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OA Fractures Flashcards

1
Q

Fracture Risk Factors

A

Primary: age, bone disease, poor nutrition

Secondary: lifestyle habits

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2
Q

Types of Fractures

A
  • transverse
  • linear
  • oblique, nondisplaced
  • oblique, displaced
  • spiral
  • greenstick
  • comminuted
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3
Q

clinical manifestations of fractures

A
  • pain
  • deformity or misalignment
  • swelling
  • hypovolemia/shock or ecchymosis
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4
Q

Complications of fractures

A
  • compartment syndrome
  • DVT
  • Fat embolism syndrome
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5
Q

compartment syndrome

A

fascia surrounding muscles do not expand. When swelling occurs, muscle dies

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6
Q

S/S of compartment syndrome

A
  • severe pain
  • swelling
  • pallor
  • numbness
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7
Q

DVT

A

Deep Vein Thrombosis

-clot forms in one of the deep veins

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8
Q

S/S of DVT

A
  • redness
  • warmth of skin
  • leg pain cramping
  • swelling
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9
Q

Prevention of DVT

A
  • early surgery
  • anticoagulation
  • compression strategies
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10
Q

Treatment for DVT

A
  • bedrest
  • anticoagulants
  • vena caval filter
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11
Q

Complications of DVT

A
  • CVA

- Pulmonary embolism

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12
Q

Fat Embolism Syndrome

A

Fat emboli are released from closed long bone or pelvic fractures.

-These emboli enter the blood stream

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13
Q

The fat emboli entering the blood stream causes…

A
  • dyspnea that may progress to respiratory failure
  • petechial rash
  • neurological symptoms such as confusion, restlessness, seizures or come
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14
Q

There is an increased risk of infection with…

A
  • open fractures
  • external fixation devices
  • immunocompromised patients
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15
Q

Collaborative Treatment Strategies

A
  • Diagnostic Xrays
  • Surgery
  • Casting
  • Traction to align bones to heal
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16
Q

3 phases of fracture healing

A

Inflammatory

Reparative

Remodeling

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17
Q

Inflammatory phase

A

damage to bone, vessels, and tissue —–> hematoma —–>macrophages/neutrophils enter wound to degrade —–> lasts until osteoblasts and endothelial cells begin to proliferate at fracture site

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18
Q

Reparative phase

A

fibroblasts, osteoblasts, and chrondoblasts begin to secrete collagen to form fibrocartilage —-> soft callus joins fractured bone —->Endothelial cells begin to form vessels in damaged area —-> woven bone replaces soft callus (endochondral ossification) —–> hard callus —->lasts 6-8 wks for relatively simple fractures

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19
Q

Remodeling phase

A

woven bone is replaced by highly organized lamellar bone

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20
Q

lamellar bone

A

stronger and more compact with better blood circulation compared to woven bone.

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21
Q

Nonunion

A

fracture that shows no clinically significant progress toward complete healing for at least 3 months based on x-rays

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22
Q

Delayed union

A

occurs when healing process takes significantly longer than expected, usually more than 3-6 months

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23
Q

Malunion

A

occurs when the bone fragments join in a position that is not anatomically correct

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24
Q

Which unions may require surgical correction?

A

nonunions and malunions

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25
Nursing Implementation
- provide effective pain management - provide proper alignment - promote mobility - monitor neurovascular status - prevent infection - provide discharge instructions
26
Providing effective pain management
- pain meds prn - elevation - ice - relaxation techniques - support above and below extremity
27
Providing proper alignment
- teach cast and splint care | - if in traction, keep aligned in bed and ensure that weights are free hanging
28
Promoting mobility
- reposition q 1-2 hours if not OOB yet - ambulate - teach to use crutches and walker
29
Monitoring neurovascular status
5Ps - Pain - Pulses - Pallor - Parasthesia - Paralysis/Paresis
30
For Paresthesia assessment....
ask client about changes in sensation such as burning, tingling, or numbness -presence of paresthesia indicates neural damage or involvement
31
For Paralysis/Paresis assessment...
Assess the client's ability to move body parts distal to the fracture such as fingers, and toes. -inability to move indicates paralysis where as muscle weakness indicates paresis.
32
Paralysis or paresis may indicate...
nerve or tendon damage
33
Preventing infection
- change dressings - provide pin care - monitor both sites for S/S of infection
34
Proving discharge instructions
- monitoring for complications - how to take meds - injury prevention - assess knowledge of use of cane/crutches/walker - assess for home care needs
35
At 50 years of age, _________ women will experience a fracture of the vertebrae, forearm, or hip in their remaining years.
4 in 10
36
Types of Hip Fractures
- Intracapsular | - Extracapsular
37
Intracapsular
within the joint capsule
38
Extracapsular
below the capsule
39
What gender are hip fractures more common?
women > 65 yo, secondary to osteoporosis
40
Most common reason for hip fractures in woman?
falls
41
Prevention Methods for Hip Fractures
- weight bearing exercises - home safety inspection - collaboration with physician/pharmacist to assist how meds affect balance and bone density - avoidance of alcohol - attention to bone health - mobility assessment
42
Clinical manifestations
- external rotation - shortening of affected leg - muscle spasm - severe pain/tenderness
43
Complications of Hip Fractures
- DVT/PE - Dislocation - UTI/pneumonia - muscle atrophy
44
Postoperative Complimentary Complications
- infection - mental status change - avascular necrosis - nonunion or malunion of bone
45
Collaborative interventions
- diagnostic studies - bucks traction (until surgery) - surgical options - pain management - physical therapy after surgery - social services arranges rehab or alternative form of care after discharge
46
Two main types of surgical repair
1. external fixation | 2. open reduction internal fixation
47
external fixation
metal pins and screws are placed into the bone above and below the fracture. - pins and screws are then attached to a metal bar outside the skin - often performed if damage to soft tissues prevents internal fixation
48
What is the nurse responsible for with external fixation?
monitoring the client for infection and neurovascular function
49
Open reduction internal fixation
surgical procedure used to internally repair a bone fracture
50
During reduction...
- the bone is placed in correct alignment | - nails, screws, pins, wires, plates, or rods are then inserted into the bone to hold the bone in place
51
What bones are typically repaired by ORIF
long bones
52
Internal fixation allows...
shorter hospital stays, earlier return to full function, and fewer instances of nonunion and malunion
53
Complications of fracture reduction
infection, neurovascular or vascular injury, and leg length discrepancy
54
Nursing interventions for internal fixation
- assess for drainage, infection, fluid, bowel sounds, lung sounds, pain, neuromuscular function - admin meds - encourage early ambulation - refer and arrange PT/OT
55
Extracapsular fracture
- variety of devices (screws, pins, nails) | - dislocation not an issue
56
Intracapsular fracture
- endoprosthesis replaces femoral head - slow to heal - dislocates easily
57
Cast
- post reduction - neurovascular checks - "hot spots"
58
hot spots
indicate infection
59
Splint
provides less support than a cast, but it can be easily adjusted to accommodate swelling and prevent compartment syndrome
60
Medications
- pain - antibiotics - anticoagulants
61
Primary purpose of bucks traction
reduce muscle spasms and also aligns bone segments
62
Pre & Post op assessment
- neurovascular status - assess alignment - cognition - pain - vital signs - monitor incision site for evidence of infection/swelling
63
Pre-op nursing interventions
- address chronic health issues - manage muscle spasm and pain - analgesics/muscle relaxants - RICE - xray, MRI, CT - CBC, PT/INR
64
RICE
- rest - ice - compression - elevation
65
Nursing implementation: Post-op
- teach and assist with correct positioning of the hip - monitor for DVT - administer anticoagulants - assist with breathing exercises - monitor for penumonia - if limited mobility, turn q2 and monitor skin - good hygiene/sterile dressing changes
66
Correct positioning of the hip
position using abduction pillow
67
Hip Prosthesis Patient Education - Do nots!
- No adduction - No sitting on chairs without arm rests - No low chairs - No internal rotation - No flexing hip more than 90 degrees - No putting on shoes and socks for 8 wks without device - No crossing legs or feet
68
Hip Prosthesis Patient Education - Dos!
- Use high-backed chair with arm rests - Use elevated toilet seats - Use chair in tub or shower - Use pillow or abductor brace between legs when lying or turning - Maintain hip in neutral position - Notify dentist before dental work - Notify MD if severe pain or loss of function
69
Providing psychosocial support
- OA may be very distressed by event - Create environment of trust which promotes patient and family discussion of feelings - Refer to homecare or rehab as needed
70
Discharge planning essentials
- be sure patient understands hip precautions - assess knowledge of ability to correctly use abduction pillow and walker/cane - review weight bearing restrictions - review meds
71
Referral
- Average hospital stay is 4 days - May need skilled nursing facility or rehab before going home - May need home health nursing - Recovery can take up to 1 year

OA Exam 2 (6 decks)

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