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Fractures Flashcards

1
Q

Soft tissue injuries

A

Soft tissue injuries is damage to the muscle, tendons and ligaments
-Contusions
-Sprains and strains
-Dislocations and subluxations

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2
Q

Contusions, sprains, and strains; treatment

A

-Rest
-Ice
-Compressikn
-Evelate

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3
Q

Joint dislocations; Collaborative management

A

-Confirm by x ray
-Reduction
-Pain management

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4
Q

Joint dislocations; nursing management

A

-Assess Nerovascular status
•CMS
-Protect joint
•immobilize

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5
Q

Neurovascular assessment

A

Circulation
-Assess the colour of the skin
-Assess temperature
-Assess capillary refill
-Assess peripheral pulse if accessible

Motor
-Assess movement of involved fingers and toes
•Radial, medial, ulnar
•Peroneal, tibial
-Assess for presence of pain with movement

Sensation
-Assess presence and abnormal sensation
-Pressure, pinprick and temperature discrimination

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6
Q

Fractures

A

-Disruption or break in continuity of the structure of bone
-Majority of fractures from traumatic injuries
-Some fractures secondary to disease process
•Cancer or osteoporosis-known as pathological

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7
Q

Avulsion fracture

A

A fracture in which a fragment of bone has been pulled away by a tendon and it’s attachment

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8
Q

Commiuted fracture

A

A fracture in which bone has splintered into several fragments

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9
Q

Compression fracture

A

A fracture in which bone has been compressed (seen in vertebral fractures)

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10
Q

Depressed fracture

A

A fracture in which fragments are driven inwards (see frequently in fractures of skull and facial bones)

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11
Q

Epiphyseal fracture

A

A fracture through the epiphysis

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12
Q

Greenstick fracture

A

A fracture in which one side of a bone is broken and the other side is bent

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13
Q

Impacted fracture

A

A fracture in which a bone fragment is driven into another bone fragment

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14
Q

Oblique fracture

A

A fracture occluding at an angle across the bone (less stable than transverse fracture)

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15
Q

Open fracture

A

A fracture in which also involves the skin or mucus membranes, also called a compound fracture

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16
Q

Pathological fracture

A

A fracture that occurs through an area of diseased bone (eg osteoporosis, bone cyst, pagers disease) can o occur without trauma or fall

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17
Q

Simple fracture

A

A fracture that remains contained, with no disruption of the skin integrity

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18
Q

Spiral fracture

A

A fracture that shifts around the shaft of the bone

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19
Q

Stress fracture

A

A fracture that results from repeated loading of bone and muscle

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20
Q

Transverse fracture

A

A fracture that is straight across the bone shaft

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21
Q

With fractures adjacent structures are damaged

A

-Soft tissue edema
-Bleed into muscles and joints
-Joint dislocations
-Ruptured tendons, severed nerves
-Damage to blood vessels
-Body organs may be damaged by force that causes the fracture

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22
Q

Fractures; clinical manifestations

A

-Pain
-Loss of function
-Guarding
-+- deformity
+- shortening of the extremity
-Crepitus
-Local swelling and discolouration
-Patient usually reports injury to the area

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23
Q

Fractures; initial management

A

-Stabilize limb and support above & below site
•assess neurovascular status before and after splinting
-Open fracture: cover with sterile dressing to prevent contamination
-Remove clothing from unaffected side first

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24
Q

Fractures; collaborative care

A

-Anatomical realignment of bone fragments
-Immobilization to maintain realignment
-Restoration of normal or near-normal function of injured parts
-Prevention of infection (open fractures)

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25
Complete break
Completely through bone
26
Incomplete break
Bone is still in one piece but break occurs across the bone shaft
27
You are an RN in the ED. The triage note for Ms. k reads “75 y/o female, fell in her outstretched hand while out walking. Obvious deformity Rt wrist. Assessment specific to this injury includes
-Edema and swelling -Pain and tenderness -Deformity -Ecchymosis or contusion -Loss of function -Crepitation -Muscle spasm
28
Immediate nursing interventions would include
-A,B,C -Control bleeding with direct pressure -Check neuromuscular status distal to the injury -Elevate injured limb if possible -Apply ice -Splint fracture site, do not attempt to straighten fractured or dislocated joints, do not manipulate protruding bone ends
29
A colles’ fracture is a
Fracture of the distal radius
30
Most colles’ fractures occour in patients
>50 years old with osteoporosis
31
The ED physician decides to reduce the fracture. A closed deduction is
A nonsurgical, Manual realignment of the bone to their previous position
32
One key intervention following the application of a cast is to check for...
circulation, sensation, and movement
33
What is traction
Traction is the application of a pulling force to an injured or diseased part of body or extremity, while countertraction pulls in opposite direction -Prevent or reduce muscle spasm -Immobilize joint or part of body -Reduce a fracture of dislocation -Treat a pathological joint condition
34
Traction is also indicated to
-Provide immobilization to prevent soft tissue damage -Reduce muscle spasm associated with low back pain or cervical whiplash -Expand a joint space before major joint reconstruction
35
Traction; pourpouse
-Prevent or decrease muscle spasm -Immobilize joint or part of body -Decrease a fracture or dislocation -Treat a pathological joint condition
36
Two most common types of traction
Skin traction Skeletal traction
37
Fractures; skin traction
-Used for short term treatment until skeletal traction or surgery is possible -Tape, boots, or splints applied directly to skin to maintain alignment, assist in reduction, and help diminish muscle spasms in injured extremity -Traction weighs 2.3-4.5Kg
38
Skeletal traction
-In place for longer periods -Used to align injures bones and joints or to treat joint contractures and congenital hip dysplasia -Provides a long-term pull that keeps injured bones and joints aligned -Physician inserts pin or wire into bone, either partially or completely, to align and immobilize injured body part -Skeletal traction weigh range 2-20kg -Too much weight results in delayed nonunion
39
Traction; cont
-Countertraction commonly supplied by patients body weight or augmented by elevating end of bed -Imperative that nurse maintains traction constantly and does not interrupt weight applied to traction
40
Overall goals of fracture treatment
-Anatomical realignment of bone fragments -Immobilization to maintain realignment -Restoration or normal or near-normal function of injured parts
41
Fracture healing
Not occour in the expected time -Delayed union Not occour at all -Nonunion -Healing time for fractures increases with age.
42
Casts
Restrict tendinoligamentous movement -Assisting with joint stabilization while fracture heals -Applicaiton incorporates joints above and below fracture -Plaster sets in 15 minutes (not strong enough for weight bearing until 24-72 hours) -Fresh plaster should never be covered with a blanket -Once completely dry may need to be petalled to avoid skin irritation
43
What are 3 main complications of bone fracture
1. Infection 2. Compartment syndrome 3. Fat Embolism
44
Infection (osteomyelitis)
-High incidence in open fractures and soft tissue injuries -Massive or blunt soft tissue injury often has more serious consequences than fracture -Deviated and contaminated tissue is an ideal medium for pathogens -May manifest years later -Must be treated aggressively with antibiotics
45
Compartment syndrome
Decreased compartment size -Resulting from restrictive dressing, splints, casts, excessive traction, or premature closure of fascia Increased compartment size -Related to fracture, bleeding, edema, chemical response to snakebite, or IV filtration
46
The 6 Ps of compartment syndrome
Pain Pressure Pallor Pulselessness Paresthesia Paralysis
47
Compartment syndrome; clinical manifestations
-Pain: distal to injury that is not relieved by opioid analgesics and pain on passive stretch of muscle travelling through compartment -Paresthesia: numbness and tingling -Urine output must be assessed because there is a possibility of muscle damage -Myoglobin released from damaged muscle cells precipitates as a gel-like substance -Causes obstruction in renal tubes -EARLY RECOGNITION AND TREATMENT IS ESSENTIAL -Ischemia can occour 4-8 hours after onset -Regualr neurovascular assessments -May occur initially or may be delayed for several days
48
Compartment syndrome; CM cont
-Large amount of myoglobin may result in acute tubular necrosis -Acute tubular necrosis causes a tire renal failure -Common signs of myoglobinuria •Dark reddish brown urine •CM associated with acute renal failure
49
Compartment syndrome; Collaborative care
-Prompt, accurate diagnosis -Extremity should not be elevated above heart level •elevation may raise blood pressure and slow arterial perfusion -Application of cold compress may result in vasoconstriction and may exacerbate compartment syndrome
50
Compartment syndrome; collaborative care
-If at all suspicious - cut bandage, release Velcro straps on simmer splint or bivalve cast -Reduction in traction weight may decrease external circumferential pressures -Surgical decompression may be nessacary
51
Fat embolism syndrome
-Presence of systemic fat globules from fracture that are distributed into tissues and organs after a traumatic skeletal injury -Contributory factor in many deaths associated with fracture
52
Fat embolism syndrome; Clinical manifestations
-Early recognition crucial in preventing potentially lethal course -Most patients manifest symptoms 24-48 hours after injury -Fat globules transported to lungs cause a hemorrhagic interstitial pneumonitis -Clinical course of fat embolus may be rapid and acute -Patient frequently expresses a feeling of impending disaster -In short time skin colour changes from pallor to cyanosis -Patient may become comatose
53
Fat embolisim syndrome; collaborative care
Treatment -Fluid resuscitation -Correction of acidosis -Replacement of blood loss -Encourage coughing and deep breathing -Oxygen to treat hypoxia -ICU-mechanical ventilation
54
Nutritional therapy
Patients dietary requirements must include: -Ample protein (1G/1KG BW) -Vitimans (B, C, D) -Calcium -Phosphorus -Magnesium
55
Indications for joint replacement
-Relieve chronic pain -Improve joint mobility -Correct malalignment -Remove intra-articular causes of erosion
56
Preoperative care hip replacement
-Typically elective surgery, unless in the case of traumatic injury (I.e. hip fracture) -Pre-operative goal: having the patient in optimal health prior to the surgery
57
Pt pre op teaching
-No flexion of affected limb past 90° -No crossing of legs -No bending over to reach for objects -No driving x 6/52 -No heavy lifting -No NSAIDs or ETOH 48 hours Preoperative (risk of bleeding)
58
Postop nursing management
-Asses pain and administer analgesics -Elevate affected leg (foot above heart) -Monitor dressing -Pillow between legs when Turing in bed -Early ambulaiton
59
Discharge teaching
-Emphasize hip percautions -Typically d/c on anticoagulation therapy (Fragmin) -Ensure pt understands when and how to take medications -Typically full weight bearing with crutches or walker -Physio and ambulation - as per surgeon -Signs of infection -When and how to contact health care provider -Dressing care -Resources for patients
60
Post op care knee athroplasty
-Compression drsg to immobilize knee in extension x 24 hours -Zimmer splint to maintain extension x 24/52
61
Complications joint surgery
-Infection -Thromboembolism -Fat embolism

Health Challenges (13 decks)

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