Flashcards in Ch 72 Fractures & Immobilization Devices Deck (49):
What is a fracture?
A fracture is a break in a bone secondary to trauma or a pathological condition.
Pathological fractures may be caused by what?
Pathological fractures may be caused by metastatic cancer, osteoporosis, or Paget's disease.
What is the role of osteoclasts& osteoblasts?
Bone is continually going thru a process of remodeling as osteoclasts release calcium from the bone and osteoblasts build up the bone.
Monitoring for osteoporosis should especially monitored in what individuals?
Post menopausal woman and those with thyroid disorders.
What med will slow bone reabsorption and treat osteoporosis?
Taking a Biphosphonate will slow bone reabsorption and treat osteoporosis.
What is a closed or simple fracture?
A closed or simple fracture does not break the skin surface.
What is a open or a compact fracture?
A open or compound fracture disrupts the skin integrity, causing an open wound and tissue injury with a risk for infection.
Open fracture are based upon what?
On the extent of tissue injury.
Grade1- minimal skin damage
Grade 2- damage includes skin and muscle contusions nut without extensive soft tissue injury.
Grade 3- damage is excessive to skin, muscles, nerves and blood vessels.
What is a complete fracture?
A complete fracture goes completely through the bone, dividing it into 2 distinct parts.
What is a incomplete fracture?
A incomplete fracture goes through part of the bone.
What is a simple fracture?
A simple fracture has 1 fracture line.
What is a comminuted fracture?
A comminuted fracture has multiple fracture lines splitting the bone into multiple pieces.
What is a displaced fracture?
A displaced fracture has bone fragments that are not in alignment
What is a non displaced fracture?
A displaced fracture has bone fragments that remain in alignment.
What is a fatigue (stress) fracture?
A fatigue (stress) fracture results when excess strai. Occurs from recreational and athletic activities.
What is a compression fracture?
A compression fracture occurs from a loading force pressing on callus bone. This condition is common in the older adult who has osteoporosis.
Common types of fractures.
Comminuted- bone is fragmented
Oblique- fracture occurs at oblique angle across bone
Spiral- fracture occurs from twisting motion (common w/ physical abuse)
Impacted- fractured bone is wedged inside opposite fractured fragment
Green stick- fracture occurs on one side (cortex) but does not extend completely through the bone...most often in children.
What are risk factors for osteoporosis?
* excessive exercising & wt. loss from dieting and malnutrition
* woman who do not use estrogen replacement therapy after menopause lose estrogen & are unable to form strong new bone.
* clients on long term corticosteroid therapy loose calcium from their bones due to direct inhibition of osteoblast function, inhibition of GI calcium absorption, and enhancement of bone resorption.
Falls, motor vehicle accidents, contact sports, physical abuse, lactose intolerant, age.
A grating sound created by the rubbing of bone fragments
Internal rotation of extremity, shortened extremity, visible bone with open fracture.
Due to the pulling forces of the bone when not aligned
What diagnostic procedure determines hairline fractures/complications and delayed healing
A bone scan
What is a closed reduction?
Closed reduction is when a pulling force (traction) is applied manually to realign the displaced fractured bone fragments.
What is a open reduction?
Open reduction she a surgical incision is made and the bone is manually aligned and kept in place with screws.
This is known as a open reduction internal fixation ( ORIF)
What type of assessment is essential throughout immobilization?
A neurovascular assessment is essential throughout immobilization.
Traction uses pulling forces to promote and maintain alignment of the injured area.
Goals of traction include;
Prevent soft tissue injury
Realign bone fragments
Decrease muscle spasms and pain
Correct or prevent further deformities.
What does External fixation involve?
External fixation involves fracture immobilization using percutaneous pins and wires that are attached to a rigid external frame.
What are external fixations used for?
Comminuted fracture or nonunion fractures with extensive soft tissue damage.
Leg length discrepancies from Congenital defects
Bone loss due to osteomyelitis
What are the advantages of a external fixation?
Immediate fracture stabilization
Minimal blood loss occurring in comparison with internal fixation
Allowing for early mobilization and ambulation
Permitting wound care with open fractures
How often should pin care be done?
Q 8-12 hours
Monitor site for drainage, color, odor, redness
Observe for signs of fat and pulmonary embolism provide Ted hose or SCD's to prevent DVT
What is compartment syndrome
Compartment syndrome usually affect extremities and occurs when Pressure within one or more of the muscle compartments of,the extremity compromises circulation, resulting in an ischemia- edema cycle.
Adults between 60-80 yrs are at the greatest risk of developing a fat embolism. Hip and pelvic fractures are most common.
Fat embolism can occur after the injury, usually within 48 hrs following long bone fractures or with total joint arthroplasty.
Fat globules fro the bone marrow are released into the vasculature and travel to the small blood vessels including those in the lungs resulting in acute respiratory insufficiency and organ perfusion.
What are clinical manifestations of a fat embolism?
Dyspnea, chest pain, decreased oxygen saturation
Decreased mental acuity R/T low arterial oxygen level (earliest sign)
DVT is the most common complication following trauma, surgery or disability related to immobility
Osteomyelitis is an infection of the bone that begins as an inflammation within the bone.
Encourage early ambulation apply anti embolism stocking SCD's
Administer anticoagulants as prescribed
Encourage fluids to prevent hemoconcentration
Instruct the client to rotate ft at the ankles and perform LE exercises.
What are clinical manifestations of osteomyelitis?
Bone pain that is constant, pulsating, localized, and worse with movement.
Erythema and edema at the site of infection
Fever( older adults may not have a elevated temp)
Leukocytosis and possible elevated sedimentation rate
Many of these infections will disappear if the infection becomes chronic.
What are diagnostic procedure for osteomyelitis?
Bone scan using radioactive material to diagnose
MRI may also facilitate a diagnosis
Cultures are performed for detection of possible aerobic and anaerobic organisms.
If septicemia develops, blood cultures will be positive for offending microbes.
What is tx for osteomyelitis?
Long term course (3mnths) of IV & oral antibiotic therapy
Surgical debridement may also b indicated. If a significant amt of bone requires removal, a bone graft may be necessary.
Hyperbaric O2 tx may be needed to promote healing in chronic cases of osteomyelitis
Surgical implanted antibiotic beads in bone cement are packed into the wound as a form of antibiotic therapy.
Avascular necrosis results from circulatory compromise that occurs after a fracture. Blood flow is disrupted to the fracture site and the resulting ischemia leads to tissue( bone) necrosis.
Avascular necrosis is commonly found where?
Is commonly found in hip fractures or in fractures with displacement of a bone.
Clients receiving long term corticosteroid therapy are at greater risk for developing Avascular necrosis.
Fracture heals incorrectly
Fracture that never heals
What may be used for a nonunion fracture?
Electrical bone stimulation and bone grafting can be used treat nonunion.
May appear in,older adults due to impaired healing process.
Malunion and nonunion can result in what?
Malunion and nonunion can cause immobilizing deformity of the bone involved.
A nurse in the ED is planning care for a client who has a right hip fracture. What immobilization device should the nurse anticipate in the plan of care?
Is a temporary immobilization device applied to diminish muscle spasms and immobilize the affected extremity until surgery is performed.
A nurse is completing discharge teaching to a client who had a wound debridement for osteomyelitis. What should the nurse include in the teaching?
Antibiotic therapy should continue for 3 months.
A nurse is completing an assessment of a client who has a external fixation device applied 2 hours ago for a fracture of the left tibia and fibula. What finding indicated compartment syndrome?
Intense pain when the left foot is passively moved.(may indicate pressure from edema on nerve endings and is a neurological sign of compartment syndrome.)
Hard swollen muscle in the left leg. ( indicated edema buildup in the area of injury and is a sign of compartment syndrome)
Burning and tingling of the left foot.(indicates pressure from edema on nerve endings & is a early neurological sign of compartment syndrome
Minimal pain relief from opioid medication. (May indicate edema on nerve endings & is a early sign of compartment syndrome.)