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H&C Ch 38
Fractures
| Question | Answer |
|---|---|
| What type of fracture is a clean puncture wound less than 2 cm long and minimal muscle injury | Type I p. 1011 |
| What type of fracture is a larger wound with moderate soft-tissue damage and no flaps or avulsions. | Type II p. 1011 |
| What type of fracture is Type III (A, B, and C subtypes) is considered the most severe, highly contaminated, and has extensive soft-tissue damage; it involves vascular injury or traumatic amputation. | Type III p. 1011 |
| ___________ fracture extends into the joint surface of a bone | intra-articular p. 1011 |
| ________fracture is non displaced, XR will not always reveal this type of fracture | intra-articular p. 1011 |
| A _______ (type of imaging) is needed to identify an intra-articular fracture | MRI p. 1011 |
| Intra-articular fractures often lead to early ___________ | osteoarthritis |
| Clinical signs and symptoms of a fracture may include: | acute pain, loss of function, deformity, shortening of the extremity, crepitus, localized edema and ecchymosis, muscle spasm, and tenderness p. 1011 |
| Immediately after injury and a fracture is suspected what is your first action ? | immobilize the body part |
| Joints located _______________ and _______________ to the fracture must also be immobilized | proximal and distal |
| Immobilization of long bones is done how ? | bandaging together (unaffected extremity is the splint for the affected one) |
| Where should you check neurovascular status of a fractured limb ? | distal to the injury |
| When an open fracture occurs the wound is covered with what ? | sterile dressing |
| True or False : When an open fracture occurs the fracture should be immedicately reduced it to improve circulation before arriving at the hospital | FALSE do not reduce an open fracture |
| How is closed reduction achieved ? | by bringing the bone fragments into anatomic alignment through manipulation and manual traction |
| What is percutaneous pinning ? | pins through the skin to maintain alighnment of the bone used in open or closed fracture management |
| Why are XR done after reduction of a fracture ? | to verify that the bone fragments are correctly aligned |
| What is an ORIF ? | open reduction internal fixation - surgical approach for severe fractures |
| what are isometric exercises used for in fracture management ? | to minimize atrophy and to promote circulation. |
| What is a closed fracture ? | fractured bones that may be nondisplaced or slightly displaced, but the skin is intact |
| A patient is being discharged after fracture repair, what instructions are provided ? | Patient education includes self-care, medication information, monitoring for potential complications, and the need for continuing health care supervision. p. 1014 |
| What specific risks do open fractures pose for patients ? | osteomyelitis, tetanus and gas gangrene p. 1014 |
| What surgical technique is used to remove debris from an open fracture | irrigation and debridement p. 1014 |
| which heals faster a midshaft femur fracture or a fracture at the acetabular head ? | Fractures at the ends of long bones, where the bone is more vascular and cancellous, heal more quickly |
| Long bones and pelvic fractures can cause what type of emboli ? | Fat |
| Where can fat emboli migrate ? | small vessels that supply the lungs, brain, kidneys and other organs p. 1015 |
| When is the onset of FES for long bone fracture ? | 24 to 72 hours p. 1015 |
| What is the triad of FES ? | hypoxemia, neurologic compromise, and a petechial rash |
| What are the typical first manifestations of FES ? | The typical first manifestations are pulmonary and include hypoxia, tachypnea, and dyspnea accompanied by tachycardia, substernal chest pain, low-grade fever, crackles, and additional manifestations of respiratory failure p. 1015 |
| How many anatomic compartments does the human body have ? | 46 |
| True or False: compartment syndrome is a medical emergency ? | true |
| What are the characteristics of compartment syndrome ? | characterized by the elevation of pressure within an anatomic compartment that is above normal perfusion pressure |
| What happens to the extremity with compartment syndrome ? | perfusion to the tissues is impaired, causing cell death, which may lead to tissue necrosis and permanent dysfunction |
| What are the 5 Ps of compartment syndrome ? | pain, pallor, pulselessness, paresthesia, and paralysis |
| What are the early signs of compartment syndrome ? | cardinal symptom of severe pain that is “out of proportion” to the injury & Exacerbation of pain on passive stretching of the involved muscles p. 1017 |
| palpation of the muscle with compartment syndrome reveals what? | reveals it to be swollen and woodlike, with the skin taut and shiny p. 1017 |
| What surgical procedure is used to relieve compartment syndrome? | fasciotomy |
| True or False : after a fasciotomy the wound is closed and closely monitored for infection | FALSE the wound is left open to allow muscle and tissues to expand p. 1017 |
| reduced skeletal muscle contractiosn and bed rest can create an early complication known as ____ | VTE, including DVT and PE p. 1018 |
| When does delayed union of a fracture occur ? | when healing does not occur within the expected timeframe for the location and type of fracture p. 1018 |
| What is a malunion of a fracture ? | healing of a fractured bone in a malaligned (deformed) position. p. 1018 |
| What non surgical methods are for treatment of impaired bone healing | ultrasound, electrical stimulation p. 1018 |
| What is an allograft | tissue harvested from a donor |
| What is an autograft | tissue harvested from the patient |
| When does AVN occur ? | when the bone loses its blood supply and dies p. 1019 |
| What is the most common site of AVN ? | the hip |
| This cast Encloses the trunk and a lower extremity. A double hip spica cast includes both legs | the hip spica |
| this device protects and supports the foot, ankle, or lower leg by controlling alignment and reducing movement; also supports the user’s weight while walking | walking boot |
| Pressure areas in arm casts are : | radial styloid, ulna styloid and lateral epicondyle |
| Pressure areas in leg casts are: | lateral mallelous, peroneal nerve, tibial tuberosity |
| True or False: a plaster cast while drying should be covered | FALSE the cast should not be covered while it is drying because the heat generated by the chemical reaction cannot escape |
| A cast has rough edges what can be done for this ? | Petaling, or smoothing the rough edges of the cast, resolves this problem if the underlying stockinette does not cover the edges of the cast. |
| How is the wet cast handled by the nurse when positioning the patient ? | with the palms of the hands p. 1021 |
| What should the nurse assess on the patient with a brace ? | assessment of the skin and neurovascular status, including the degree and location of swelling, bruising, and skin abrasions p. 1021 |
| What is the main concern follwoing application of an immobilization device ? | assessment and prevention of neurovascular dysfunction or compromise of the affected extremity p, 1022 |
| A casted arm has been identified as having compartment syndrome what is typically done to the cast without removing it ? | bivalving |
| how is swelling controlled in an arm that has a fracture ? | elevated above heart level with a pillow. |
| What nursing interventions may be used for a patient with an immobilized lower extremity for discomfort ? | leg is supported on pillows to the level of the heart to control swelling. Cold therapy or ice packs are applied as prescribed over the fracture site for 1 to 2 days p, 1024 |
| Body spica casts are typicall in place for how many weeks ? | 3 to 6 weeks |
| What is mesenteric syndrome ? | caused by body casts ; a rare condition characterized by compression of the third portion of the duodenum between the aorta and superior mesenteric artery |
| With body casts what physiologic manifestations occur ? | abdominal distention and discomfort, nausea, and bilious vomiting, which can lead to food aversion, poor intake, malnourishment, and weight loss p. 1025 |
| What discharge instructions does a nurse need to provide caregivers for care of a loved on with a body cast? | hygienic, cast, and skin care; proper positioning; preventing complications; and recognizing symptoms that should be reported to the provider. p. 1025 |
| External fixators put a patient at risk for : | increased risk for pin site loosening and infection, which can lead to osteomyelitis, septic arthritis, and progressive pain p. 1025 |
| True or False: It is important to clean of crusting around pin sites | pin site crust acts as a natural barrier from the external environment, which can reduce the likelihood of infection, removal may not be necessary p. 1026 |
| What technique is used for pin site care ? | aseptic p. 1026 |
| How often should pin sites be checked ? | every 12 hours |
| True or False : pin sites should only be cleansed at the ordered times, even if exudate or the dressing is wet | FALSE p. 1026 |
| What should be included for pin site care ? | pin site care procedure, including the condition of the pin sites, any signs of infection, the type of cleaning solution used, and the patient’s response to the care. |
| What is the purpose of traction ? | pulling force to promote and maintain alignment to an injured part of the body p. 1026 |
| What are signs/symptoms of pin site infection ? | redness, tenderness, increased or purulent pin site drainage p. 1027 |
| When a patient is in bed and needs to use the bedpan - because it is for a short period of time can the traction be interrupted ? | NO p. 1028 |
| The nurse should check all ropes for : | The ropes are in the wheel grooves of the pulleys, aligned and unobstructed and run smoothly through the pulleys and be without knots . p. 1028 |
| The weights in traction must _________________. | hang freely and not rest on the bed or floor. |
| What is Buck's traction ? | traction to the lower leg p. 1028 |
| What is Buck's traction used for ? | It is used as a temporary measure to overcome muscle spasms and promote immobilization of hip fractures in adult patients waiting for more definitive treatment such as surgery. p. 1028 |
| How is Buck's traction applied ? | directly to the skin through the use of a foam boot, Velcro straps, and traction tape. Weights and pulleys are then attached and pressure is applied. |
| After skin traction is applied how often should the nurse assess circulation ? | within 15 to 30 minutes after application and then every 1 to 2 hours p. 1029 |
| The nurse should assess a patient in traction for the following : | atelectasis - pneumonia constipation - anorexia urinary stasis - urinary infection VTE p. 1031 |
Created by:
Kelly Quijano