Unit 3

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Unit 3
2012-04-26 16:52:45

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  1. What is a possible early complication of a compound or crushing fracture of a long bone?
    Fat embolus
  2. Whta is a late sign of compartment syndrome?
  3. How can the nurse best assess circulation to an extremity of a patient with a lower leg fracture?
    By having the pt wiggle his toes
  4. What is an unusual odor under a cast an indication of?
    An infection
  5. When fracture fragments heal in improper alignment what would the nurse expect to see?
    external deformity of involved extremity
  6. What position should an extremity be kept in after an ORIF
  7. After hip surgery the patient must:
    • use walker for balance
    • not bear weight on afffected side
    • not dangle legs or sit in a chair
    • aviod flexion on the hips
  8. What is it called when opposing joint surfaces are no longer in contact?
  9. What are the symptoms of a fat embolism?
    • tachycardia
    • red-brown nonpalpable petechiae over upper body
    • hypoxia
    • diffuse rales and rhonchi
  10. What are the risk factors for hip fractures
    • low bone mass and increasing age
    • genetic factors that influence low bone mass
    • low body weight
    • physical inactivity
    • low calcium intake
    • inadequate levels of serum vitamin D
    • smoking
    • ETOH consumption
  11. What are more than 90% of hip fractures caused by?
  12. What are environmental risk factors for falls?
    • Loose carpeting
    • poor lighting
    • slippery floors
    • slippery tub or shower
    • irregular pavement
    • loose clothing or footwear
  13. How are fractures classified?
    • Intracapsular (located within the joint capsule)
    • Extracapsular (located outside the joint capsule)
  14. Describe femoral neck fratures
    most common in frail adults, females and adults with osteoporosis (mild trauma causes this)
  15. what are intertrochanteric fractures
    between the femoral neck and the greater trochanter (caused by mild trauma)
  16. what are subtrochanteric fractures
    Seen in males and vigorous older adults (caused by great traumatic force)
  17. what are the clinical manifestations of a hip fracture
    • shortened leg and an externally rotated hip
    • deformity may be evident in lateral hip if the fracture is displaced
    • localized hip pain
    • difficulty bearing weight on limb
  18. What nursing care do you do post op for a hip fracture
    • compare peripheral pulses in affected extremity to the uneffected extremity
    • recognize abnormal data
    • assess clients mobility
    • assess client's self care needs
    • neurovascular checks
    • skin integrity
    • I's & O's
  19. What are some complications after hip surgery
    • DVT - Use heparin, SCD, TED hose
    • pressure ulcers - turn, bony areas cushioned, pressure reduction bed
    • Acute confusion - delirium, monitor meds
    • Infection (osteomeylitis)
    • bladder infection (from immobility)
    • Dislocation and subluxation
  20. What are some long term complications after hip surgery
    • fractures
    • nonunion of bone
    • loosening of the femoral and acetabular components
    • bone infection
  21. What type of diet should the client have after a hip fracture
    High carb, high protein to assist with healing
  22. What are the favorable factors affecting bone healing?
    • Location (good blood supply at bone ends, flat bones)
    • Minimal damage to soft tissue
    • anatomic reduction possible
    • effective immobilization
    • weight-bearing on long bones
  23. What are unfavorable factors affecting bone healing?
    • Fragments widely separated
    • Fragments distracted by traction
    • severly comminuted fracture
    • severe damage to soft tissue
    • bone loss from injury or surgical excision
    • motion/rotation at fracture site as result of inadequate fixation
    • infection
    • location
    • impaired blood supply
    • smoking, ETOH
  24. What are the signs and symptoms of a fracture
    • deformity
    • swelling
    • bruising
    • muscle spasms
    • tenderness
    • pain
    • loss of function
    • neurovascular changes (tingling no palpable pulse)
    • shock
  25. How do you classify fractures
    • Open (break in skin over bone)
    • Closed (intact skin over site of injury)
  26. What is reducing a fracture?
    Reduction or bone setting - manipulate bone to restore alignment, position and length (allieviates compression or stretching of nerves and blood vessels)
  27. What is a closed reduction
    manual traction to restore bone alignment done by provider. Immobilization device placed after x-ray confirms bone alignment.
  28. what is an open reduction and internal fixation
    surgical procedure where fracture fragments are realigned. Screws, plates, pins and wires are used to maintain alignment of fragments. Rods also used
  29. what is external fixation
    If soft tissue damage preludes use of cast, external fixation would be indicated. Maintains position for unstable fracture and weakened muscles.
  30. what is a traction
    application of a pulling force to an injured body part or extremity while a counter-traction pulls in opposite direction. Pulling force can be hands or weights (buck's or russell)
  31. What is the purpose of a traction
    • reduce and realign
    • promote healing of fractured bones
    • decrease muscle spasms
    • prevent soft tissue damage through immobilization
    • prevent deformities
  32. What is a skin traction
    Application of a pulling force directly to skin through skin strips or boots or foam splints (Buck's is most common) should be used temporarily
  33. What are some complications after fractures
    • nerve injury
    • compartment syndrome
    • volkmanns contrature
    • fat embolism syndrome
    • DVT and PE
    • infection
    • cast syndrome
  34. What are some long-term complications of fractures
    • joint stiffness or traumatic arthritis
    • avascular necrosis
    • nonfunctional union, malunion (improper alignment), delayed union (slowed), nonunion (healing did not occur) and fibrous union
    • complex regional pain syndrome
  35. What is windowing
    cutting into the cast to see wounds under the cast or remove drains and pulse assessment
  36. what is bivalving
    cutting along both sides and then splitting it to decrease the pressure on underlying tissue
  37. What do you want to do in the neurovascular assessment
    • Assess circulatory (color, warmth, pulses, cap refill)
    • Nerve function (movement of distal fingers or toes, awareness of light touch)
    • assessment of pain
    • assessment of cast
  38. what needs to be assessed in the assessment of the cast
    • skin around cast edges for swelling
    • cast itself
    • hot spots (indicate infection or tissue necrosis)
    • wet spots (drainage)
    • stains (outline, time and date could be drainage or bleeding)
    • smell - infection/perspiration
    • pain
  39. What do you assess about compartment syndrome
    • assess for tingling or parasthesia in effected extremity
    • muscle strength and motion
    • circulation
    • pulses distal to injury
    • cap refill
    • skin color and temp
    • Increase tenseness and erythema of skin also suggests increasing compartment pressures
    • paralysis is late sign of comparment syndrome
    • irriversible after 24 hrs, nerve damage after 12-24 hrs
  40. What interventions should be performed for clients in casts
    • elevate extremity higher than client's heart for 1st 24 to 48 hours
    • place effected extremity on pillows
    • prevent foot drop
    • apply ice bags around cast
    • relieve pressure at edges of ast
    • position changes q 2 hours