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Chp. 63 Fractures

Adult Exam 2

Fracture? disruption or break in the structure of the bone
Edema and Swelling Manifestation in fractures? due to the bone penetrating soft tissues and can cause occluded circulation and damaged nerves.
Pain and Temperature Manifestation in fractures? due to increase pressure on nerves, immobilize wound to reduce movement
Muscle Spasms Manifestation in fractures? its a protective response that can cause a non-displaced wound to be displaces so immobilization is important
Deformity Manifestation in fractures? obvious sign of a fracture that can cause problems with union
Ecchymosis and Contusion Manifestation in fractures ? its a normal discoloration at the distal proportion of the bone.
Crepitation Manifestation in fractures? the bone is making audible grating/crunching sounds that can increase the chance of nonunion if bones are not immobilized
The 6 Healing Phases of the bone? 1. Hematoma. 2. Granulation. 3. Callus. 4.Ossification. 5. Consolidation. 6. Remodel
Hematoma Phase?(time) The blood forms a clot 72hours post injury
Granulation?(time) phagocytosis occurs 3-14 days post injury
Callus?(time) layer of woven bone covers the hematoma by the end of the 2nd week post injury
Ossification?(time) bone is starting to heal causing a clinical union and immobilizes it self so patient is allowed limited mobility, this phase takes up to 3weeks-6months
Consolidation?(time) bones are closing in forming a radiologic union that occurs 1 year post injury
Remodeling? union is complete and stress by exercising and weight bearing is introduced.
The three main factors that effect healing? age, blood supply and infection
What are the three goals for fracture Treatment? 1. reduction (realignment). 2. Immobilize 3. Restore to normal/near normal function
Traction? pulling force on fractured extremity to realign, reduce muscle spasm, immobilize, treat pathological joint condition and expand a joint before reconstruction and during procedures.
Skeletal Traction? long-term; used to pull and realign a bone by inserting a pin or wire into the bone. patient's diet include small frequent meals.
Skin Traction? short-term to prepare for skeletal traction or surgery, tape, boots or splints applied to skin to maintain alignment.
Countertraction? pull in opposite forces by body weight and traction weights supplied. The force can be adjusted by raising or lowering HOB
What is a imperative nursing role when dealing with traction? maintain traction constantly and do not interrupt weight applied to traction.
Types of immobilization?(3) Cast, External Fixation and Internal Fixation?
Cast types?(7) Sling, Body Jacket Brace, Hip Spica Cast, Sugar-Tong(swelling wrist), Posterior Splint(accommodates swelling), Short Arm Cast(wrist immobilization), Long Arm Cast(forearm or elbow immobilization).
Cast? temporary immobilization so patient can perform normal ADL. Restricts joint movement .
Assessments for Cast?(2) Assess pulses around fracture before casting, check pules or capillary refill after casting, allow no pressure or indention on case during drying time.
Sling? type of cast that immobilizes upper joints that should be padded on axillay area, no pressure should be on the neck and have patient move fingers
Body Jacket Brace? Assessments for?(5). Intervention?(1) immobilizes the spine. Assess for cast syndrome, respiratory status, bowel sounds, number of voids, inspect skin and bony prominence. Turn patient every 2hrs while cast drys.
Hip Spica Cast? Assessments for?(4). Consideration?(1) cast to immobilize femoral fractures. Assess the respiratory status, bowel, bladder, cast syndrome. patient may be in need of a bed pan for voiding.
External Fixation? metal pins inserted into bone and attached to external rods to apply traction and immobilize.
Nursing Considerations with External Fixation? Infection control is critical. examine for Exudation(fluid), Erythema(red, tender, soreness, swelling) while maintaining skin care.
Internal Fixation? pins are surgically inserted to realign and maintain bony fragments. alignment is checked by X-ray
How many meals per day should a patient with a Body Jacket and Hip Spica cast eat? 6 small meals per day
Assessment findings of the intergumentary with fractures?(4) laceration, ecchymosis, hematoma, edma
Assessment findings of the neurovascular with fractures?(1) sensation if any
Assessment findings of the cardiovascular with fractures?(3) pulses, skin temp, cap refil
Assessment findings of the musculosketel with fractures?(3) deformities, crepitation and functioning
What are some ongoing monitoring assessment with fractures?(5) vital signs, LOC, O2 sat, neurovascular status and pain
If a patient complains of new weakness what are your interventions before and after surgery? Before Surgery: assess pulses, use doppler if needed After Surgery: assess pulses because cast could be too tight.
What are the Overall goals for a fracture?(3) 1. Healing with no complications 2. Pain relief 3. Maximal rehabilitation potential
How to prevent external rotation of hip? place a pillow between legs to prevent hips from adducting
Important Cast care Do's?(4) Ice, dry cast, elevate for first 48hrs, move joints above and below cast regularly
Important Cast car Dont's?(2) dont bear weight for first 48hrs, no covering because it may cause yeast or sweating.
Types of Complications with fractures?(3) Indirect, Direct and Infections
Indirect Complications with fractures? Types?(3) blood vessels and nerve damage there are 3 types, Compartment Syndrome, Venous Thromboembolism, and Fat Embolism Syndrome
Direct Complications with fractures? Types? bone infection, bone union and necrosis.
Infection Complications treatment with fractures? TX: surgical debridement, wound would either be closed or drained
Compartment Syndrome(indirect complication)? Type of Indirect Complication; swelling and increased pressure within a limited space, compromises the function of blood vessels, nerves and tendons
What causes Compartment Syndrome? capillary perfusion reduce blood flow to an area
Types of Compartment Syndrome?(2) Decreased:caused by splints, cast, tractions Increased: caused by bleeding, inflammation, edema or IV filtration
What is the first sign of Compartment Syndrome? pain that is not resolved from opiods
The 6 Ps of Compartment Syndrome to assess? Pain(unsolved by opiods), Pressure, Paresthesia(numbness), Pallor(cool to the touch), Paralysis and Pulselessness
Treatment for Compartment Syndrome? Remove or loosen cast, reduce traction, decrease any external pressure, fasciotomy(in a bad case), amputation(worse case). DO NOT APPLY ICE OR ELEVATE EXTREMITY!
Types of Fractures?(4) Colles', Humerus, Pelvic and Hip
Colles' Fracture? distal radius injury, common in older adult and those who try to break a fall. it leads to vascular insufficiency secondary to edema
S/S of Colles' Fracture?(3) Pain, swelling, and deformities(dorsal displacement of distal fragments)
Care for Colles' Fracture?(3) prevent edema, frequent neurovascular assessments and active movements.
Humerus Fracture? common among young adults and middle aged adults. causes radial nerve injury and vascular injury to the brachial artery due to laceration transection or muscle spasm
S/S of Humerus Fracture?(3) shortened extremity, abnormal mobility and pain
Pelvic Fracture? severity range from innocent to life threatening. its the highest morality rate(due to sepsis, FES, and VTE). can cause paralytic ileus,hemorrhage and laceration of the urethra, bladder or colon
S/S of Pelvic Fracture?(5) swelling, tenderness, deformity, unusual pelvic movement and ecchymosis on the abdomen
Hip Fracture? common in older adults due to falls. more common in women due to osteoporosis.
S/S of Hip Fracture?(4) external rotation, muscle spasm, shortening of affected extremity and severe pain and tenderness
Care for Hip Fracture and Hip Replacement? Pre-op?(3) Post-op?(5) surgery is perferred Preop: muscle relaxants, comfortable positioning, traction. Postop:VS, I/O, TCDB, pain control, neurovascular assessment
Nursing Considerations for Hip Fracture and Hip Replacement? avoid flexion by placing pillow between legs, ambulation on first day, anticoagulant, HOB no higher than 45degrees
Discharge Instruction for Hip Fracture? avoid stairs, prolong sitting, bending. take antibiotics and resume ADL in 3mths.
Amputation? Removal of body extremity. performed due to peripheral vascular disease never because of pain.
What is the Nutritional Therapy for Fractures? Protein, Vitamins B, C, D, Calcium, Phosphorus and Magnesium. Adequate fluid intake of 2000-3000ml/day
Application of cast?(3 steps) 1.Fist cover with stockinette that is longer than cast. 2.Place padding, extra padding on prominence 3.Immerse in water and wrap around extremity 4.set for 15 minutes non weight bearable 5.may bear weight 24-72 hours after
Buck's Traction? type of skin traction used to immobilize a fracture
Assessments for Skin Traction? skin care and pressure points every 2-4 hours
What is a critical complication for External Fixation? Infection: exudate, erythema, tenderness and pain
Cast Syndrome? Body jacket brace is applied too tightly compressing the superior mesenteric artery against the duodenum
Assessments for Cast Syndrome?(3) Bowel and Bladder(expect decreased bowel sounds), monitor respiratory status, and areas of bony prominences
S/S of Cast Syndrome?(4) abdominal pain, abdominal pressure, nausea and vomiting
Treatment of Cast Syndrome? use gastric decompression with NG tube and suction
Pre-op(3)and Post-op(2) for Amputation? Pre-op:reinforce reasons for amputation, promote opposite extremities exercises, and supply ambulation expectations in case of a prosthesis Post-op:prevent flexion contractures and monitor vitals
Positioning for Amputation?(3) avoid sitting in a chair for more than an hour, lie on abdomen for 30mins 3-4 times a day and position the hip in extension while prone.
Compression Bandage for Amputation? reduce edema, hasten healing, minimize pain and promote residual lib shrinkage and maturation,
Phantom Limb Sensation? Treatment? still perceive pain in the missing portion of the limb. Tx: mirror therapy(neurological manipulation)
Assessments for Hip fracture and Hip replacement?(1) Neurovascular. color, temperature, capillary refill, distal pulses, edema, sensation,motor function and pain.
CPM and transfer for Hip fracture and Hip replacement? CPM: exercise unaffected leg and both arms. Transfer: out of bed and chair transfer
Pre-op(4) and Post-op(6) for Hip fracture and Hip replacement? Pre-op:analgesics or muscle relaxants, comfortable positioning and adjust traction Post-op:assess VS, I/O, Respiratory status, TCDB, pain meds, observe dressing and incision for bleeding and infection
Hip Arthroplasty? also known as Total Hip Replacement; relief of pain and improved function for patients with joint deterioration from OA, RA and other conditions.
Knee Arthroplasty? also known as Total Knee Replacement; either part of the knee or entire knee joint may be replaced with a metal and plastic prosthetic device
Positioning for Knee Arthroplasty? Knee should be in extension and immobilized by compression dressing
Post-op care for Knee Arthroplasty?(1) immediate Physical Therapy
CPM for Knee Arthroplasty? the CPM machine promotes joint mobility and full weight bearing is begun before discharge.
Discharge for Knee Arthroplasty? home exercise program involves progressive ROM with muscle strengthening and flexibility.
Post-op instructions for Spinal Surgery? Logroll patient when turning, pillows under thighs of each leg when supine and between legs when side-lying. frequently monitor peripheral neurologic signs and sensations
Complications for Hip fractures and Hip Replacement? Shock-Hemorrhage, immobility, delayed union or nonunion, aspetic necrosis, deformities
Created by: aneshia