Chapter 47 Care of Patients with Musculoskeletal Trauma

A. Morphine 1 to 2 mg IV Meperidine should not be used with older adults & many hospitals no longer use this drug for patients of any age. Acetaminophen will most likely not relieve pain that is rated at 8 on a scale of 0-10. Ice may help with the swelling & pain, but will likely not relieve the patient's pain.

A 54-year-old man presents to the ED with a deformed right ankle. He states that he was jogging close to the edge of a hillside, and that he tripped and fell down the hill. There are no openings in the skin. A pulse cannot be obtained by touch to the right foot, which is pale and cool to palpation. The patient rates his pain as an "8" on a 0-to-10 scale. To control the patient's pain, which order would you expect from the provider? A. Morphine 1 to 2 mg IV B. Meperidine 50 mg IM C. Acetaminophen 650 mg by mouth D. Apply ice packs to the right ankle

C. Obtain a Doppler of the right foot pulse.

A 54-year-old man presents to the ED with a deformed right ankle. He states that he was jogging close to the edge of a hillside, and that he tripped and fell down the hill. There are no openings in the skin. A pulse cannot be obtained by touch to the right foot, which is pale and cool to palpation. The patient rates his pain as an "8" on a 0-to-10 scale. Which is the priority nursing action at this time? A. Administer pain medication. B. Prepare for reduction. C. Obtain a Doppler of the right foot pulse. D. Notify the physician of the lack of a pulse in the right foot.

A. Monitor for signs of infection. B. Assess peripheral capillary refill. D. Ask the patient about frequency of bowel movements. E. Insert a finger between the skin and the cast to be sure the cast is not too tight.

A 54-year-old man presents to the ED with a deformed right ankle. He states that he was jogging close to the edge of a hillside, and that he tripped and fell down the hill. There are no openings in the skin. A pulse cannot be obtained by touch to the right foot, which is pale and cool to palpation. The patient rates his pain as an "8" on a 0-to-10 scale. An ankle x-ray confirms the pt. has an ankle fracture. A fiberglass cast is applied to immobilize the ankle and allow for healing. Which are priority interventions after the cast is applied? (Select all that apply.) A. Monitor for signs of infection. B. Assess peripheral capillary refill. C. Keep the cast uncovered for air-drying over several hours. D. Ask the patient about frequency of bowel movements. E. Insert a finger between the skin and the cast to be sure the cast is not too tight.

C. Wear a support stocking to prevent lower extremity swelling. The ankle should be supported on pillows. Dead scaly skin should be removed by soaking, not scrubbing. Exercise should be done slowly.

A 54-year-old man presents to the ED with a deformed right ankle. He states that he was jogging close to the edge of a hillside, and that he tripped and fell down the hill. There are no openings in the skin. A pulse cannot be obtained by touch to the right foot, which is pale and cool to palpation. The patient rates his pain as an "8" on a 0-to-10 scale. The patient's ankle heals and his cast is removed. Which teaching point would you include for care of his ankle after the cast is removed? A. Keep your ankle in a low position to facilitate perfusion to the healed bone. B. Exercise vigorously at least 3 times a day as directed by the physical therapist. C. Wear a support stocking to prevent lower extremity swelling. D. Scrub your lower leg and ankle to remove dead, scaly skin.

b. Complex regional pain syndrome When pain is not managed appropriately or interventions are not implemented to prevent complex regional pain syndrome (CRPS), the client is at risk for developing CRPS, a chronic debilitating complication of traumatic injury.

A client had a fractured tibia repair several weeks ago and tells the nurse that she has persistent burning pain, ongoing edema, and muscle spasms in her affected leg. For which chronic complication is the client at risk? a. Chronic osteomyelitis b. Complex regional pain syndrome c. Severe osteoporosis d. Compartment syndrome

c. Large amount of serosanguineous or bloody drainage A large amount of serosanguineous or bloody drainage may indicate hemorrhage or, if an incision is present, that the incision has opened. This requires immediate attention. Mild to moderate pain controlled with prescribed analgesics would be a normal finding for this client. Absence of erythema and tenderness of the surgical site would also be normal findings for this client. The client would be able to flex and extend the right knee (limb) after surgery.

A client has undergone an elective below-the-knee amputation of the right leg as a result of severe peripheral vascular disease. In postoperative care teaching, the nurse would instruct the client to notify the primary health care provider immediately if which change occurs? a. Absence of erythema and tenderness at the surgical site b. Ability to flex and extend the right knee c. Large amount of serosanguineous or bloody drainage d. Mild to moderate pain controlled with prescribed analgesics

d. Inspect the skin at least every 8 hours. The client's skin should be inspected at least every 8 hours for signs of irritation, inflammation, or actual skin breakdown. Weights must never rest on the floor because they will not be effective. They must hang freely at all times. Pin sites would be checked for signs and symptoms of infection and for security in their position to the fixation and the client's extremity. However, the nurse does not adjust the pins. Any loose pin site or alteration must be reported to the health care provider. Traction weights are not removed for bathing.

A client is in skeletal traction for a complex femoral fracture. Which nursing intervention ensures proper care of this client? a. Ensure that weights are placed on the floor. b. Remove the traction weights only for bathing. c. Ensure that pins are not loose and tighten as needed. d. Inspect the skin at least every 8 hours.

a. Monitor neuromuscular status for decreased circulation and sensation in the extremity. The most important intervention the nurse teaches the client is to monitor the neurovascular status during the first 24 hours after ED discharge. The client should apply ice for discomfort, not heat. The client should not place anything between the cast and the skin. In assessing fit, one finger should easily fit between the cast and the skin. The cast dries quickly because it is made of synthetic materials.

A client sustains a fracture of one arm and the primary health care provider applies a synthetic cast to the extremity. What will the nurse teach the client to do during the first 24 hours after discharge from the emergency department? a. Monitor neuromuscular status for decreased circulation and sensation in the extremity. b. Check the fit of the cast by inserting a tongue blade between the cast and the skin. c. Apply a heating pad for 15 to 20 minutes four times daily to help with pain. d. Keep the cast covered with a soft towel to help it to dry quickly.

a. Check the dorsalis pedis pulses. The essential nursing action is to check the dorsalis pedis pulses. It is necessary to assess the circulatory status of the leg because the client is at risk for acute compartment syndrome, which can begin as early as 6 to 8 hours after an injury. Severe tissue damage can also occur if neurovascular status is compromised. Immobilization will be needed, but the nurse must assess the client's condition first. Administering an analgesic and placing a dressing on the affected area would both be done after the nurse has assessed the client.

A client with an open fracture of the left femur is admitted to the emergency department after a motorcycle crash. Which action is essential for the nurse to take first? a. Check the dorsalis pedis pulses. b. Administer the prescribed analgesic. c. Place a dressing on the affected area. d. Immobilize the left leg with a splint.

a. "Elevate your right leg as often as possible to reduce swelling" b. "Report increased pain or burning sensation under your cast" c. "Use ice on the affected leg for the first 24-36 hours" d. "Do not bear weight on the affected leg until instructed to do so" Ice and elevation of the affected leg can decrease swelling which is needed to prevent pressure from the cast (Choices A and C). The purpose of the cast is to immobilize the foot such that the tibia can heal. Therefore, no weight-bearing is allowed (Choice D). Increased pain and burning are indicators that the cast may be too tight and the skin under the cast may break down. These changes need to be reported promptly to the primary health care provider (Choice B). A synthetic cast dries immediately (unlike a plaster cast) and therefore Choice E is an incorrect response.

A patient has a new synthetic leg cast for a right fractured tibia. What health teaching will the nurse include before discharge? (SATA) a. "Elevate your right leg as often as possible to reduce swelling" b. "Report increased pain or burning sensation under your cast" c. "Use ice on the affected leg for the first 24-36 hours" d. "Do not bear weight on the affected leg until instructed to do so" e. "Do not cover the cast when you are in bed; keep it open to air dry"

a. assessing the pulses and skin temperature distal to the splint

A patient who had a plaster splint applied to the ankle at 0700 and received pain medication at 0900 now at 1100 reports that the pain is getting worse, not better. What is the nurse's best first action to prevent harm? a. assessing the pulses and skin temperature distal to the splint b. loosening the splint and reassessing the patient's pain in 15 minutes c. requesting a prescription to administer the pain medication IV d. repositioning the extremity on a pillow and placing an ice pack

d. "On a scale of 0 to 10, how would you rate your pain?" Nurses should treat any pain as real to the patient, even if the pain is perceived in a part of the body that is no longer there. Choice D demonstrates that the nurse acknowledges that the pain is real and further assesses is intensity. Choices A, B, and C dismisses the client's report of pain.

A patient who had an elective below-the-knee amputation (BKA) reports pain in the foot that was amputated last week. What is the nurse's most appropriate response to the patient's pain? a. "The pain will go away after the swelling decreases" b. "That's phantom limb pain, and every amputee has that" c. "Your foot has been amputated, so it's in your head" d. "On a scale of 0 to 10, how would you rate your pain?"

b. Acute compartment syndrome (ACS) c. Fat embolism syndrome (FES) d. Osteomyelitis ACS is a serious condition in which increased pressure within one or more compartments reduces circulation to the area. A fat embolus is a serious complication in which fat globules are released from yellow bone marrow into the bloodstream within 12 to 48 hours after the injury. FES usually results from long bone fracture or fracture repair but is occasionally seen in clients who have received a total joint replacement. Bone infection, or osteomyelitis, is most common in open fractures. Heart failure is not a potential complication for this client; pulmonary embolism is a potential complication of venous thromboembolism, which can occur with fracture. The client is at risk for wound infection resulting from orthopedic trauma, not a UTI.

A rock climber has sustained an open fracture of the right tibia after a 20-foot (6 m) fall 2 days ago. The nurse plans to assess the client for which potential complications? (Select all that apply.) a. Urinary tract infection (UTI) b. Acute compartment syndrome (ACS) c. Fat embolism syndrome (FES) d. Osteomyelitis e. Heart failure

d. removing or cutting the patient's clothing to inspect the affected area while supporting the injured area above and below the injury

After ensuring airway, breathing, and circulation along with a head-to-toe assessment, which action will the nurse take next in the emergency care of a patient with an extremity fracture? a. check the neurovascular status of the area distal to the injury: temperature, color, sensation, movement, and distal pulses by comparing the affected and unaffected limbs b. elevating the affected area on pillows, applying an ice pack that is wrapped to protect the skin, and obtaining a prescription for pain medication c. immobilizing the extremity by splinting; include joints above and below the fracture site, followed by rechecking the circulation d. removing or cutting the patient's clothing to inspect the affected area while supporting the injured area above and below the injury

a. Keep the client's heels off the bed at all times. Because the client is an older adult and is more at risk for skin breakdown because of impaired circulation and sensation, the client's heels must be kept off the bed at all times to avoid constant pressure on this sensitive area. Repositioning the older adult client must be done every 2 hours, not every 3 to 4 hours, to prevent skin breakdown and to inspect the skin for any signs of breakdown. Pain medication would not be administered for deep-breathing exercises because this client typically would not experience pain upon breathing. Antiembolic stockings or sequential compression devices are used for older adults to help prevent venous thromboembolism (VTE).

An older adult client has had an open reduction and internal fixation of a fractured right hip. Which intervention does the nurse implement for this client? a. Keep the client's heels off the bed at all times. b. Reposition the client every 3 to 4 hours. c. Avoid the use of antiembolism stockings. d. Administer pain medication before deep-breathing exercises.

c. "Do not allow the traction weights to rest on the ground." Although Buck's traction is not used commonly today because clients have surgical hip repairs to reduce pain, for some clients such as this client, it is used short term until surgery can be performed. The AP should allow the weights to hang freely and not remove them. There are no pins and the boot can be removed by the nurse for skin inspection.

Buck's (skin) traction for a fractured hip is applied to a client while a urinary tract infection is treated before surgery. What instruction will the nurse give assistive personnel (AP) for providing client care related to the traction? a. "Inspect the pins in the traction for signs of infection." b. "Remove the boot every shift to inspect the skin." c. "Do not allow the traction weights to rest on the ground." d. "Remove traction weights when turning the client."

b. perform a neurovascular assessment The nurse would suspect neurovascular compromise which is causing the client's reported signs and symptoms. Therefore, the first nursing action is to perform a complete neurovascular assessment, also called a "circ" or "CMS check" to validate the client's condition (Choice B). Neurovascular compromise results in decreased arterial perfusion and elevating the leg would decrease it further (Choice A). Although the nurse would report the client's complication to the primary health care provider and give the client an analgesic, these actions would not be performed first (Choices C and D).

The nurse is assigned to care for a postoperative patient who had an open reduction, internal fixation of the right tibia yesterday. The patient reports increased right leg pain, numbness, and tingling. What would the nurse's first action be at this time? a. elevate the surgical leg on a pillow b. perform a neurovascular assessment c. administer pain medication d. call the primary health care provider

a. Inspect the pins to monitor for infection and do not remove crusts. An external fixator is a series of pins attached to a metal frame to hold the bone ends in place while the wound can be managed. The nurse would frequently monitor the pin insertion sites for signs and symptoms of infection. Crusting that occurs at the sites should not be removed because it helps seal the open pin site areas to prevent infection. Leg elevation is important but the client would not necessarily need three pillows.

The nurse is caring for a client who has an external fixator for an open fracture of the tibia and fibula. What is the nurse's priority for care related to the fixator? a. Inspect the pins to monitor for infection and do not remove crusts. b. Make sure that the wound is managed using a moist wound healing method. c. Keep the leg covered to keep the extremity warm to promote circulation. d. Keep the extremity elevated to three pillows while in bed or in a chair.

b. assess the severity and quality of pain c. perform a neurovascular assessment d. elevate the affected extremity e. immobilize the injured knee joint The nurse always performs an assessment as part of nursing care, including pain and neurovascular assessments (Choice B and C). Musculoskeletal injuries are usually treated using RICE (rest/immobilization, ice, compression, and elevation) Choice D and E). Therefore, Choice A using heat for the new injury is contraindicated.

The nurse is caring for a patient who was admitted to the ED with report of left knee pain and swelling after playing baseball with friends. Which nursing actions are appropriate when caring for the patient? (SATA) a. apply heat to the affected area b. assess the severity and quality of pain c. perform a neurovascular assessment d. elevate the affected extremity e. immobilize the injured knee joint

d. Reports tingling and numbness in affected foot. This client is at risk for neurovascular compromise or compartment syndrome from the external dressing. Pain and a slightly cooler foot is to be expected. However, the client should not have tingling and numbness suggesting that arterial blood flow is diminished.

The nurse is caring for an older client who has a large bulky lower leg dressing with posterior splint to maintain alignment after closed reduction for an ankle fracture. Which client assessment finding would the nurse report to the primary health care provider or Rapid Response Team immediately? a. Affected foot slightly cooler than the other foot. b. Reports pain level is 4 on a 0-10 pain intensity scale. c. Pedal pulse on affected foot is 1+ and regular. d. Reports tingling and numbness in affected foot.

c. "Wear helmets when riding a motorcycle." Those who ride motorcycles or bicycles should wear helmets to prevent head injury. Telling the general public to avoid contact sports or to avoid driving in inclement weather is not realistic. Telling the general public to avoid rigorous exercise is not only unrealistic, but it is also opposed to what many health care professionals recommend to maintain health.

The nurse is instructing a local community group about ways to reduce the risk for musculoskeletal injury. What information will the nurse include in the teaching plan? a. "Avoid rigorous exercise." b. "Avoid contact sports." c. "Wear helmets when riding a motorcycle." d. "Avoid driving in inclement weather."

c. "We should keep the surgical leg as flat on the bed as possible" One of the complications of an AKA is flexion hip contracture of the affected leg. The flexor muscles become spastic which causes hip flexion; therefore, the surgical leg ("stump") should be positioned as flat as possible in an extended position to prevent that complication (Choice C). Elevation would promote flexion (Choice A). Placing the client occasionally in a prone position can help promote hip extension but the client cannot remain in that position for a prolonged period of time (Choice D). Prolonged sitting can lead to sacral or buttock pressure injuries and would not be the best client position (Choice B).

The nurse teaches assistive personnel (AP) how to position a patient who had an above-the-knee (AKA) last week. Which statement by the AP indicates understanding of the teaching? a. "We should keep the surgical leg elevated on two pillos at all times" b. "We should keep the patient in a sitting position as long as possible" c. "We should keep the surgical leg as flat on the bed as possible" d. "We should keep the patient in a prone position most of the day"

c. documenting the finding as the only action

What is the most appropriate action for the nurse to take when assessment on a patient with external fixation reveals crusts have formed around the pin sites? a. assessing the patient's temperature b. notifying the surgeon immediately c. documenting the finding as the only action d. removing the crusts and culturing drainage

c. assessing the patient's temperature and other vital signs hot spot and odor may indicate infection under the cast

Which action will the nurse perform first when a patient in a body cast reports a painful "hot spot" underneath the cast and an unpleasant odor? a. requesting a cast change b. offering the patient a PRN pain medication c. assessing the patient's temperature and other vital signs d. elevating the extremity and appyling an ice pack over the spot

b. patient reports numbness and tingling pain from wiggling fingers is expected and the other two choices are late findings

Which assessment finding in a patient who has a fracture of the right wrist alerts the nurse to a possible early indication of a complication? a. wiggling fingers causes pain b. patient reports numbness and tingling c. fingers are cold and pale; pulses are impalable d. pain is severe and seems out of proportion to injury

b. pedal pulse of the affected limb is easily palpated and strong cap refill not as reliable as pulse

Which assessment finding on a patient who has a closed fracture of the lower femur with extensive swelling and bruising best indicates to the nurse that perfusion in the affected limb is adequate? a. pulse oximetry on the right forefinger is 98% b. pedal pulse of the affected limb is easily palpated and strong c. femoral pulse of the affected limb is easily palpated and strong d. capillary refill on great toe of the affected limb is about 4 seconds

c. one leg is shorter than the other and has a protruding bump on the side

Which assessment finding on an older patient who fell while getting out of bed indicates to the nurse a possible fracture? a. the patient is extremely confused and trying to get up b. the patient cries out when the nurse attempts to examine him c. one leg is shorter than the other and has a protruding bump on the side d. the skin of both legs is cooler and darker than that of the upper extremities

b. petechiae on the neck and chest c. decreased platelet count e. sudden-onset confusion f. PaO2= 72 mmHg

Which assessment findings in a patient with a complete and displaced fracture of the femur indicates to the nurse possible fat embolism syndrome? (SATA) a. increased swelling over the fracture site b. petechiae on the neck and chest c. decreased platelet count d. dry mucous membranes e. sudden-onset confusion f. PaO2= 72 mmHg

c. oxygen saturation

Which assessment is the priority for the nurse to perform on a patient admitted to the ED with multiple rib fractures? a. pulses in all four extremities b. pulse rate and rhythm c. oxygen saturation d. pain intensity

a. checking vital signs c. examining urine for presence of blood e. determining the level of consciousness

Which assessments are a priority for the nurse to perform to prevent harm on a patient who was hit by a motorcycle and has a suspected pelvic fracture? (SATA) a. checking vital signs b. asking about opioid use c. examining urine for presence of blood d. asking the patient to rate his or her pain e. determining the level of consciousness f. performing neurovascular checks of the lower limbs

b. Urine specimen to assess for the red blood cells It is most important for the nurse to determine the presence of blood in the urine as well as assessing the abdomen for rigidity. Clients with crushing injuries to the pelvis are at increased risk of internal hemorrhage. Pelvic injuries are the second cause of death from trauma after head injuries. Assessing the skin for external trauma and monitoring pain and alertness will be performed as part of the overall assessment but are not critical nursing actions at this time. Assessing lung sounds is more critical with chest injuries and rib fractures.

Which information about a client who was admitted with a pelvic fracture after being crushed by a tractor is most important for the nurse to assess to monitor for serious complications from this type of injury? a. Lungs for bilateral normal breath sounds b. Urine specimen to assess for the red blood cells c. Pain score and level of alertness d. Skin to evaluate lacerations and abrasions

c. "Keep your hand and arm elevated above the level of your heart to reduce swelling" d. "Use an ice pack on the cast for the first 6-8 hours, and cover the pack with a towel" e. "When upright, wear the sling so that it distributes over your shoulders and not just your neck" f. "Call your primary health care provider immediately if numbness and tingling occur in your hand or fingers"

Which precautions or care information are appropriate for the nurse to include when teaching a patient going home with a synthetic forearm cast? a. "Be sure to change the stockinette at least once a week" b. "Limit movement of the fingers and wrist joints to prevent pain" c. "Keep your hand and arm elevated above the level of your heart to reduce swelling" d. "Use an ice pack on the cast for the first 6-8 hours, and cover the pack with a towel" e. "When upright, wear the sling so that it distributes over your shoulders and not just your neck" f. "Call your primary health care provider immediately if numbness and tingling occur in your hand or fingers"

d. "When was your last bowel movement?"

Which question is most appropriate for the nurse to ask a patient who has been receiving scheduled and PRN opioids for severe pain with multiple fractures who now has a distended abdomen and hypoactive bowel sounds? a. "Did you use opioids or other recreational drugs before your injury?" b. "What specific foods have you eaten in the past 2 days?" c. "How would you rate your pain on a 0 to 10 scale?" d. "When was your last bowel movement?"

acute compartment syndrome (aka ischemia-edema cycle)

a serious but uncommon limb threatening condition in which increased preasure within one or more compartments (that contain muscle, blood vessels, and nerves) reduces circulation to lower leg or forearm; acute complication of fracture

-infection: bone (osteomyelitis) and soft tissue -venous thromboembolism: DVT and PE -fat embolism syndrome: caused by bone marrow releasing fat globules that clog small vessels (12-48 hours after injury) -acute compartment syndrome (rare but serious)

acute complications of fractures

comminuted fracture

breaks in > 2 fragments; requires high degree of force/energy (trauma such as MVA)

-avascular necrosis: death of bone tissue due to poor perfusion -delayed union, nonunion, or malunion: refers to bone not being set right or not being able to maintain reduction so it doesn't heal properly (will have persistent pain and mobility issues) -complex regional pain syndrome (CRPS): dysfunction of central and peripheral nerves (persistent pain)

chronic complications of fractures

-hemorrhage -infection -phantom limb pain -problems associated with immobility -neuroma: sensitive tumor consisting of damaged nerve cells -flexion contractures

complications of amputation

-splints, boots, or shoes are better for perfusion and swelling -fiberglass cast: waterproof, synthetic, dries quickly and becomes rigid, and decreases risk of impaired skin integrity -plaster cast: original cast, takes 24 hours to fully dry

different types of immobilization used for fractures

-pain: opioids (never Demerol), non-opioid analgesics, NSAIDs, muscle relaxants -stool softeners or laxatives -possible prophylactic antibiotics

drug therapy for fractures

-altered LOC -hypoxemia -dyspnea -tachypnea

early signs of fat embolism syndrome

transverse fracture

fracture at right angle to bone's axis (straight across)

compression fracture

fracture in which the bone is crushed by loading force, common in vertebrae

closed/simple fracture

fracture in which the skin remains in tact

open/compound fracture

fracture resulting in an open wound through the skin

incomplete fracture

fracture that goes only through part of the bone

complete fracture

fracture that is across the entire width of the bone

fatigue or stress fracture

fracture that occurs due to excessive strain on the bone

pathologic/spontaneous fracture

fracture that occurs with minimal trauma, related to disease such as osteoporosis

fasciotomy: cut through fascia to release pressure and tension on the blood vessels and nerves

how is acute compartment syndrome treated surgically?

-loss of sensation -loss of peripheral pulses -impaired circulation -necrosis -infections/gangrene -sepsis

indications for amputation

-assess for tissue perfusion -management of pain (including phantom limb pain) -TENS and alternative therapies -prevention of infection -promotion of ambulation with PT and OT -exercise ROM for AKA and BKA -prevent flexion contractures by laying prone for short period daily -emotional support -prosthetics

management of amputations

-elevate above heart -ice -don't stick anything under the cast -manage pain -check for circulation

nursing care of the patient with a cast

assess for internal bleeding because pelvis is very vascular and close to major organs and blood vessels (leading cause of death): -blood in urine or stool -check abdoment for rigidity and swelling also may result in bladder or urethral injury

nursing consideration regarding pelvic fractures

-pain control -no strenous activities -cough, turn, and deep breathing every hour for several days until reassessed -encourage Fowler's and Semi-Fowler's -education on s/sx of complications: increased or sudden difficulties in breathing, spitting up blood, sudden sharp or increased chest pain (not otherwise explained)

nursing interventions for patient with rib fractures

-hemothorax -pneumothorax -laceration of liver -atelectasis (poor lung expansion from pain) -flail chest

potential complications of rib fracture

spiral fracture

rotational force, most often when body is in motion

-decreased perfusion -severe pain with passive motion -reduced feeling

symptoms of acute compartment syndrome

-bedrest -gentle handling -oxygen -hydration (IV fluids) -possibly steriod therapy -fracture immobilization

treatment of fat embolism

-open bone reduction: surgery that realigns bone ends for proper healing -immobilization: cast, splint, or immobilizer -traction/closed bone reduction: application of pulling force to a body part to reduce fracture (skin and skeletal), used before surgery -external fixation: pins and wires are inserted through the skin and bone, then connected to a rigid external fram -internal fixation: surgical procedure in which plates and screws are used to stabilize the fracture -physical therapy

treatments for fractures

a cut lengthwise can be made to release pressure (called a bivalve); two halves held together with tape

what can be done if a patient's cast becomes too tight?

a window is cut in the cast so the wound can be observed and treated; piece of cast is replaced after the wound has healed

what can be done if tissue integrity becomes a problem while a patient has a cast on?

external pressure: tight, bulky dressings internal pressure: blood or fluid accumulation

what causes acute compartment syndrome?

cancer, osteomyelitis, trauma (higher is rare)

what conditions are associated with above the knee amputations (AKAs)?

most of the foot is removed but the ankle remains (common for peripheral vascular disease) weight bearing may be accomplished without prosthesis

what is a midfoot amputation, what population most commonly has this procedure done, and what is the impact?

weight must not touch the floor, needs to dangle

what is a nursing consideration when it comes to traction for a fracture?

loss of "push off"

what is the impact of losing a great toe?

minor disability

what is the impact of losing a small toe or toes?

diabetes mellitus

what is the number one cause of limb amputation?

in fat embolism syndrome, patient will develop red rash (petechiae) over upper body and torso (late sign)

what symptom differentiates fat embolism syndrome from pulmonary embolism?

greenstick fracture

young, soft bone in which the bone bends and breaks; often seen in infancy and childhood when bones are soft