Ch. 44

Question 1

fracture

Answer 1

break or disruption in continuity of a bone

Question 2

complete fracture

Answer 2

the break is across the entire width of the bone in such a way that the bone is divided into two distinct sections
- may be displaced: called a displaced fracture if the bone alignment is disrupted or altered. the ends of the bone sections are more likely to damage surrounding nerves, blood vessels, and other soft tissues

Question 3

incomplete fracture

Answer 3

the fracture does not divide the bone into two portions because the break is through only part of the bone
- not typically displaced

Question 4

open or compound fracture

Answer 4

the skin surface over the broken bone is disrupted, which causes an external wound
- graded to define the extent of tissue damage

Question 5

closed or simple fracture

Answer 5

does not extend through the skin and therefore no visible wound

Question 6

pathologic (spontaneous) fracture

Answer 6

aka fragility fracture
occurs after minimal trauma to a bone that has been weakened by disease
- bone cancer or osteoporosis patient

Question 7

fatigue or stress fracture

Answer 7

results from excessive strain and stress on the bone
- commonly seen in recreational and professional athletes

Question 8

compression fracture

Answer 8

produced by a loading force applied to the long axis of cancellous bone
- commonly occur in the vertebrae of older patients with osteoporosis and are extremely painful

Question 9

oblique fracture

Answer 9

diagonal break

Question 10

occult fracture

Answer 10

break is hidden or not easily recognized

Question 11

open fracture

Answer 11

fragment of bone protruding through an open wound

Question 12

pathologic

Answer 12

break as a result of disease rather than injury

Question 13

segmented

Answer 13

bone is splintered into pieces

Question 14

spiral

Answer 14

twisted break

Question 15

transverse

Answer 15

horizontal break

Question 16

green stick

Answer 16

partially bent; partially broken

Question 17

impacted

Answer 17

bone is wedged into the interior of the other

Question 18

bone healing: stage one

Answer 18

within 4-72 hours after the injury, hematoma forms at the site of the fracture because bone is extremely vascular

Question 19

bone healing: stage two

Answer 19

occurs in 3 days-2 weeks, when granulation tissue begins to invade the hematoma. this then prompts the formation of fibrocartilage, providing the foundation for bone healing

Question 20

bone healing: stage three

Answer 20

occurs as a result of vascular and cellular proliferation. the fracture site is surrounded by new vascular tissue known as callus (within 3-6 weeks). callus formation is the beginning of a nonbony union

Question 21

bone healing: stage four

Answer 21

healing continues, the callus is gradually resorbed and transformed into bone. this stage usually takes 3-8 weeks

Question 22

bone healing: stage five

Answer 22

remodeling/healed

Question 23

acute complications (of fractures)

Answer 23

• VTE
• infection
• acute compartment syndrome
• crush syndrome
• hemorrhage or hypovolemic shock
• fat embolism syndrome

Question 24

chronic complications

Answer 24

• complex regional pain syndrome (CRPS)

Question 25

incidence of fractures

Answer 25

depends on the location of the injury

Question 26

health promotion and maintenance: teaching to prevent fractures

Answer 26

- Osteoporosis screening - Fall prevention - Home safety - Dangers of drinking and driving under the influence - Use of helmets

Question 27

assessment: history

Answer 27

- Determine cause of fracture - Events leading up to injury - Substance use (especially opioids) - Occupational and recreational activities

Question 28

physical assessment & s/sx

Answer 28

- Check for trauma to other body systems - Assess all body systems for life-threatening complications - Check urine for blood - Assess for swelling, skin color, and peripheral pulses

Question 29

psychosocial assessment

Answer 29

status depends on extent of injury, possible complications, coping ability, and available support systems patients w/ single, uncomplicated fracture usually returns to daily activities within a few days- less at risk for long-term psychosocial problems patients with severe or multiple traumas are more at risk for psychosocial trauma - disruption in life style can create high levels of anxiety, stress, and/or depression - depression: pain, lonely - ask patient how they cope w/ stressful events, coping skills - support systems and love: family, friends, church, community groups - body image and sexuality may be altered

Question 30

imaging assessment

Answer 30

- CT - MRI - XRay

Question 31

lab assessment

Answer 31

- Hemoglobin - Hematocrit - ESR - WBC - Serum calcium, and phosphorus

Question 32

patient problems/ nursing diagnoses

Answer 32

- Acute pain due to broken bone(s), soft-tissue damage, muscle spasm, and edema  - Decreased mobility due to pain, muscle spasm, and soft-tissue damage - Potential for neurovascular compromise related to impaired tissue perfusion - Potential for infection due to a wound caused by an open fracture

Question 33

Interventions

Answer 33

- Managing acute pain - Increasing mobility - Preventing and monitoring for neurovascular compromise - Preventing infection

Question 34

closed reduction devices

Answer 34

- most common nonsurgical method for managing a simple fracture - manual pull or traction on the bone: PCP will move bone ends to realign - moderate sedation used (monitor O2 sat) - splint or boot will be used to keep the bone aligned to heal

Question 35

fiberglass synthetic cast

Answer 35

waterproof synthetic casting material - most often used for fracture immobilization - can dry and become rigid within minutes and decrease the risk for impaired tissue integrity - firm, odorless casts

Question 36

skeletal traction

Answer 36

screws are surgically inserted directly into the bone - allow use of longer traction time and heavier weights (15-30lb) - aids in bone realignment but impairs mobility - use pressure-reduction measures and monitor for indications of impaired tissue integrity - pin site care: infection monitoring (clean, doc drainage)

Question 37

external fixation device

Answer 37

with closed reduction is used when patients have soft tissue injury (open fracture) - pins and wires are inserted through the skin and affected bone and then connected to a rigid external frame outside the body to stabilize the fracture during healing - used for upper or lower extremities, esp with open fractures when wound management is needed - after removed, patient placed in boot/splint/cast or undergo internal fixation advantages: - minimal blood loss compared to internal fixation - allows early ambulation and exercise of affected body part while relieving pain

Question 38

preventing and monitoring for neurovascular compromise

Answer 38

- perform neurovascular assessments - be aware of symptoms of acute compartment syndrome and the 6 P's: - pain - pressure - paralysis - paresthesia - pallor - pulselessness

Question 39

preventing infection

Answer 39

- Use aseptic technique for dressing changes and wound irrigation - Monitor vital signs - Notify provider immediately if inflammation, purulent drainage is noted - Patient may need antibiotics, VAC system

Question 40

care coordination and transition management

Answer 40

- home care management - self-management education - health care resources

Question 41

evaluation of patient with a fracture

Answer 41

- has adequate pain control 2-3 on scale 0-10 to accomplish ADL's - is free of physiologic consequences of decreased mobility - is free of infection - has adequate blood flow to maintain tissue perfusion