Complications of Fractures
Name complications that can occur with fractures
- Compartment syndrome
- Osteomyelitits
- Fat embolisms
Pain management & preventative measures of DVTs
▪ Compression Stockings
▪ Blood thinners
Purpose of skin traction
Reduces & prevents painful muscle spasms
Stabilizes and realigns bones
Corrects stiff muscles, tendons, and skin
What is osteoporosis
When bone mass and density of bone decrease
S/S of a MI
- Chest pain: substernal or precordial (Can radiating down the shoulder or arm, or present as jaw pain)
▪ Can be described as pressure on chest
- Dyspnea
- Anxiety, feeling of impending doom
- Epigastric distress
Percutaneous Coronary Intervention (PCI): Nursing Interventions
Non surgical procedure normal activity within a few hours. A balloon is inflated to dilate the artery sometimes a stent is placed to hold the artery and prevent restenosis
Pathophysiology of compartment syndrome
Damage or destruction on nerve or blood vessels that result in swelling & edema
pain management & preventative measures of infections
antibiotics before & after surgery
Complications of skin tractions, splints, bandages, & adhesive tapes near fractures
- Skin breakdown (pressure sores/allergic reaction)
- Nerve damage (peroneal nerve palsy)
- Circulatory impairment
Osteoporosis prevention
- Exercises- weight bearing/walking
- Calcium and vitamin D supplements
- Sunlight
- Regular intake of calcium rich foods and vit D foods
Atypical Manifestations for women
o Indigestion
o Nausea
o Weakness
o Palpitations
o Numbness
Acute Coronary Syndrome (ACS) Clinical Manifestations
ACS unstable angina, NSTEMI, STEMI
Combination of symptoms
S/S of compartment syndrome
- swelling
- pain (new onset, severe)
- muscle weakness (paresis)
- Tingling & numbness (Paresthesia)
- diminished pulses
- cool limb distal to fracture (Polar)
- pale limb distal to fracture (Pallor)
Pain management & preventative measures for Dislocation of Prosthesis
Maintain abduction immediately after surgery (abduction pillow should not be removed)
Discharge education to avoid bending more than 90 degrees, crossing legs, and twisting or pivoting at the hips
Purpose of skeletal traction
Used to realign and allow fracture to heal properly
Osteoporosis treatment
Calcitonin
- Estrogen
- Calcium
- Vitamin D
- Raloxifene prevents breast cancer but increases risk of DVTs
- Alendronate- take weekly in the morning with a full glass f water on an empty stomach and sit up afterwards
Pathophysiology of an MI
plaque rupture and thrombus formation results in complete occlusion of the artery, lead to ischemia and necrosis of the myocardium
What does P wave represent
atrial depolarization
What are the 6 P's of compartment syndrome
Pain (new onset severe pain)
▪ Paresis (muscle weakness)
▪ Paresthesia (tingling and numbness)
▪ Pulses- diminished
▪ Polar (cool limb distal fracture)
▪ Pallor (pale limb distal fracture)
Pain Management for fractures
RICE
- Rest
- Ice
- Compress
- Elevate
Complications of skeletal traction
Atelectasis and pneumonia
Constipation and anorexia
Urinary stasis and UTI
DVT
Infection biggest risk due to skeletal traction being invasive
Diagnosis of Osteoporosis
Dexa Scan
MI Causes
- decreased O2 Supply
- Vasospasm
- Increased demand of oxygen ( rapid heart rate, cocaine use)
What does QRS complex represent
ventricular depolarization and atrial repolarization
Treatment for Compartment Syndrome
▪ Remove cast
▪ Fasciotomy
Complications of casting
Unpleasant odor, drainage, or fever that indicate infection
Pin site care (when does it start, what to watch for, and how to clean)
- Starts after 48-72 hours
- Every 8 hours nurse should inspect for signs reaction (redness, warmth, serosanguinous drainage)
- Chlorhexidene is used unless a reaction occurs other than that saline solution can be used.
Osteoporosis Risk Factors
- Alcohol use- excess alcohol interveres with the balance of calcium
- Corticosteroids- reduce the body ability to absorb calcium and increase how fast bone is broken down
- Low calcium- caffeine and some medications like diuretics cause loss of calcium
- Estrogen low- leads to more bone resorption than formation
- Smoking- active or passive affects the body ability to absorb calcium
- Sedentary lifestyle- immobility depletes bone
- Older adult women- lose bone due to loss of estrogen after menopause
Nursing Assessment for MI
include careful history of the patient’s condition and the factors that may have caused the symptoms.
▪ What was the patient doing before symptoms started?
▪ What objective and subjective symptoms is the patient experience
Each symptom should be evaluated for time duration factors that relieve
Watch for
▪ SOB
▪ LOC changing
▪ Vomiting
▪ Pallor and cool clammy skin
What does T wave represent
ventricular repolarization
Fat embolism risk factors
- Long bone fractures
- pelvic fracture
Focused assessment done before casting
Skin neurovascular assessment prior to casting
What to do if skin tinting over pins occurs
Massage skin to loosen it around the pins, clean site
Osteomalacia interventions
- Surgery to correct bone deformities in severe cases
- Wear brace to reduce or prevent bone irregularities
- Adequate exposure to sunlight
Nursing Interventions for MI
- give O2
- manage pain
- Bed rest/semi fowlers position
- 12 lead ECG
- troponin levels
- Vital signs
- reduce anxiety
▪ Increase Heart Rate
▪ Chest Pain
▪ Increase Respiratory Rate
▪ Hypoxia
▪ Dyspnea
▪ Confusion
▪ Petechia on face, neck, chest (hallmark difference between pulmonary and fat embolism)
Education on casting
- No sharp object down the cast
- You want to prevent denting
- Let the cast completely dry only use palm of hands to move it
Nursing interventions for amputations
No pillow under leg
Prone position for short periods
Compression dressing
Be gentle with handling limp
S/S of Carpal Tunnel
Numbness
tingling
burning
pain but primarily in the thumb, middle, and ring fingers
Angina Causes
- atherosclerotic disease
- obstruction of one of the major coronary artery
Treatment for fat embolisms
- Oxygen
- Hydration
- Corticosteroids for inflammation
Indications for amputations
Relieve symptoms
Improve function
Save/improve quality of life
Risk Factors of carpal tunnel
- Wrist injury
- More common in women
- Work place factors (repetitive motions)
- Fluid retention
Stable angina
predictable and consistent pain that occurs on exertion and is relieved by rest and/nitroglycerin
What is Osteomyelitis and what Causes it
Infection in the bone
Causes
Endogenous
- Spread of bloodborne infection
Exogenous
- Contamination of an open fracture or surgical
- Puncture wound from animal or human bite
Management for acute amputations
pressure to bleeding site
elevate limb above level of heart
wrap severed body part in gauze
Put on ice
Definition of a sprain
tear of the ligament
Unstable Angina
symptoms increased in frequency and severity, may not be relieved with rest or nitroglycerine
Treatments for osteomyelitis
Antibiotics prolonged course
Surgery: debridement, amputation
Hyperbaric oxygen therapy
Treatment for phantom limb pain
Calcitonin, gabapentin, pregabalin, baclofin, heat, massage, acupuncture, therapy, relaxation
Definition of a strain
stretching of a muscle and fascia sheath
Complications of Osteomyelitis
Chronic Osteomyelitis - the infection never goes away. Patient will have bone pain and recurring drainage like pus.
Complications of amputations
Hemorrhage
Infection
Skin breakdown
Phantom limb pain
Joint contracture