Don't move
Pull on it
What else can go wrong?
It's broken!
Hodge Podge
100
Accomplished by bringing the bone fragments together in alignment through manipulation and manual traction.
What is closed reduction. The extremity is held in the aligned position while a cast or splint is applied.
100
Used to control muscle spasms and to immobilize fractures of the proximal femur prior to surgery. It is applied to the skin.
What is Buck's traction. A type of skin traction used temporarily before surgical fixation. Usually 5-8 lbs of weight is used, depending on the weight of the patient.
100
Muscle atrophy and loss of strength related to immobilization in a cast, splint or other orthopedic device.
What is disuse syndrome. The pt needs to perform isometric exercises (contraction or tensing of muscles) to prevent this. Isometric exercises should be performed once an hour while awake.
100
A fracture that remains contained, with no disruption of skin integrity.
What is a simple fracture. AKA: closed fracture
100
The nurse performs meticulous pin site care per MD order or hospital policy. At discharge, the RN would teach the patient to perform "clean" technique care, but report these signs of a potential infection.
What are redness, increased tenderness (or pain), warmth, purulent drainage from site, fever. The patient needs to be instructed to immediately report these finding to the HCP for a treatment plan. With drainage remember: COCA
200
The fracture fragments are anatomically aligned via surgery.
What is an open reduction. Internal fixator devices (pins, screws, nails, plates, rods) may need to be used to hold the bone fragments in place.
200
A metal pin or wire is inserted through the bone, distal to the fracture. Pull is applied directly to the bone.
What is skeletal traction. Used often with fractures of the femur, tibia and cervical spine. The orthopedic surgeon applies skeletal traction using surgical asepsis. After insertion, the pin or wire is attached to the traction apparatus.
200
Bony prominences are at risk if a cast or splint are too tight.
What is a pressure ulcer. May also occur over soft tissue areas if the device is incorectly applied. Pt may c/o tightness and pain. Area on the cast may feel warm and there may be drainage noted on the surface of the device. If not corrected, necrosis may occur. Bivalving the cast can be done.
200
Damage also involves the skin or mucous membranes. The bone may protrude through the soft tissue.
What is an open fracture. AKA: complex or compound fractures. Can range from clean small breaks in the skin to large very dirty/contaminated wounds.
200
The nurse will assess the patient in traction for potential complications of immobility: List 4
What are *atelectasis (incomplete expansion or collapse of alveoli), *respiratory secretions will pool (increasing risk of resp. infections), *venous stasis: DVT *atrophy of muscles (at least weakness), *constipation (slowed GI motility), + lack of apetite *urinary statis (urine remains in the renal pelvis an ureters longer and favors bacterila grwoth causing UTIs), *psychosocial issues (disturbed sleep pattern, impaired social interaction, diminished self esteem, depression)
300
The nurse should tell the patient that this type of immobilization device will give off heat when it is applied and is drying.
What is a fiberglass cast. The heat can be uncomfortable for the patient. Fiberglass casts will reach full rigid strength within minutes.While it is "setting", it must be handled with the palms of the hand because it will dent. Do not rest it on hard surfaces while drying.
300
The wounds at pin insertion sites require fastidious care by the nurse. The nurse knows that this patient is at high risk for this type of infection.
What is osteomyelitis. For the 1st 48hrs pins are covered with sterile dsg. After that time period, typically the sites will be left open to air with pin site care 1-2 times a day. The nurse must inspect the pin sites Q8H. This applies to both skeletal traction and external fixators.
300
Increased tissue pressure within a limited space, that compromises circulation and function of tissue within the confined area.
What is Compartment Syndrome. Edema is a natural response to trauma. Edema may make a cast or splint too tight causing vascular insufficiency and nerve compression. Can also occur in anatomic compartments from musculoskeltal trauma simply related to a sudden and severe decrease in bld flow to tissues distal to the injury. Severe tissue damage and loss are a risk.
300
One side of the bone is broken and the other is not.
What is a Greenstick fracture. AKA: incomplete fracture. A break through only one part of the cross-section of the bone.
300
This is the correct height for elevating an extremity (casted, splinted, externally fixated), to aid in decreasing edema.
What is no higher than heart level. This will enhance arterial perfusion, and control edema. Too high will impair arterial circulation to the body part.
400
The nurse knows that this will be needed with an open, comminuted fracture to immobilize the fracture and allow access to damaged soft tissue.
What is an external fixator. The fracture is reduced, aligned and immobilzed by pins that are inserted into the bone. Pins maintain their position by being attached to an external, portable frame. The fixator is removed when the soft tissue damage heals.
400
The nurse will assess cap refill, sensation, movement, pulse and temperature often in an extremity that is immobilized by traction (or in a cast). This type of assessment is called:
What is a neurovascular assessment. DVT is a HUGE risk for these immobilized patients. Isometric exercises are helpful to decrease venous stasis. Anticoagulant therapy is often ordered.Any abnormality must be reported immediately.
400
Risk with long bone & pelvic fractures, crush injuries. Very sudden onset of hypoxia, tachypnea and tachycardia. Life threatening.
What is a Fat Embolism. More frequently with younger adults (<40) and men. And with multiple fractures. Fat globules are released from the marrow into the vascular compartments and may occlude vessels that supply lungs, brain, kidneys, etc. Very rapid onset of symptoms & is life threatening. Other s/s: restlessnes, irritablility, crackles, wheezes. Onset typically within 12-48hrs of injury, but may be later.
400
The bone has splintered into fragments.
What is a comminuted fracture. Typically requires open reduction with internal or external fixation.
400
A patient presents with a dirty open/compound fracture of their tibia/fibula (tib/fib). In addition to providing care for the fractured bones, soft tissue and comfort, the RN would assess the patient's need for:
What is a tetanus booster. If the last known booster was administered >5 years ago.
500
A plaster cast takes this long to dry completely, depending on the thickness and environmental conditions.
What is 24-72 hours. A newly applied plaster cast should be exposed to circulating air to dry and should not be covered or placed on hard surfaces. Handle with palms of hands until dry. A wet plaster cast is dull/gray. Will become white/shiny when it is dry.
500
These are 4 principles of effective traction. (There are more than 4!)
What are: 1) must be continuous to be effective 2) skeletal traction is NEVER interrupted 3) weights are not removed unless ordered 4) pt must be in good/proper body alignment 5) the ropes must not be impeded 6) weights MUST hang freely 7) knots in the ropes must not be tangled in the pulley 8) ***When traction is applied, there must be counter-traction too- usually the pt's own body weight and bed postion. (You don't want the poor pt being pulled out of the bed!)
500
The 5 "P"s that are typically evident in Compartment Syndrome.
What are Pain, Paralysis, Paresthesias, Pallor, Pulselessness Deep throbbing pain that is unrelenting. Burning or numbness/tingling. Motor weakness is a late sign. No movement indicates nerve damage. Color (pallor) and pulslessness indicate impaired circulation. Cyanotic nail beds.
500
Seen commonly in women with osteoporosis- in their vertebrae.
What is a compression fracture. May be asymptomatic and be associated with loss of height and respiratory dysfunction (kyphosis).
500
ORIF
What is open reduction with internal fixation. You see this acronym on OR schedules and in patient charts all the time.
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