Fractures Flashcards
What is a fracture ?
Break / crack in bone
- either completely or partially
What are the S&S of a fracture (BROKEN)
Bruising w pain and swelling
Reduced movement
Odd appearance
Krackling sound (bone frags rubbing together )
Edema + erythema @ site
Neuro vascular impairment
Fractures can be
Closed fractures or open fractures
What is a closed fracture ?
Broken bone does not penetrate through the skin- so overlying skin left intact
What’s is an open fracture
Bone breaks through the skin
- bleeding/bruising
- exposed 2 external environment via traumatic violation of soft tissue and skin
What is a complete fracture ?
When break separates bone into 2
What is an incomplete fracture ?
When fracture does not break bone all the way through
How can we diagnose a fracture ?
- x-ray : show above and below joint - at least 2 views to diagnose type of fracture
-CT scan - MRI ( not 4 diagnosis but to see tiny structural damage w head injury
What is the nursing interventions for fractures?
- immobilise fx w a splint above and below it
-stop bleeding by applying pressure w a clean cloth - elevate extremity to reduce swelling
- apply ice to reduce swelling
- keep NPO until evaluated by MD
- get x-ray
- pain mgt w meds- document + monitor closely the relief (compartment syndrome)
- monitor 4 fat embolism
What is compartment syndrome ?
Increased pressure in fascia squeezing and cutting of nerve and blood supply to muscle
- if not reverted within 6 hrs- pt will lose muscle
What is the mgt of compartment syndrome /
- 6 P’s
- early sign is pain
- keep extremity @ heart lvl
- loosen n d remove restrictive clothing
- notify MD
- bivalve cast- reduces wgt on fx + relieves pressure
- severe - fascitomy
What are the 6 P’s that we should assess and that will tell us if a pt is experiencing compartment syndrome ?
- Pain - early sign
- Paresthesia - tingling, pins + needles sensation in affected extremity
- Pallor- extremity will have a dusty pale colour- compare w other extremity
- Paralysis - check if pt has movement in fingers
- Poikilothermia- compare temps of both extremities- one colder than the other?
- Pulslessness- late sign
What are the treatments for fractures
- bone reduction
- bone traction
What is a bone reduction ?
Putting the bone back in its original position
How is a bone reduction done in a closed fracture ?
Manually
How is a bone reduction done in a an open fracture ?
Surgically
- internal - bone inside - pins, rods, plates
-external - outside skin- metal braces, + screws
What is a traction ?
Aligning the bone w a steady pulling action
-wgts hang freely + not on the floor
- never remove wgts
- pin care- infection, skin integrity
- monitor 6 P’s
- overhead trapeze 2 help w movement
What is the cast care ?
- monitor 6 P’s 4 compartment syndrome
- keep infection free
- elevate above heart lvl 2 reduce swelling and improve circulation
- ice for 2 days
- use palms to handle case when freshly applied- using fingers can leave dents which will stay and cause pressure ulcer
- turn every 2 hrs to make sure each side dries equally
- maintain skin integrity around the cast
- keep cast dry + dont get it wet
-educate pt and family on these points
What is the initial mgt of an open fracture ?
- inspect wound
- remove foreign bodies
- photo of wound
- cover area w saline
- antibiotics within 30 mins- prevent infection
- tetanus prophylaxis
What is the definitive mgt for open fracture
Surgery ASAP
- clean out nd debride wound
- stop bleeding
- preserve as much as possible