fractures - 405

Question 1

3 phases of bone healing

Answer 1

1) inflammatory -> hematoma
2) reparative -> fibrous cartilage, callous, ossification
3) remodeling

Question 2

transverse fracture

Answer 2

straight line horizontally through the bone

Question 3

spiral fracture

Answer 3

bone is broken in a twisted motion

Question 4

greenstick fracture

Answer 4

spilter break, doesn’t go fully through the bone
most often in children

Question 5

comminuted fracture

Answer 5

bone shatters

Question 6

oblique facture

Answer 6

diagonal line through the bone

Question 7

pathologic fracture

Answer 7

a disease process precipitates the bone break like bone cancers or severe osteoporosis
fracture would not happen in a healthy individual

Question 8

stress fractures

Answer 8

due to overuse / repetitive stress on the joints

Question 9

fracture emergency care

Answer 9

1) assess airway, bleeding, head injury
2) splint fracture asap
-immobilization
-maintain body alignment
-elevate body part to promote venous return & dec swelling
-apply cold pack 1st 24hr for vasoconstriction

Question 10

3 goals for fracture treatment

Answer 10

1) reduce
2) immobilize
3) restore function

Question 11

fracture reduction

Answer 11

replacing bone fragments in the correct anatomic position
can be closed or open

Question 12

closed reduction

Answer 12

preferred
-non surgical manual realignment of bone fragments
-no incision in the skins
-uses local anesthesia

Question 13

open reduction

Answer 13

usually coupled w/ internal fixation
open the patient to reduce it and then add internal fixation devices in like nails or screws

Question 14

what is the next step in fracture care after fracture is reduced

Answer 14

immobilize the bone to hold broken bones together until healing takes place

Question 15

how is immobilization achieved

Answer 15

external: cast, splints, brace, traction, & external fixators

internal: metal plates, screws, nails, pins & possible bone graft

Question 16

cast care for a plaster of paris cast

Answer 16

-heat is felt
-handle w/ palms while wet
-petal edges to avoid casts from digging into skin

Question 17

cast care

Answer 17

-no covering to allow for ventilation
-reposition q1-2 hrs until set
-neurovascular distal to cast checks q1 for 24 hrs
- fit 1-2 fingers into the cast
-ice for the first 24-36 hrs

Question 18

what are the 5 Ps

Answer 18

pain*
pallor **
puleslessness **
paresthesia
paralysis **
* = first sign PVS problem
** = late sign PVS problem

Question 19

cast complications

Answer 19

-infection r/t pressure necrosis
-circulation impairment
-peripheral nerve damage
-comps of immobility

Question 20

how would we know if there is injury happening inside the cast

Answer 20

listening to subjective queues from the pt

Question 21

benefits of a splint

Answer 21

removable

Question 22

traction

Answer 22

-applies pulling force on fractured extremity
-2 types: skin & skeletal
-pulling force must be continuous
-running vs countertraction

Question 23

skin traction

Answer 23

-short term
-5 to 10 lbs
-bucks & russels

Question 24

skeletal traction

Answer 24

-longer term & tolerated better
-5 to 45 lbs
-pins used to immobilize part
-disadv: impaired skin integrity & risk for osteomyelitis

Question 25

running traction

Answer 25

-pulling is unidirectional -pt will slip in direction of traction

Question 26

counter traction

Answer 26

pulling force is going in both directions

Question 27

bucks traction

Answer 27

-simplest form -provides straight pull on affected extremity (running) -relieve muscle spasm or temporary immobilization before ORIF

Question 28

russels traction

Answer 28

-permits pt to move somewhat in bed d/t counter traction -permits flexion of knee joint -relieve muscle spasm/back pain

Question 29

balanced suspension traction benefits

Answer 29

**for skin or skeletal** -provides counter traction -prevents pt from sliding to end of bed -pulling force of traction is not altered when bed or patient moves -allows for increased pt movement & facilitates care **must maintain constant traction w/ no interruption in wts**

Question 30

line of pull

Answer 30

should never be interrupted

Question 31

external fixators

Answer 31

screws are placed into the bone above and below the fracture and a device is attached to the screws from outside the skin, where it may be adjusted to realign the bone

Question 32

external fixators (pins) related nursing care

Answer 32

-assess for pin loosening -assess for infection -meticulous pin care: 1/2 & 1/2 solution and cleaning the pins w/ a sterile qtip -do not put ointments around the pin -avoid touching the area

Question 33

internal immobilization devices

Answer 33

-pins -screws -plate

Question 34

nursing care for internal immobilization devices

Answer 34

-assess 5 Ps -elevate extremity above heart -apply ice compresses -notify HCP immediately if pain increases & it is unrelieved by meds -teach signs of neurovascular dysfunction

Question 35

pain control w/ internal immobilization devices

Answer 35

-ACT medications -use non drug measures to support **if pain is unrelieved, think compartment syndrome**

Question 36

compartment syndrome

Answer 36

swelling within a compartment that has no where to go d/t fascia not budging, can cause major issues within hours

Question 37

what to do if person develops compartment syndrome

Answer 37

emergency fasciotomy

Question 38

nursing mgt related to infection control

Answer 38

-assess pins -aseptic technique -culture site prn -administer abx -monitor temp -monitor WBC

Question 39

nursing mgt related to impaired skin integrity

Answer 39

-examine potential pressure areas q4 -petal cast edge if plaster of paris -do not insert items into cast to scratch -instruct pt to report warmth, inc pain and foul odor -moisture contributes to breakdown -turn if permissible (avoid friction/shearing)

Question 40

nursing mgt related to impaired physical mobility

Answer 40

-pain control before ROM -AROM/PROM/physical therapy -weight bearing or NWB -instruct use in assistive devices

Question 41

fractures put pts at risk for what

Answer 41

venous thromboembolism &/or fat embolisms **monitor for chest pain, tachypnae, cyanosis, apprehensin, tachycardia, petechial ras & hypoxemia**

Question 42

what reduces the likelihood of fat embolisms

Answer 42

promote surgical stabilization of fractures

Question 43

fat embolism s/s

Answer 43

neurological features occurs 6-12 hrs before pulmonary symptoms

Question 44

treatment for fat embolism

Answer 44

supportive care oxygen fluids