Fractures BABBBAY

Question 1

Risk Factors

Answer 1

• Riding in cars
• Falling
• Malnutrition
• Sports
• Osteoporosis

Question 2

Incidence

Answer 2

Adults: Ribs
Young/ middle age: Femoral
Oler: Femur

Question 3

Health Promotion

Answer 3

Seat belts, airbags, reducing driving while impaired, osteoporosis screening/ treatment, fall prevention

Question 4

Assessment

Answer 4

History- type of injury, alcohol and drug use, disease states
Physical assessment- ABC, PAIN, HTT, change in bone alignment, shortening, change in shape, bruising & swelling

Question 5

CMS

Answer 5

Circulation-
Color, pulse, cap refill, Temp (warm, cool)

Motion -
Movement

Sensation-
Tingling? Pain? Numbness?

Check extremity distal to injury compare it to other extremity

Question 6

Diagnostics

Answer 6

• H&H
• WBC
• ESR
• XR
• CT- scan (hip & spine)
• MRI

Question 7

Problems/ND

Answer 7

• Pain, potential for infection, potential for impaired circulation/ NV compromise , immobility

Question 8

Interventions

Answer 8

-Proritize based on clinical situation and presentation
-ABC
- Pain management
-Immobilize via splint
-Sterile guaze
- reduction
Elevation
ICe

Question 9

In a closed Reduction

Answer 9

Assist and support provider and patinet

- monitor patinet and admin meds

Question 10

Immobilizers

Answer 10

• Splints: Commerical immobilizer, preferred over cast if appropriate, more commonly used on body parts that do not bear weight
• Orthopedic shoes and boots: used to immbolize ankle and foot when bearing weight is allowed. Also preferred overcast if possible

Question 11

Casts Fiberglass

Answer 11

• Reserved for complex fractures and LE fractures
• Fiberglass is most commonly used
• dries and hardens quickly, reduce skin breakdown, can get wet (but padding underneath cannot)
• Also requires a stockinette and a padidng
• Cannot be fully immersed in water

Question 12

Plaster Casts

Answer 12

• Traditional material/ not used often
• requires a stockinette under plaster/ then padding/ then plaster
  takes 24 hours and feels warm when drying

Question 13

Cast interventions

Answer 13

• May have a window if skin is open
• May be too tight
• bivalve
• Elevation
• ICe
• Used in conjuction with sling or critches when appropriaet
  Assess For:
  increase pain, drainage, foul smell, CMS

Question 14

TRaction

Answer 14

• reduction in aligment in bone

- Used to reduce muscle spasms

Question 15

Running verus balance traction

Answer 15

Balanced: Fracture extremity is suspended with two opposing forces
Running: Force exerted in one plane only (fractured limps is opposing force)

Question 16

Skin versus Skeletal

Answer 16

Skin: Force is applied to the fractured limp with use of bandage or splint
skeletal: Force is applied to fractured limp with use of pins inserted into bone

Question 17

Tractions

Answer 17

do not let wieghts drop on floor

Question 18

Buck’s traction

Answer 18

• Running, skin traction

- used for pain reduction

Question 19

Cervical traction

Answer 19

• bolted in skull
• halo
• pain reduction

Question 20

Open reduction with internal fixation (ORIF)

Answer 20

• One of the most common ways to reduce and fix a fracture
• open surgery
• metal pins, rods, prostheses, or plates are used for fixation
• Affected area is kept immobile during healing process
• Allows for mobility

Question 21

Post operative care

Answer 21

Pain management, NV compromise, ambulation, prevent complications, PT

Question 22

External Fixation

Answer 22

Less blood loss

• Early ambulation
• promotes healing

Question 23

Complications ( fractures) - Acute compartment syndrome

Answer 23

• Assess for CMS
• Avoid tight dressing and casts
• 6 P’s
• Prevention of outward expansion

Question 24

Volkmans contracture

Answer 24

common in forearm from acute comaprment syndrome

Question 25

Fat embolism syndrome

Answer 25

Fat globules released with all long bone fractures - also hip and knee arthroplasty - small percentage of people will develop FES - 24-72 hours after trauma - Traid of sumptoms: - Lungs (low O2, dyspnea, tachypnea) - Brain (Confusion, headache, seizure, altered LOC) - Skin (petechia on neck, chest and arms)

Question 26

Prevention of FES

Answer 26

- early fixation | - surgical technique

Question 27

Supportive of FES

Answer 27

- oxygen, fluids, albumin

Question 28

infection

Answer 28

- increased risk of infection with open fractures - can lead to osteomyelitis - surgical site infection: if site becoes infected within 30 days of surgery) or if hardware becomes infected in the 1st year - Assess and educate

Question 29

Expcted outcomes

Answer 29

- pain is manged - free of infection - able to ambulate with or without assistive devices - No NV compromise

Question 30

Upper extremity fractures

Answer 30

- Remove jewely - perfrom NV assessment - immobilize - Elevate - Apply ice - mange pain

Question 31

Hip Fractures

Answer 31

Most common injury in Older adults - High moraltity rate - Osteoporosis is the biggest risk of factor - IV morphine/ PCA - Avoid demerol - Delirium - mobility

Question 32

Chest/ pelvis fractures

Answer 32

``` Potential for heart and lung damage - ABC - Internal organ damage - Lookfor blood in urine orstool Abdominal rigidity - Abd swelling - pelvis fractures can lead to death ```

Question 33

Spinal fractures

Answer 33

Associated with osteoporis, cancer, MM - cause pain, deformity and neuro compromise - non-surgica - surgical (kyphoplasty and vertebroplasty)