Care of Patients with Musculoskeletal Trauma

Which statement indicates to the nursing instructor that the nursing student understands the normal healing process of bone after a fracture?

"A hematoma forms at the site of the fracture." In stage 1, within 24-72 hours after a fracture, a hematoma forms at the site of the fracture because bone is extremely vascular. This then prompts the formation of fibrocartilage, providing the foundation for bone healing. Stage 2 of bone healing occurs within 3 days to 2 weeks after the fracture, when granulation tissue begins to invade the hematoma. Stage 3 of bone healing occurs as a result of vascular and cellular proliferation. In stage 4 of a healing fracture, callus is gradually reabsorbed and transformed into bone.

A patient with a fracture asks the nurse about the difference between a compound fracture and a simple fracture. Which statement by the nurse is correct?

"Compound fracture involves a break in the bone, with damage to the skin." A compound fracture involves a break in the bone with damage to the skin. A simple fracture does not extend through the skin. A compound fracture is accompanied by damage to blood vessels.

The nurse is teaching a patient with a long-leg cast about care of the extremity after cast removal. What statement made by the patient indicates a need for further teaching?

"I will remove dead skin by gentle scrub." After removing the cast, the patient should avoid scrubbing the dead skin. Instead, the patient must remove dead and scaly skin by soaking. Wearing support stockings or elastic bandages prevents swelling. The patient must exercise slowly as instructed by the physical therapist. The patient will have to support the extremity with pillows or other orthotic device until strength and movement are back to normal.

A patient is recovering from an above-knee amputation resulting from peripheral vascular disease. Which statement indicates that the patient is coping well after the procedure?

"It will take me some time to get used to this." Acknowledging that it will take time to get used to the amputation indicates that the patient is expressing acceptance and effective coping. Stating that the spouse will change the dressing indicates the patient does not want to participate in self-care. Expressing disbelief and disgust over the amputation indicates the patient is unwilling to address what has happened. The patient who does not want to receive visitors is having difficulty coping with the change in body image.

The nurse is teaching a group of nursing students about venous thromboembolism (VTE). What statement made by a participant indicates a need for further instruction?

"Surgery lasting at least 1 hour can cause VTE." Surgeries longer than 30 minutes increase the risk for VTE. VTE is the most common cause of death due to musculoskeletal surgeries. Chemotherapy, oral contraceptives, smoking, and immobility also make patients with fractures or trauma more likely to develop VTE.

The nurse is instructing a local community group about ways to reduce the risk for musculoskeletal injury. What information does the nurse include in the teaching plan?

"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; it is also opposed to what many health care professionals recommend to maintain health.

Arrange the following nursing actions pertaining to the emergency care of a patient who experiences fracture in the correct sequence.

1. Assess airway, breathing, and circulation. 2. Render cardiopulmonary resuscitation (CPR), if necessary. 3. Control bleeding by direct pressure. 4. Manage pain. Assessing the patient's airway, breathing, and circulation (ABC) are the first actions that need to be taken when caring for a patient suffering from a fracture. Cardiopulmonary resuscitation (CPR) is then provided, if needed. Any bleeding is controlled by applying direct pressure to the area and applying digital pressure over the artery above the fracture. After assessment and stabilization, pain is managed with intravenous (IV) opioids.

What is the appropriate weight of the pulling force in skeletal traction?

15 pounds Skeletal traction aids in bone realignment, allowing the use of longer traction time and heavier weights, usually 15 to 30 pounds (6.8 to 13.6 kg). Any weight below 15 pounds may not align the fragments properly.

A 70-year-old patient has an infected tibia fracture. What is the estimated healing time?

90 days. Complete healing of a bone fracture often takes 3 months (90 days) or longer for adults over the age of 70. Infections at the fracture site tend to prolong the duration of healing.

Which bone fracture complication is also known as ischemia-edema cycle?

Acute compartment syndrome Acute compartment syndrome (ACS) is a serious condition in which increased pressure within one or more compartments reduces circulation to the area. ACS is also called ischemia-edema cycle. Crush syndrome, fat embolism syndrome, and venous thromboembolism are complications of bone fractures, but ACS is the only complication called ischemia-edema cycle.

The nurse refers a patient with an amputation and the patient's family to which community resource?

Amputee Coalition of America (ACA) The ACA is an available resource for patients with amputations and supports them and their families. The AAS, CWA, and NAAS do not exist.

The nurse prepares to perform a neurovascular assessment on a patient with closed multiple fractures of the right humerus. Which technique does the nurse use?

Assess sensation of the right upper extremity. Assessing sensation of the right upper extremity is part of a focused neurovascular assessment for the patient with multiple fractures of the right humerus. Inspecting the abdomen and auscultating lung sounds of the patient with multiple fractures are not part of a focused neurovascular assessment. Because the patient does not have a head injury, assessing the patient's level of consciousness and ability to follow commands is not part of a focused neurovascular assessment.

A patient's left arm is placed in a plaster cast. Which assessment does the nurse perform before the patient is discharged?

Assess that the cast is dry The cast must be dry and free of cracking and crumbling before the patient is discharged. The patient should not place anything between the cast and the skin. In assessing fit, one finger should easily fit between the cast and the skin. Capillary refill longer than 3 seconds indicates impairment of the circulation in the extremity and requires the health care provider's immediate attention.

Through radiographic analysis of a patient, the primary health care provider confirms a displaced fracture of the femoral neck. Which complication should the nurse monitor for in the patient?

Avascular necrosis (AVN) The disruption of blood supply in the area of the femoral neck can lead to ischemic or avascular necrosis (AVN) of the femoral head. AVN causes death and necrosis of the bone tissue, resulting in pain and decreased mobility. This condition is most common in patients with displaced fractures. Venous oozing is seen in pelvic fractures. Delayed union is most commonly seen in tib-fib fractures. Patients with chest trauma have an increased risk of puncture of the vital organs.

Which statement about chronic complications from fractures is accurate?

Avascular necrosis is a chronic complication of fracture. Avascular necrosis is a chronic complication of fracture which occurs due to death of the bone tissue from a lack of blood supply. Fat embolism syndrome can occur within 12 to 48 hours following a fracture, and therefore is not a chronic complication. Surgical repair of fractures can cause chronic complications such as aseptic necrosis because the hardware used in the procedure can interfere with circulation. Long-term corticosteroid therapy such as prednisone therapy also increases the risk for chronic complications such as aseptic necrosis.

The nurse admits an older adult patient who sustained a left hip fracture and is in considerable pain. The nurse anticipates that the patient will be placed in which type of traction?

Buck's traction Buck's traction may be applied before surgery to help decrease pain associated with muscle spasm. Balanced skin traction is indicated for fracture of the femur or pelvis. Overhead traction is indicated for fracture of the humerus with or without involvement of the shoulder and clavicle. Plaster traction is indicated for wrist fracture.

A patient with a compound fracture of the left femur is admitted to the emergency department after a motorcycle crash. Which action is most essential for the nurse to take first?

Check the dorsalis pedis pulses. The first action should be to assess the circulatory status of the leg because the patient is at risk for acute compartment syndrome (ACS), which can begin as early as 6-8 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 patient's condition first. Administering an analgesic and placing a dressing on the affected area should both be done after the nurse has assessed the patient.

A patient reports a history of wrist pain after an attempt to break a fall by landing on the heel of the hand with an extended wrist. Which type of fracture should the nurse suspect?

Colles' fracture A Colles' fracture, or "dinner fork" injury, commonly occurs when a person attempts to break a fall by landing on the heel of the hand when the wrist is extended. Phalangeal, metacarpal, and proximal humerus fractures do not involve wrist fractures.

While assessing a patient's bone fracture, the nurse finds that the fracture features a break across the entire width of the bone. The broken bone also extends through the skin. Which type of fracture does the nurse recognize?

Complete and open A complete and open fracture is a break across the entire width of the bone with disruption of the overlying skin. A complete and closed fracture is a break across the entire width of the bone without disruption of the overlying skin. An incomplete and open fracture is a break through part of the bone with skin disruption. An incomplete and closed fracture is a break through part of the bone without skin disruption.

Radiographic assessment of a patient with femoral fracture reveals spotty and diffuse osteoporosis. The patient gives a history of excessive sweating, intense burning pain, and edema. Which side effect of fractures does the nurse suspect?

Complex regional pain syndrome (CRPS) CRPS is actually a dysfunction of the central and peripheral nervous systems that leads to severe, chronic pain. Spotty and diffuse osteoporosis can be seen on x-ray examination, which is characteristic of CRPS. The symptoms may include intense burning pain, muscle spasms, and raised temperature. CTS is a condition in which the median nerve in the wrist becomes compressed, causing pain and numbness. In FES, fat globules are released from the yellow bone marrow into the bloodstream, which may block the flow of blood. ACS is a life-threatening condition in which increased pressure within one or more compartments reduces circulation to the area.

Which complication resulting from a fracture might necessitate the use of an implanted device to block pain perception?

Complex regional pain syndrome (CRPS) Pain in patients with CRPS can be managed by peripheral or spinal cord neurostimulation using an external or internal implanted device that delivers electrical pulses to block pain from reaching the brain. This actually blocks the pain perception. CTS, FES, and ACS are not managed with an implanted device to block the pain perception.

Which type of fracture extends through the skin?

Compound A compound fracture occurs when the skin surface over the broken bone is disrupted, causing an external wound. Comminuted, displaced and greenstick fractures are all closed fractures and do not extend through the skin. There is no visible wound with a closed fracture.

The nurse is assessing the laboratory report of a patient with a fractured hip. Which finding indicates the presence of fat embolism syndrome (FES)?

Decreased red blood cell (RBC) count A decreased RBC count indicates the presence of FES, which is a condition where fat globules are released from the bone marrow into the bloodstream after an injury or illness. These fat globules may clog small blood vessels supplying vital organs and cause organ dysfunction. An increased ESR and decreased serum calcium levels indicate the presence of FES. Increased serum lipase level is a symptom of FES, whereas increased serum potassium is seen in myoglobinuric renal failure and crush syndrome.

A patient has a short-leg cast following a fracture of the ankle. What does the nurse teach the patient about managing the fracture?

Elevate the affected leg on several pillows. The patient should elevate the leg on several pillows to reduce the swelling. The patient can attach a cast shoe or a rubber walking pad to the cast to prevent damaging the cast. Ice is applied for the first 24 to 36 hours to reduce swelling and inflammation. The patient must ensure that the cast is not too tight; the patient should be able to insert a finger between the cast and the skin.

The nurse is caring for a patient with Buck's traction. What care does the nurse provide for this patient?

Ensure the weights are freely hanging at all times. The nurse should ensure that the weights are freely hanging at all times. Weights are not to be removed without a prescription, and should not be lifted manually or allowed to rest on the floor. The nurse should inspect the skin at least every 8 hours for signs of irritation or inflammation. The belt or boot used for traction is removed every 8 hours and the skin is assessed. Circulation is usually monitored every hour for the first 24 hours after traction is applied and every 4 hours thereafter.

Which type of fracture has the highest incidence in young and young-middle aged adults?

Femoral shaft fracture Femoral shaft fractures occur most often in young and middle-aged adults. Rib fractures are the most common type of fracture in the adult population. The incidence of proximal femur (hip) fractures is highest in older adults. Humeral fractures are common in adults. The older the person, the more proximal the fracture.

Which type of fracture is most commonly complicated by delayed union because of poor perfusion?

Fractures of the tibia and fibula Fractures of both the tibia and the fibula, particularly the lower third, is often referred to as a "tib-fib" fracture. Because of poor perfusion to parts of the tibia and fibula, delayed union is not unusual. It is uncommon for pelvic, spinal, and femoral fractures to be complicated and have a delay in union.

What assessment finding typically indicates there is a fracture of the hip?

Groin pain Patients with a fractured hip may have groin pain or pain referred to the back of the knee or lower back. Pain is mostly due to muscle spasm and edema, which are caused by the fracture. For patients with pelvic fracture, skin color is assessed for signs of possible hypovolemic shock. Urine is checked for blood which indicates possible damage to the urinary system or bladder. If the patient cannot void or empty the bladder, it may mean the bladder or urethra has been damaged.

The nurse determines that a 60-year-old obese patient with hip fracture may have a high risk of venous thromboembolism (VTE). Which factors increase the risk of VTE in the patient? Select all that apply.

Heart disease History of smoking Prolonged immobility Venous thromboembolism occurs when blood slows down or stagnates in the extremity and forms clots inside the blood vessels. Heart disease, a history of smoking, and prolonged immobility increase the likelihood of VTE in patients with fractures. An open fracture of the hip and an immunocompromised state does not contribute to the increased likelihood of development of VTE.

The incidence of what type of fracture is highest in older adults?

Hip The incidence of hip or proximal femur fracture is highest in older adults. Wrist fractures are usually seen in middle and late adulthood. Rib fractures are the most common type of fractures in adults. Femoral shaft fractures occur most often in young and middle-aged adults.

The nurse is attending to a patient with acute compartment syndrome (ACS). What physiologic changes are observed in with this condition? Select all that apply.

Increase in compartment pressure Release of histamine Pressure on nerve endings ACS is a serious condition where compartment pressure increases and reduces circulation to the affected area. The ischemic muscle tissue releases histamine, which increases capillary permeability. Plasma proteins leak into the interstitial fluid space and causes edema. Edema then causes pressure on the nerve endings. Capillary pressure increases due to dilation of the capillaries within the muscle. Lactic acid production is increased in the muscle.

Which physiological change related to compartment syndrome is responsible for symptoms of flexed posture and unequal pulses in a patient?

Increased production of lactic acid Increased production of lactic acid may result in flexed posture and unequal pulses. Anaerobic metabolism may cause cyanosis. Pain may result due to pressure on nerve endings. Increased capillary permeability would result in edema.

A patient is in skeletal traction. Which nursing intervention ensures proper care of this patient?

Inspect the skin at least every 8 hours. The patient's skin should be inspected every 8 hours for signs of irritation, inflammation, or actual skin breakdown. Weights are not allowed to be placed on the floor; weights should hang freely at all times. Pin sites should be checked for signs and symptoms of infection and for security in their position to the fixation and the patient's extremity. However, the nurse does not adjust the pins. Any loose pin site or alteration must be reported to the health care provider. Weights must never be removed without a request from the health care provider.

An older adult patient has had a right open reduction and internal fixation (ORIF) of a fractured hip. Which intervention does the nurse implement for this patient?

Keep the patient's heels off the bed at all times. Because the patient is an older adult and is more at risk for skin breakdown because of impaired circulation and sensation, the patient's heels must be kept off the bed at all times to avoid constant pressure on this sensitive area. Repositioning the older adult patient must be done every 2 hours, not every 3-4 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 patient typically would not experience pain upon breathing. Antiembolic stockings are not contraindicated for older adults; rather they help prevent deep vein thrombosis.

Which type of cast may be applied for a patient who sustains an unstable fracture of the ulna?

Long-arm cast A long-arm cast stabilizes an unstable fracture of the ulna. A short-arm cast immobilizes a stable fracture of the distal radius. A thumb spica cast immobilizes a fractured thumb. A hanging-arm cast is used for fractures of the humerus that cannot be aligned by a long-arm cast.

What is the major concern related to pelvic injury?

Loss of blood volume Pelvic injury most commonly results in venous oozing or arterial bleeding. Loss of blood volume due to pelvic injury leads to hypovolemic shock. AVN may cause death and necrosis of bone tissue, resulting in pain and decreased mobility. This problem is most likely seen in patients with displaced fractures of the femur. Chest trauma might increase the risk for developing pneumonia. Neurologic dysfunction can be seen when trabecular, or cancellous, bone within the vertebra becomes weakened and causes the vertebral body to collapse, resulting in compression fractures.

The nurse is assisting the orthopedic surgeon in the management of nonunion of a fracture of a patient. The patient receives low-intensity pulsed ultrasound and allografts from cadavers, which are frozen or freeze dried and stored under sterile conditions in a skin bank. Which procedure is the patient receiving?

Low-intensity pulsed ultrasound One of the newest modalities for healing fractures is the use of low-intensity pulsed ultrasound, or exogen therapy. Allografts from cadavers may also be used. These grafts are frozen or freeze dried and stored under sterile conditions in a bone bank. Autografts are chips of bone taken from the iliac crest, or other site, packed between the bone ends to facilitate union. A noninvasive, external electrical bone stimulation system delivers a small continuous electrical charge directed toward the non-healed bone.

What statements about amputation are correct? Select all that apply.

Lower extremity amputations are more common than upper extremity amputations. In a Syme amputation, most of the foot is removed but the ankle remains. Lisfranc and Chopart amputations are types of midfoot amputations. Lower extremity amputations are performed more frequently than upper extremity amputations. In the Syme amputation, most of the foot is removed but the ankle remains. Lisfranc and Chopart amputations are types of midfoot amputations. Traumatic amputations usually result from accidents and are often upper extremity amputations. Lower extremity amputations are more common in black and Hispanic populations due to the high incidence of diabetes and arteriosclerosis.

A 70-year-old male patient who underwent open reduction internal fixation (ORIF) surgery experiences a seizure after 24 hours. Which drug can cause seizures related to its toxic metabolites?

Meperidine Meperidine should not be used for pain management. Its toxic metabolites cause seizures and other adverse drug events, especially among older adults. Tramadol, ketorolac, and morphine are all employed in the management of post-operative pain. These do not cause any adverse reactions if administered in safely tolerated amounts.

An older adult patient is undergoing treatment for a fracture. Which pain medication must be avoided in this patient?

Meperidine Meperidine should not be used in older adult patients because it has toxic metabolites that can cause seizures and other complications. Oxycodone and oxycodone with acetaminophen are common oral opioid drugs that are effective for most patients with fracture pain. Morphine is often used for pain due to severe or multiple fractures.

The nurse is caring for an older patient post hip-repair surgery. What postoperative care must the nurse perform for this patient?

Monitor the patient frequently to prevent falls After hip repair, the older patient is at risk to experience acute confusion and delirium. The patient must be monitored frequently to prevent falls, especially when trying to get out of bed. The patient is encouraged to begin ambulating the day after surgery to prevent complications associated with immobility. The patient must be repositioned every 1 to 2 hours to prevent pressure ulcers. The heels of the patient must be kept off the bed at all times to prevent ulcer formation. The heels and other bony prominences should be inspected every 8 to 12 hours.

A patient has undergone a kyphoplasty. What discharge teaching does the nurse provide to the patient and family?

Monitor the puncture site for infection. The nurse should teach the patient and family to monitor the puncture site for infection, which may manifest as redness, swelling, pain, or drainage. The patient should keep the dressing dry and remove it the next day. The patient must not drive or operate machinery for 24 hours after surgery because of the effect of the drugs used during the procedure. The patient may start activities the day after surgery and slowly increase his or her activity level over the next few days.

A patient has undergone an elective below-knee amputation of the right leg as a result of severe peripheral vascular disease. In postoperative care teaching, the nurse instructs the patient to notify the health care provider if which change occurs?

Observation of a 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 patient. Absence of erythema and tenderness of the surgical site would also be normal findings for this patient. The patient should be able to flex and extend the right knee (limb) after surgery.

The nurse anticipates providing collaborative care for a patient with a traumatic amputation of the right hand with which health care team members? Select all that apply.

Occupational therapist Physical therapist Psychologist An occupational therapist and a physical therapist will help to enable the patient to become more independent in performing activities of daily living (ADLs). An amputation can be traumatic to the patient; loss of a body part should not be underestimated because the patient may experience an altered self-concept, so counseling support should be made available to the patient. The patient does not have a respiratory condition that warrants collaborative care with a respiratory therapist. A speech therapist is not indicated because the patient does not have speech impairment.

Which condition is the biggest risk factor for hip fracture?

Osteoporosis Osteoporosis is the biggest risk factor for hip fractures. Osteoporosis is characterized by the demineralization of the bones, making them porous and brittle. Anemia, atherosclerosis, and diabetes mellitus are not risk factors for hip fractures since these conditions may not show any effect on the demineralization of bones.

A 60-year-old male patient who underwent open reduction internal fixation (ORIF) complains of constipation. Which drug may have caused this complication?

Oxycodone Patients who have open reduction internal fixation (ORIF) surgery are usually prescribed analgesics. Constipation is a common side effect of opioid analgesics such as oxycodone, especially for older adults. Ketorolac, naproxen, and acetaminophen may also be used for analgesia but are not known to cause constipation.

Which motor clinical manifestation may be seen in a patient with complex regional pain syndrome (CRPS)?

Paresis Paresis, or weakness of the extremities, is a manifestation of abnormal motor perception in patients with complex regional pain syndrome (CRPS). Edema, a change in color of the affected skin, and excessive sweating are manifestations of the autonomic nervous system dysfunction seen in CRPS.

The serum calcium level of a patient with a femoral fracture is 12 mg/dL. What type of fracture does the nurse suspect that the patient has?

Pathological fracture A healthy adult's normal serum calcium level ranges between 9 and 10 mg/dL. An increase in the serum calcium level might be due to osteoporosis. Osteoporosis might lead to a pathological fracture. A fatigue, or stress, fracture is caused by excessive strain and stress on the bone; this fracture is commonly seen in recreational and professional athletes. A buckled fracture, also known as an impacted fracture, is one where bone fragments are driven into each other. This is commonly seen in arm fractures in children. A greenstick fracture is a fracture in a young, soft bone in which the bone bends and breaks.

What manifestation is usually seen in fat embolism but not in blood clot embolism?

Petechiae The assessment findings for blood clot embolism and fat embolism are nearly identical except for the presence of petechiae. Petechiae is a macular, measles-like rash, and may occur over the neck, upper arms, or chest and abdomen. Petechiae is not seen in blood clot embolism. Altered mental status, increased pulse, and dyspnea are seen in both cases.

Sensation that is felt in an amputated part immediately after surgery is known as which of the following?

Phantom limb pain Sensation that is felt in the amputated part immediately after surgery is referred to as phantom limb pain. It is more common in patients who have had chronic limb pain prior to surgery. A neuroma is a sensitive tumor consisting of damaged nerve cells. Flexion contractures of the hip or knee are seen in patients with amputations of the lower extremity.

Which statement is accurate about the types of tractions used for musculoskeletal trauma of the upper extremities?

Plaster traction may be employed for fractures of the wrist Plaster traction, or pins, inserted through the bone are fixed in the cast for fractures of the wrist. Skeletal traction is used for fractures of the humerus, with or without involvement of the shoulder and clavicle. 90-90 traction is employed for fractures of the humerus. Plaster traction is not employed for fractures of the humerus, but for the wrist.

Which long-term drug therapy increases the risk of developing ischemic bone necrosis?

Prednisone Patients on long-term corticosteroid therapy, such as prednisone, are at risk for ischemic necrosis. Ketorolac, ibuprofen, and acetaminophen do not increase the risk for developing ischemic necrosis.

Which description accurately defines a closed reduction?

Process where the ends of the bones are manually pulled and realigned Closed reduction involves applying a manual pull or traction to move the ends of a fractured bone to realign them. This is the most common nonsurgical method for managing a simple fracture. A commercial immobilizer or an elastic bandage is used to keep the scapula or clavicle bone in place during healing. A fiberglass synthetic cast is used to immobilize the extremity if the fracture is complex. Moderate sedation or analgesia is used during a closed reduction to reduce pain.

Which is the priority intervention in the management of a patient with complex regional pain syndrome (CRPS)?

Relieving pain Complex regional pain syndrome (CRPS) is a musculoskeletal disorder that manifests as unrelenting pain, possibly interfering with a patient's daily activities. Therefore, the priority intervention in CRPS management is pain relief so that the patient can resume normal activities. Paresis, edema, and muscle spasms can be managed once the pain is managed.

The x-ray report of a patient shows a fracture at the femur. The nurse anticipates that which type of traction will be prescribed to reduce muscle spasm and tissue damage?

Russell's traction Russell's traction is a skin traction that stabilizes and aligns the lower extremities after a fracture. Russell's traction also reduces muscle spasm and tissue damage. A 90-90 traction is used for humerus fractures. Cervical halter traction is used for cervical muscle spasms. Plaster traction is beneficial for a patient who has a wrist fracture.

Which type of traction is used to correct bone deformities of the lower extremities?

Russell's traction Russell's traction is a type of lower extremity traction in which the affected leg is extended and a sling under the knee suspends the leg. A pelvic belt is a type of pelvic traction in which a strap around the hips at the iliac crests is attached to weights at the foot of the bed. A pelvic sling is a type of pelvic traction where a wide strap around the hips is attached to an overhead bar to keep the pelvis off the bed. Overhead, or 90-90, traction is a type of upper extremity traction where the elbow is flexed and the arm is at a right angle to the body over the upper chest.

A patient has sustained a metatarsal fracture. Which type of cast would be used to immobilize a patient who has a metatarsal fracture?

Short-leg cast (SLC) A short-leg cast (SLC) is used for fractures of the ankle, metatarsals, and foot. A leg cylinder cast immobilizes stable fractures of the tibia, fibula, and knee. A long-leg cast (LLC) is used for unstable fractures of the tibia, fibula, and ankle. A long-leg cylinder cast immobilizes stable fractures of the distal femur, proximal tibia, and knee.

Which type of cast is used to immobilize an unstable fracture of the humerus?

Shoulder spica cast A shoulder spica cast is considered ideal for an unstable fracture of the humerus for proper support. A long-arm cast stabilizes an unstable fracture of the ulna. A short-arm cast immobilizes a stable fracture of the distal radius. A hanging-arm cast is used for fractures of the humerus that cannot be aligned by a long-arm cast.

Which type of fracture may occur when a person attempts to break a fall by landing on the heel of the hand when the wrist is flexed?

Smith fracture A Smith fracture commonly occurs when a person attempts to break a fall by landing on the heel of the hand when the wrist is flexed. Colles', phalangeal, and metacarpal fractures are not likely to occur when an attempt is made to break a fall by landing on the heel of the hand when the wrist is flexed.

A patient with bone cancer is most susceptible to what type of fracture?

Spontaneous fracture A patient with bone cancer is prone to spontaneous, or pathologic, fractures. Spontaneous fracture occurs after minimal trauma to a bone that has been weakened by disease. A simple fracture is a fracture in which there is no external or visible wound and it does not extend through the skin. A compound fracture is a fracture in which the skin surface over the broken bone is disrupted causing an external wound. A stress fracture is caused from excessive strain and stress on the bone, which is commonly seen among athletes.

In which stage of bone healing is callus formed?

Stage three Stage three of bone healing occurs as a result of vascular and cellular proliferation. The fracture site is surrounded by new vascular tissue known as callus. In stage one, a hematoma forms at the site of the fracture because the bone is extremely vascular. In stage two, granulation tissue begins to invade the hematoma and prompts the formation of fibrocartilage. In stage four, the callus formed in stage three is gradually resorbed and transformed into bone.

Which organism is commonly responsible for hospital-acquired infections and is often the causative agent in osteomyelitis?

Staphylococcus aureus Staphylococcus aureus is the organism most commonly involved in nosocomial infections (hospital-acquired), such as methicillin-resistant Staphylococcus aureus (MRSA). Bone infection, or osteomyelitis, is most common with open fractures, when skin integrity is lost after surgical repair of a fracture. For patients experiencing this type of trauma, the risk for hospital-acquired infections is increased. These infections are common, and many are from multidrug-resistant organisms, such as methicillin-resistant Staphylococcus aureus (MRSA). Streptococcus mutans, salivarius, and lactobacillus acidophilus are not commonly associated with nosocomial infections.

What might be the consequence of early ambulation of a patient who underwent open reduction internal fixation (ORIF) surgery?

Surgical site healing Early mobility and ambulation increases surgical site healing and reduces the chance of surgical site infection. The patient begins to move with assistance the day after surgery to prevent any complications associated with immobility, such as atelectasis and venous thromboembolism.

Which intervention does the nurse suggest to a patient with a leg amputation to help cope with loss of the limb?

Talking with an amputee close to the patient's age who has had the same type of amputation Meeting with someone of a comparable age who has gone through a similar experience will help the patient cope better with his or her own situation. Drawing a picture is not therapeutic and may cause more harm than good. Unless the patient is having serious maladjustment problems or has a coexisting psychological disorder, meeting with a psychiatrist should not be necessary. Diversional activities do not help the patient deal with loss of the limb.

Which clinical sign of complex regional pain syndrome (CRPS) does the nurse know to be a manifestation of the sensory perception abnormalities seen in this syndrome?

Unrelenting burning pain Intense burning pain is a characteristic feature of complex regional pain syndrome (CRPS) and is considered an abnormality in the sensory perception caused by disease pathology. Change in color, excessive sweating, and change in temperature over the affected area are manifestations of the autonomic nervous system dysfunction seen in CRPS.

For what type of fracture is physical assessment done with the patient in a sitting or standing position?

Upper arm The patient with a fracture of the upper arm and shoulder is assessed in a sitting or standing position to observe for drooping shoulder or other abnormal positioning. If the patient has a fracture in a more distal area of the arm, the patient is placed in a supine position with the extremity elevated to reduce swelling. The patient with a fracture of the leg or pelvis is also placed in a supine position for assessment.

A patient has a grade III compound fracture of the right tibia. To prevent infection, which intervention does the nurse implement?

Use strict aseptic technique when cleaning the site. Using aseptic technique is the best way to prevent infection. Chlorhexidine, 2 mg/mL solution, is the better cleansing solution for pin site care, not bacitracin ointment. A wound of this type should be kept covered, not left open to the air. The wound site of a compound fracture must not be exposed to a shower; this practice violates maintaining aseptic technique.