INP 400 Final Exam

Colle's Fracture

"fractured wrist" This occurs at the lower end of the radius when a person tries to stop a fall by landing on his or her hands -common with women

Purpose of Traction

-Prevent or reduce pain and muscle spasm -Immobilization -Reduction -Treat a pathological condition -Prevent deformity

Care of a Client with Traction (acronym)

-Temperature (infection, extremity) -Ropes hang freely -Alignment -Circulation ( 5 P's) -Type and location of fracture -Increased fluid intake -Overhead trapeze -No weights on bed or floor

Spiral Fracture

A break in a bone shaped as an "S" due to torsion and twisting.

Strain

A condition resulting from damaging a muscle or tendon.

Fracture

A disruption or break in the continuity of the structure of bone

Pelvis Fracture Treatment

A less severe non-weight-bearing fracture treated with bed rest on a firm mattress or bed board for a few days to 6 weeks -Severe weight-bearing fracture may require a pelvic sling, skeletal traction, double hip spica cast, or external fixation -Monitor patient so injuries can be treated immediately -Check for presence of blood in urine and stool, and watch abdomen for signs of rigidity or swelling

Compartment Syndrome Late Sign

Absence of peripheral pulse = ominous late sign

Greenstick Fracture

An incomplete break in the bone and usually occurs in children ("tree branch" where the bone hangs)

Skin Traction (short term)

Buck's traction: -For hip and knee contractures, muscle spasms, and alignment of hip fractures -Weight used during skin traction should not be more than -5 to 10 pounds to prevent injury to the skin

Open reduction

Correction of bone alignment through a surgical incision at site -used for comminuted or open fractures to clean up site

Hypovolemic Shock

Loss of excessive fluids (blood +1L) from burns, hemorrhage or severe dehydration

Closed Reduction

Non-surgical, manual realignment

Transverse Fracture

Occurs straight across the bone.

Cast Care

Plaster casts: -Keep cast dry -Cover when in shower -Don't put any pressure on it for at least 24 hours -If it gets wet, soft or cracked, see you doc Do not trim or reshape the cast

Skeletal Traction (long term)

Provides a strong, steady, continuous pull and can be used for prolonged periods -gardner-wells, crutchfield

Avulsion Fracture

Tendon or ligament pulls bone away at site of attachment.

Avulsion Fracture

the tendon or ligament pulls off a piece of the bone can occur anywhere in the body-most commonly around pelvis, knees, feet, digits

Osteomyelitis Treatment

will depend on the bacteria involved, the site of infection, and the type of osteomyelitis (acute or chronic) •IV antibiotic therapy for 2-6 weeks •Bed rest and opioid analgesia •Nutritional support to aid in healing •Surgery is considered when antibiotic therapy fails, the patient develops neurologic deficits or the bone becomes deformed •Splinting and cast immobilization

Fracture Healing Stage 3

**callus formation : -Within 1 to 4 weeks after injury, granulation tissue changes into a callus, which is made up of cartilage, osteoblasts, calcium, and phosphorus. -The callus is larger than the diameter of the bone and serves as a temporary splint

Fracture Healing Stage 5

**consolidation and remodeling: -Consolidation occurs when the distance between bone fragments decreases, then closes -During bone remodeling, immature bone cells are gradually replaced by mature bone cells -Excess bone is chiseled away by stress to the affected part from motion, exercise, and weight bearing -Bone then takes on its original shape and size

Fracture Healing Stage 2

**granulation (fibrocartilage formation): -3 to 7 days -Hematoma that surrounds fracture does not reabsorb, as it does in other parts of the body -Instead, other tissue cells enter the clot, and granulation tissue replaces the clot -The tissue then forms a collar around each end of the broken bone, gradually becoming firm and forming a bridge between the two ends

Fracture Healing Stage 1

**hematoma formation: -Immediately after a fracture, bleeding and edema occur -In 48 to 72 hours, a clot or hematoma forms between the two broken ends of the bone

Fracture Healing Stage 4

**ossification: -Within 3 weeks to 6 months after the break, a permanent bone callus, known as woven bone, forms -During this stage the ends of the broken bone begin to knit

Fracture Assessments

-6 P's of compartment syndrome -pain -any changes -integrity of cast -assess distal to injury

Fixation

-A surgical procedure in which an incision is made at -An attempt to attach the fragments of the broken bone together when reduction alone is not feasible because of the type and extent of the break -ORIF-internal -OREF-external

ABCDEFGHI's of Emergency Trauma

-Airway patent -Breathing: symmetry, depth, rate, listen -Circulation: CWMS -Disability: do they answer/follow commands -Examine: pupils, check for trauma -Fahrenheit -Get vitals: no vitals=CPR -Head-to-toe -Interventions: keep warm, NPO, cal 4 help, stop bleed, keep airway patent

Fracture Treatment

-Anatomic realignment of bone fragments (reduction) -Immobilization to maintain alignment -Restoration of normal function

Late Signs of Shock

-BP below 90mmHg -increased HR, weak -pale, cold -comatose -RR increased and shallow

FES Commonly Effects

-Bone most often affected: Long bones, Ribs, Tibia , Pelvis -Tissues most often affected: Lungs, Brain, Heart, Kidneys and Skin

Shock Types

-Cardiogenic -Obstructive -Vasogenic (3) -Hypovolemic

Stages of Shock (3)

-Compensatory (early/reversible) -Progressive (intermediate) -Refractory (irreversible)

Compartment Syndrome Etiologies (2)

-Decreased compartment size: Restrictive dressings, Splints, Casts -Increased compartment content: Bleeding, Edema/swelling

Compartment Syndrome Treatment

-Do not apply ice or elevate above heart level -Prompt, accurate diagnosis is critical -Early recognition is the key -removal of pressure (external=cast, internal=surgical fasciotomy/decompression)

Internal fixation

-Done during open reduction surgical procedure -Rods, pins, nails, screws, or metal plates used to align bone fragments and keep them in place for healing -Promotes early mobilization; preferred for older adults who have brittle bones that may not heal properly, or who may suffer the consequences of immobility

Fat Embolism

-Embolism that originates from the bone marrow • -Occurs within 48 hours -Characterized by the presence of fat globules in tissues and organs after a traumatic skeletal injury -usually fat globules break off from long bones (from bone marrow) that are fractured and move into veins

FRACTURE (care of client in traction)

-Foot drop -ROM -Alignment -Complications -Trapeze -Urinary retention -Respiratory complications -Eval. circulatory/impairments

Fracture Signs

-Immediate localized pain -decreased Function -Inability to bear weight or use affected part -Guarding -May not be accompanied by obvious bone deformity

Traction Complications

-Impaired circulation, inadequate fracture alignment, skin breakdown, and soft tissue injury -Pin track infection and osteomyelitis can occur with skeletal traction

Progressive (intermediate)

-P down, thready and weak -RR up, rapid and shallow -BP plummets, O2 goes down further -cold, clammy, cyanotic -drowsy, LOC/LOO decreased

6 P's of a Fracture

-Pain -Pulse -Pallor -Paresthesia -Paralysis Interventions to watch out for and prevent with fracture

Hip Fracture

-Pain, impaired peripheral circulation on the affected side, complications of immobility, skin breakdown, and ability to carry out activities of daily living -A direct hip fracture- the injured leg is usually around an inch shorter (compare the underside of the heels with the ankles together) and is turned outward compared to the uninjured side.

External Fixation

-Pins are inserted into the bone, above and below fracture -Pins are then attached to an external frame and adjusted to align the bone -If there is soft tissue damage or infection, external fixation allows access to the site and facilitates wound care -Pin care is extremely important to prevent the migration of organisms along the pin from the skin to the bone -Patients should be taught to do their own pin care and to recognize signs of infection

Hip Fracture Interventions

-Relieving pain, promoting mobility and independence, and preventing complications -Proper body alignment is extremely important in preventing injury to the fracture area -Turn patients from side to side as ordered -Post op affected hip must not be adducted or flexed more than 90 degrees because excessive flexion/adduction can dislocate the prosthesis -DB&C -TED stockings -pain control -mobilize asap

Pelvis Fracture Assessment

-Signs of bleeding, swelling, infection, thromboembolism, and pain -Assess urine output because the absence of urine may indicate a perforated bladder -10-20% death rate due to location: puncture bladder causing sepsis

Cast Types

-Sugar-tong splint -Short arm cast -Long arm cast -Body jacket cast -Hip spica cast Casts used for lower extremities: -Long leg cast -Short leg cast -Cylinder cast -J-ones dressing

Compensatory (early/reversible)

-T, RR, P all spike, BP spikes initially -pale and clammy skin -O2 decreased to peripherals -urine output decreased -mild changes in LOO/LOC

Trauma Complications

-Tissue perfusion (decreased O2 to organs) -Respiratory problems (pneumothorax, broken ribs, obstruction) -Anxiety -Unstable clotting factors (hypovolemic, liver damage) -Malnutrition -Altered body image -Thrombembolism -Infection -Coping problems

Fat Embolism Mnaifestation

-Usually occur 24-48 hours after injury -Interstitial pneumonitis -Produce symptoms of ARDS

Splint and Braces Nursing Care

-Watch for and prevent pressure areas -Alignment -Remove as per dr's orders-skin care, ROM, comfort -Neurovascular assessments -Pain assessment -Document

Osteomyelitis S+S (acute vs. chronic)

-acute:pain in the affected area, redness, swelling, and warmth over the area of infection, fever, irritability, malaise -Chronic: redness, swelling, and warmth over the area of infection, pain or tenderness in the affected area, drainage from an open wound in the area of infection, fever (in some cases).

First Six Weeks Post Hip Surgery

-avoid sitting on low chairs or couches- sit only in chairs with arms where your knees remain lower than your hips -avoid leaning forward while sitting -avoid flexing your hips more than 90 degrees -avoid rotating your foot and leg inward -avoid picking up objects from the floor or bending to put on your socks and shoes

In emergency and theres no BP?

-check radial: if pulse present, BP=80 mmHg -check femoral: if pulse present= 70 mmHg --check carotid: if pulse present= 60 mmHg

Pin Care

-done weekly or daily -Clean in a circular motion -New swab for each pin -1/2 H2O2 and sterile Saline (or as facility policy) -Remove crusting -Dry sterile cling gauze

Vasogenic Shock (distributive)

-excess dilation of blood vessels causing blood to distribute to wrong areas/amount -vasodilate->decreased O2 to organs->organ failure-> organs die 1. septic (bacteria in blood) 2. anaphylaxis (allergic reaction) 3. neurogenic (Spinal cord injury)

Shock Early Signs

-normal BP -increased HR -skin is cool/moist (but normal color) -anxious/restless -increased RR

Fracture Effects on person

-pain, edema, deformity, decreased function -false movement, crepitation, decreased sensation

Compartment Syndrome Effects

-permanent damage in 24 hours -tissue death in 4-6 hours -can result in renal failure or sepsis

Manage FES

-reposition as little as possible -fluid resuscitation -careful immobilization of long bone

Incomplete Fracture

-runners -Fracture that does not go across the entire width of the bone (greenstick)

Refractory (irreversible)

-s+s of organ failure, blood clotting -carely conscious -0 urine output, bowel sounds absent/sluggish -bradycardia, arrhythmia, non-existant BP

Cardiogenic Shock

-the heart fails to pump, cardiac output and blood pressure decrease. -Blood backs up into lungs, causing pulmonary edema. Inadequate amounts of oxygen reach the myocardium, impairing heart's pumping action --MI, cardiomyopathy, CHF, dysrhythmias

Overriding Fractures

...

Fracture Healing Stages (5)

1. Hematoma formulation 2. fibrocartilage formation 3. callous formation 4. ossification 5. remodeling and consolidation

6 P's of Compartment syndrome

1. Parasthesia 2. Pain 3. Pallor 4. Paralysis 5. Pulselessness 6. Poikilothermia

ARDS

Acute respiratory distress syndrome: -chest pain, cyanosis, dyspnea, tachypnea, tachycarsia, apprehensive or agitated, petechial rash, feeling of impending doom

Compartment Syndrome

An elevated intracompartmental pressure within a confined myofascial compartment or external cast/splint compromises the neurovascular function of tissues within that space -internal or external pressure -most common in lower leg and forearm

Osteomyelitis

An infectious process in the bone that usually starts in the spongy medullary bone. -Osteomyelitis literally means inflammation of the bone and is usually caused by bacteria -common S+S: sweating, swelling, chills, lower bavk pain

Sprain

An injury in which the ligaments holding bones together are stretched too far and tear -pain, swelling

Traction

Application of a pulling force to an injured part of the body while countertraction pulls in the opposite direction

Fiberglass cast vs. Plaster Cast

Fiberglass: -dries in 10-15 minutes -lightweight -porous causing fewer skin issues ("breathes") -can get wet -$$$$$$ Plaster: -24 hour dry times -cheap but heavy -more support for bad breaks -cannot get wet

Fracture Healing Complications (5)

Healing disruption: malunion, nonunion, delayed union -Malunion: healing in an abnormal position -Non union: permanent failure of bones to heal -Delayed union: prolonged time to heal (+6 months) -Infection (osteomyelitis, blood infection etc) -Venous Thrombosis -Compression syndrome -Fat emobolism

Primary Survey

Initial assessment to determine the presence of a life-threatening injury -Allergies -Medications -Past hx -Last meal -Event

Venous Thrombosus

Veins of the lower extremities and pelvis are highly susceptible to thrombus formation after fracture, especially hip fracture -from pressure to vein, immobilization

Unstable fracture

a fracture grossly displaced during injury, thus a site of poor fixation. (oblique or comminuted fractures)

Parasthesia

abnormal sensation such as numbness, prickling and tingling

Osteomyelitis Diagnosis

blood work, bone biopsy, x-ray, bone scan, CT scan, MRI

Poikilothermia

body temp varies w/environmen, cannot regulate temperature

Crepitation

dry, grating sound or sensation caused by bone ends rubbing together, indicating a fracture or joint destruction

Complete Fracture

extends across bone

Comminuted Fracture

fracture in which the bone is splintered or crushed

Oblique Fracture

occurs at an angle across the bone

Stable fracture

occurs when a piece of the periosteum is intact across the fracture and either external or internal fixation has rendered the fragments stationary -not displaced after accident/immobilization -transverse, spiral, greenstick

Obstructive Shock

physical impairment; obstructed heart valves or vessels that block