TEST 1: FRACTURES Flashcards

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created 9 days ago by tamerjones
updated 7 days ago by tamerjones
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1

FRACTURE THAT DOESN'T BREAK SKIN

CLOSED FRACTURE

2

FRACTURE WHERE SKIN SURFACE IS BROKEN

OPEN FRACTURE/COMPOUND FRACTURE

3

THIS TYPE OF FRACTURE IS SEEN THE MOST IN CHILD ABUSE

SPIRAL FRACTURE

4

THIS FRACTURE HAPPENS WHEN A MASSIVE OBJECTIVE CRUSH BONE

  • FAT EMBOLISM IS MOST SEEN WITH THIS TYPE OF FRACTURE

CRUSH/COMPRESSION FRACTURE

5

WHAT ARE SOME COMMON CAUSES OF FRACTURES

  • OSTEOPOROSIS
  • BED REST
  • STEROIDS - EX. PREDNISONE
  • TRAUMA

6

SOME SIGNS AND SYMPTOMS FOR A FRACTURE

PRIORITY: INTERNAL BLEEDING

  • HYPOTENSION
  • TACHYCARDIA
  • HEMATURIA
  • PAIN SWELLING
  • CREPITUS
  • MUSCLE SPASMS

7

IN THIS TYPE OF FRACTURE, CEREBRAL SPINAL FLUID IS SEEN DRAINAGE FROM NOSE CAUSING RHINORRHEA

BASILAR SKULL FRACTURE

8

THIS FRACTURE HAPPENS WHEN IT IS LOCATED T-6 OR HIGHER CAUSING THIS TYPE SHOCK (TWO ANSWERS)

  1. SPINE FRACTURE
  2. NEUROGENIC SHOCK

9

IN THIS FRACTURE, PATIENT IS BLEEDING/DROOLING FROM THE MOUTH. WHAT IS THE PRIORITY NURSING ACTION?

  • MANDIBULAR FRACTURE
  • SUCTION OF THE MOUTH

10

WHAT ARE SOME SIGNS AND SYMPTOMS OF A HIP FRACTURE?

  • SHORTENING OF THE LEG ON THE AFFECTED SIDE
  • MUSCLE SPASM AROUND THE AFFECTED AREA
  • ECCHYMOSIS OF THIGH AND HIP
  • GROIN AND HIP PAIN WHEN BEARING WEIGHT

11

THE NURSE IS ASSESSING A CLIENT WITH AN OPEN LEG FRACTURE. THE NURSE SHOULD INQUIRE ABOUT THE LAST TIME THE CLIENT HAD WHICH DONE?

TETANUS BOOSTER

12

USED SHORT TERM BEFORE SURGERY (PRE-OP) TO REALIGN BONES IN THE HIP AND FEMUR FRACTURES (PULLS BACK INTO PLACE THE BONE THAT WAS DISPLACED.

BUCK'S TRACTION

13

SOME KEY POINTS TO REMEMBER FOR BUCKS TRACTION

  • WEIGHTS = FREE HANGING; NEVER REMOVED UNLESS ORDERED BY PCP
  • TRACTION ROPES ARE TIGHT (NOT LOOSE OR RESTING ON FLOOR/BED)
  • TO REPOSITION PATIENT - HOLD WEIGHTS
  • KEEP LIMB IN NEUTRAL POSITION
  • ASSESS FOR SKIN BREAKDOWN
  • NEURO CHECKS: PULSES, MOTOR, SENSATION AND CAP REFILL
  • SUPINE POSITION (NO FOWLERS!)
  • INFECTION: ELEVATED WBC; ASSESS SITE FOR DRAINAGE - "COCA); PERFORM PIN CARE FOR TRACTION WITH STERILE TECHNIQUE (PRE-OP: BUCK'S TRACTION)
  • ABDUCTION IS NOT REQUIRED

14

PRIORITY AFTER HIP/FEMUR SURGERY

  1. BLEEDING (PRIORITY): HGB: <7 - REPORT TO HCP! , MONITOR PULSES DISTAL TO INJURY; OBSERVE TO HYPOTENSION AND TACHYCARDIA
  2. POSITIONING CARE: ABDUCT LEGS; NO CROSSING LEGS; NO LEANING FORWARD; NO SITTING AT 90 DEGREE ANGLE

15

MAJOR COMPLICATION W/ LONG BONE INJURIES (FEMUR), FEMUR, AND PELVIS FRACTURES, COMPRESSION FRACTURES

FAT GLOBULES ARE RELEASED INTO THE BLOODSTREAM THAT CAN LEAD TO BLOCKAGE

FAT EMBOLISMS

16

KEY SIGNS W/ FAT EMBOLISM SYNDROME

  1. MENTAL STATUS CHANGES - CONFUSION, RESTLESSNESS, AND ALTERED MENTAL STATUS
  2. DYSPNEA
  3. CHEST PAIN
  4. LOW PULSE OX
  5. PETECHIAE OVER NECK AND CHEST

17

THE MOST FAVORABLE INDICATION OF RESOLUTION OF FAT EMBOLISMS

CLEAR MENTATION

18

MOST IMPORTANT INTERVENTION FOR FAT EMBOLISM

MINIMIZE MOVEMENT OF FRACTURE

NO PROPHYLATIC MEDS/BONE THINNERS OR COMPRESSION DEVICES

19

SIGNS AND SYMPTOMS OF OSTEOMYELITIS

TEMP

YELLOW DRAINING FROM SITE

20

TREATMENT FOR OSTEOMYELITIS

LONG TERM USE OF ANTIBIOTICS FOR WEEKS TO MONTHS

WOUND DEBRIDEMENT

AMPUTATION

21

POSSIBLE COMPLICATIONS OF CASTS

HOT SPOTS - INFECTION

COMPARTMENT SYNDROME - DECREASED PERFUSION

  • COMES FIRST IN PRIORITIZATION BETWEEN THE 2

22

SIGNS OF COMPARTMENT SYNDROME

  • SEVERE PAIN (EARLIEST SIGN OF SUDDEN COMPARTMENT SYNDROME) - UNRELIEVE W/ MORPHINE ; NOT RESOLVING W/ MEDS ; EXTREME PAIN W/ PASSIVE MOVEMENT
  • PARESTHESIA - TINGLING/BURNING/ NUMBNESS ; PROBLEMS MOVING FINGER/TOES
  • DISCOLORATION
  • LATE SIGN: LACK OF PULSE - MEDICAL EMERGENCY

23

INTERVENTIONS FOR COMPARTMENT SYNDROME

  • NOTIFY PCP
  • ASSESS FINGER/TOES W/ NEURO CHECKS : 'PMSC'
  • ELEVATE LIMB TO THE LEVEL OF THE HEART
  • FASCIOTOMY

24

THINGS TO REMEMBER FOR CAST CARE

  • C - CLEAN AND DRY : COVER CAST W/ A PLASTIC BAG FOR BATHING AND ALLOW CAST TO DRY FOR 24-48 HOURS
  • A - ABOVE (ELEVATE) THE HEART FOR 1ST 48 HOURS ON A PILLOW
  • S - SCRATCH AN ITCH : USE HAIR DRYER ON LOW/COOL SETTING
  • T - TAKE IT EASY : NO BEARING WEIGHT AND NO FINGER INDENTATIONS (USE PALM OF HANDS) OR PRESSURE AND NO HARD SURFACES; NEVER CUT IT OFF UNLESS ORDERED TO DO SO

25

REVIEW CANE AND CRUTCHES SECTION OF FRACTURES VIDEO STARTING AT 27:30

REVIEW

26

PRESSURE ON AN ANATOMIC COMPARTMENT IS INCREASED BEYOND NORMAL

COMPARTMENT SYNDROME

27

WHAT TYPE OF ASSESSMENT CAN REVEAL SYMPTOMS OF COMPARTMENT SYNDROME OR FRACTURES IN GENERAL?

NEUROVASCULAR ASSESSMENT

28

WHAT DOES A NEUROVASCULAR ASSESSMENT CONSIST OF?

  • COLOR OF EXTREMITY: PALLAR CAN INDICATE VASCULAR INSUFFICIENCY
  • TEMP
  • CAP REFILL
  • PERIPHERAL PULSES
  • EDEMA
  • SENSATION
  • PAIN
  • 5 P'S - PAIN, PARALYSIS, PARENTHESIAS, PALLOR, AND PULSELESSNESS

29

WHAT CAN DEVELOP 24-48 HOURS POST SURGERY FOR A HIP FRACTURE

ATELECTASIS OR PNEUMONIA

OLDER PATIENTS ARE ALSO AT RISK FOR DELIRIUM AND PULMONARY EMBOLISM, ESPECIALLY IN OLDER ADULT PATIENTS WHO HAVE PREEXISTING RESPIRATORY CONDITIONS

30

MEDICAL MANAGEMENT OF FRACTURES THAT PROMOTE BONE AND SOFT TISSUE HEALING

REDUCTION

IMMOBILIZATION

31

THE RESTORATION OF BONE FRAGMENTS TO ANATOMICAL ALIGNMENT AND ROTATION (FOR INJURIES THAT ARE NOT AS SEVERE)

  • CLOSED OR OPEN MAY BE USED

REDUCTION

32

AFTER A FRACTURE HAS BEEN REDUCED, IT IS NECESSARY TO DO THIS TO THE BONE FRAGMENTS

  • EX. BANDAGES, CASTS, SPLINTS, CONTINUOUS TRACTION, AND EXTERNAL FIXATORS, METAL IMPLANTS

IMMOBILIZATION

33

WHAT SHOULD PATIENT W/ EDEMA DO TO THEIR INJURED AREA?

ELEVATE EXTREMITY AND APPLY ICE TO THE INJURED AREA

34

CONTROLS MUSCLE SPASMS AND IMMOBILIZES AN EXTREMITY BEFORE SURGERY

SKIN TRACTION

35

USED TO TREAT FRACTURES OF THE FEMUR, TIBIA, AND CERVICAL SPINE

SKELETAL TRACTION

36

MEDICAL MANAGEMENT OF COMPARTMENT SYNDROME

  • CONSERVATIVE MEASURES FIRST! ELEVATION OF LIMB AT HEART LEVEL AND REMOVAL OF ANY CONSTRICTIVE DRESSINGS *CASTS
  • IF S/S AREN'T RELIEVED IN 1 HOUR, FASCIOTOMY IS PERFORMED TO RELIEVE PRESSURE IN THE COMPARTMENT THROUGH EXCISION OF THE FASCIA

37

NURSING MANAGEMENT FOR ACUTE FRACTURES

  • MONITORING FOR S/S OF INFECTION
  • USING STERILE TECHNIQUE FOR DRESSING CHANGE
  • ADMINISTERING ANTIBIOTICS ON TIME TO MAINTAIN SERUM LEVELS, AND MONITORING FOR SIDE EFFECTS
  • MAIN SKIN INTEGRITY AND PROPER BODY ALIGNMENT
  • MONITOR FOR PAIN/DISCOMFORT
  • ADMINISTER PAIN MEDS AS PRESCRIBED

38

NURSING MANAGMENT FOR CASTS:

  • DURING DRYING TIME, PICK UP CAST W/ PALMS OF HAND TO PREVENT DENTING THE CAST. AS DENTS CAN CAUSE PRESSURE ON UNDERLYING TISSUES AND CAUSE SKIN BREAKDOWN
  • NEUROVASCULAR CHECKS

39

TYPICAL PRESENTATION OF A HIP FRACTURE

SHORTENED LIMB AND EXTERNALLY ROTATED

40

SOFT TISSUE INJURY

CONTUSION

41

SPRAIN

INJURY TO LIGAMENTS AND TENDONS AROUND A BONE

42

CHILDREN (NOTES)

NOT COMMON FOR CHILDREN <2 YEARS OLD

  • USUALLY CAUSED BY SOMEONE ELSE OR ACCIDENTAL TRAUMA

43
  1. SEVERE CLOSED DISPLACED FRACTURE
  2. SEVERE OPEN DISPLACED FRACTURE

REQUIRES OPEN REDUCTION INTERNAL FIXATION

REQUIRES OPEN REDUCTION EXTERNAL FIXATOR

44

NOTES

IF A PATIENT HAS SEVERE SWELLING A SPLINT MAY BE USED BEFORE A CAST TO PREVENT COMPARTMENT SYNDROME

CLOSED REDUCTION - MAY BE CAST, SPLINT OR OTHER DEVICE - CAN BE DONE IN SURGERY

ORIF - REQUIRES SURGERY - SEVERE FRACTURES

45

INTERVENTIONS FOR PRESSURE INJURIES IN SPLINTS/CASTS

WINDOW OR BIVALVE CAST

46

INTERVENTIONS FOR DISUSE SYNDROME (NOT USING MUSCLES)

ISOMETRIC EXERCISES

47

WHAT DOES OCCUPATIONAL THERAPY DO?

ADL'S INCLUDING EATING

48

WHAT DOES PHYSICAL THERAPY DO?

EVERYTHING OT DOESN'T DO

49

MOST COMMON CONCERNS FOR PELVIS FRACTURES

SHOCK AND HEMORRHAGE BECAUSE IT'S EXTREMELY VASCULAR