to use affected extremity
  • Site of infection is tender, and bone pain worsens with movement
54
Q

What do we assist with in osteomyelitis?

A
  • Assit with diagnostic procedures (obtaining skin, blood, and bone cultures)
  • Assit with joint or bone biopsy
  • Assit with proper positioning to promote comfort
55
Q

What should we administer for patents who have osteomyelitis?

A
  • Administer IV and oral antibiotic therapy

- Administer pain med as prescribed

56
Q

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

D

57
Q

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

B

58
Q

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

A

B, C, E

59
Q

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

A, B, C, E

60
Q

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

A

B, E

ATI Pediatrics-MJ (41 decks)

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