Strains and Sprains, Fractures
What treatment is used for first and second degree sprains/strains?
R.I.C.E.
rest for 72 hours
ice for 30 minute increments up to 5 times a day
compression with ace wrap or similar compression device to minimize swelling (check circulation)
elevate the limb on a couple pillows to aid in decreasing the swelling
Classification of fractures:
Define incomplete:
the break does not go through the entire bone
Patterns of Fractures:
compression
excessive force along the axis causing it collapse in on itself
Types of Fractures:
impacted
segments of bone are wedged into each other at the fracture
can you as a nurse, adjust the weights, ropes, knots, or anything on a patients traction device?
not without specific orders from a physician. weights must hang freely, ropes remain unobstructed, knots cannot touch the pulley or be at the foot of the bed
What is P.R.I.C.E. and how is it different from R.I.C.E.?
P stands for protection and this is the use of braces and splints to protect the extremity
Classification of fractures:
Define closed, displaced and non-displaced:
closed means the skin is not broken
displaced means the break forced the halves to separate and move away from each other
non-displaced means the break did not move the bone halves away from each other
Patterns of Fractures:
depressed
bone is forced inward, usually found on skull or face from blunt force trauma
Clinical manifestations of fracture include...
pain, swelling, muscle spasms, deformity, ecchymosis, crepitus (grating sound/feeling in the fracture)
How would you assist patient to adjust with traction in place?
an overhead trapeze
What is the treatment options for third degree sprains/strains?
All of the treatment options for 1st and 2nd but 3rd may require surgery
Classification of fractures:
Define open, types 1-3:
1: puncture wound with minimal soft tissue damage
2: fragments of broken bone and moderate skin and muscle contusions, and/or significant wound contamination
3: severe damage, extreme contamination, and possible numerous fractures
Patterns of Fractures:
green stick
incomplete disruption of bone in which one side of the bone is bent and the other is fractured. usually seen in children. looks like a toothpick sticking out to the side
Whats the difference in an external fixation and an internal fixation?
external fixation is the use of rods and pins placed outside of the break to secure the bone fragments in place. mostly used when there is extensive soft tissue damage
internal fixation is when the surgeon places plates, screws, rods and other hardware to realign bone fragments.
How would you care for the patients limb that is hooked up to traction?
wound care for the pins and screws that are embedded, maintain skin integrity and prevent infection, 6 P's of the neurovascular assessment
Fractures are more common in which age groups?
younger and older. the bones are more porous, less bone density, and areas of weakness
Patterns of Fractures:
avulsions
the over stretching, tearing of a ligament of tendon resulting in a small portion of bone separating at the insertion sight
Types of Fractures:
oblique
fracture crosses the bone at a 45 degree angle
pros and cons of external fixation devices
pros: immediate fracture stabilization, minimize blood loss, increase patient comfort, improved wound care, earlier mobility and weight bearing on limb
cons: increased risk of infection at pin sites
what are the 6 P's fo the neurvascular assessment?
pain, pallor, pulselessness, poikolothermia, paraesthesia, possible paralysis
Classification of fractures:
Define complete:
a break spanning the entire width of the bone, separating the halves
Patterns of Fractures:
comminuted
several disruptions producing several bone fragments
Types of Fractures:
spiral
fracture wraps around the shaft of the bone
What are the goals of traction? (4)
reduce pain
reduce muscle spasms
maintain alignment
prevent deformities
What meds are used to treat fractures?
narcotics (possibly a PCA pump), anti-inflammatories, antibiotics (if open fracture or surgery), tetenus shot (if at risk of bacterial infection)