Fractures
The difference between an open fracture and a closed fracture.
An open (compound) fracture breaks through the skin, causing an open wound with a risk for infection.
A closed (simple) fracture does not break through the skin.
List 2 types of immobilization devices
Braces, casts, splints, traction, external fixation, internal fixation, orthopedic shoes/boots.
**casts and traction should be your focus for the exam.
Risk factors for amputation
Traumatic injury (MVA, work-related, war-related)
Thermal injury (frostbite, burns...)
Malignancy
Chronic disease (PVD, diabetes, osteomyelitis)
Pain and numbness caused by compression of the median nerve in the wrist from swollen or thickened synovium.
BONUS!!! Name 3 nursing cares/post-op cares/patient education points.
Carpal Tunnel Syndrome.
Nursing care: NSAIDs for pain, steroid injections, splint for immobilization, yoga/exercise, carpal tunnel release to decompress pressure on the nerve.
Post-op care: VS, dressing check for drainage and tightness, hand elevation, neuro checks every hour, pain meds, assist with personal care.
Patient education: restrict hand movement and heavy lifting - how long?, weakness and discomfort - how long?, report increase in pain and changes in neurovascular status.
Which medication would the nurse administer first to a patient recovering from an above-the-knee amputation of the right leg that is complaining of pain in the right foot?
IV morphine
PO acetaminophen
PO ibuprofen
IV calcitonin
IV calcitonin.
IV calcitonin during the first week after amputation can help reduce phantom limb pain. Oral ibuprofen and acetaminophen are not used in treatment of phantom limb pain. Opioids like morphine are more effective for residual limb pain.
Name 3 risk factors for fractures
Falls, osteoporosis, MVA, bone cancer, physical abuse, age, substance use, contact sports
What type of diet will help aid in bone healing?
A diet high in protein and calcium.
Vital signs, assess site for bleeding.
Monitor tissue perfusion.
Monitor for infection - what could this lead to?
Prevent post-op complications - what might these be?
What is a strain, and how do you care for one?
Excessive stretch or pull of muscle or tendon. May be caused by fall, heavy lifting, exercise.
Cold, then heat application, light exercise with limitations, anti-inflammatories and muscle relaxants, surgical repair if third-degree strain with ruptured muscle or tendon.
A nurse delegates care of a patient in traction to a UAP. Which statement would the nurse include when delegating hygiene care for this patient?
“Remove the traction when re-positioning the patient.”
“Inspect the patient’s skin when performing a bed bath.”
“Provide pin care by using alcohol wipes to clean the sites.”
“Ensure that the weights remain freely hanging at all times.”
“Ensure that the weights remain freely hanging at all times.”
Traction weights should be freely hanging at all times. They should not be lifted manually or allowed to rest on the floor. The patient should remain in traction during hygiene activities. The nurse would assess the patient’s skin and provide pin and wound care for a patient who is in traction; this would not be delegated to the UAP.
How do you handle a wet plaster cast?
Handle cast with palms to prevent denting, use a cloth-covered pillow to elevate extremity to promote drying.
What is included in the neurovascular assessment and when are they done?
Neurovascular assessments are done every hour for the first 24 hours, then every 1-4 hours. They include: pain, sensation, skin temperature, capillary refill, pulses, and movement.
Patient education for residual limb and prosthesis.
Wrap residual limb
Perform limb-strengthening exercises
Properly apply and care for prosthesis
Use mobility devices and adaptive aids to safely transfer
Manage phantom limb pain
What is a sprain, and how do you care for one?
Excessive stretching of a ligament caused by twisting from a fall or sports activity.
Mild sprains - RICE (what does this stand for)?
Possible immobilization and partial weight bearing
A nurse cares for an older adult patient who is recovering from a leg amputation surgery. The patient states, “I don’t want to live with only one leg. I should have died during the surgery.” How would the nurse respond?
“Your vital signs are good, and you are doing just fine right now.”
“Your children are waiting outside. Do you want them to grow up without a father?”
“This is a big change for you. What support system do you have to help you cope?”
“You will be able to do some of the same things as before you became disabled.”
“This is a big change for you. What support system do you have to help you cope?”
The patient feels like less of a person following the amputation. The nurse would help the patient to identify coping mechanisms that have worked in the past and current support systems to assist the patient with coping. The nurse would not ignore the patient’s feelings by focusing on vital signs. The nurse would not try to make the patient feel guilty by alluding to family members. The nurse would not refer to the patient as being “disabled” as this labels the patient and may fuel the patient’s poor body image.
Important nursing action when it comes to skeletal traction.
Make sure that the weights are hanging freely and are not resting on the floor.
What else will you do?
List 2 complications of fractures.
Compartment syndrome, fat embolism, DVT, PE, osteomyelitis, avascular necrosis.
Patient feelings regarding amputation and nursing interventions.
Nursing interventions: assess psychosocial well-being of patient, assess for self-esteem, assess willingness to rehab, facilitate a supportive environment for patient/family to process grief, refer to counselor, social worker, religious adviser.
Name of test used to help with diagnosis of carpal tunnel syndrome.
BONUS! How do we test for this?
Phalen's Test
Ask patient to place backs of hands together and flex wrists at the same time for 1 minute.
Considered positive if patient experiences paresthesias in thumb, index, middle finger and half of ring finger.
A trauma nurse cares for several patients with fractures. Which patient would the nurse identify as at highest risk for developing deep vein thrombosis?
An 18-year-old male athlete with a fractured clavicle
A 36-year-old female with type 2 diabetes and fractured ribs
A 55-year-old woman prescribed aspirin for rheumatoid arthritis
A 74-year-old man who smokes and has a fractured pelvis
A 74-year-old man who smokes and has a fractured pelvis
Deep vein thrombosis (DVT) as a complication with bone fractures occurs more often when fractures are sustained in the lower extremities and the patient has additional risk factors for thrombus formation. Other risk factors include obesity, smoking, oral contraceptives, previous thrombus events, advanced age, venous stasis, and heart disease. The other patients do not have risk factors for DVT.
Types of medications we give to patients with fractures.
Analgesics - opioids and non-opioids. If your patient has multiple fractures, what do you suppose would be the best way to manage pain?
Muscle relaxants for muscle spasms.
Stool softeners for constipation prevention
Prophylactic antibiotics in open fractures to decrease risk of infection
What are the five P's when assessing compartment syndrome?
Pain - increased and unrelieved with elevation or pain medication. Severe pain with passive movement.
Paralysis - motor weakness, inability to move extremity. This is a late manifestation that indicates major nerve damage.
Paresthesia - numbness, burning, tingling. Early manifestation.
Pallor - paleness of affected tissue, cyanosis of nail beds.
Pulselessness - also late manifestation
3 pharmalogical measures commonly used in treating patients with phantom limb pain.
Calcitonin during first week may decrease phantom pain.
Beta blockers (propranolol) to relieve dull/burning sensation.
Gabapentin for sharp/stabbing/burning pain.
Also antispasmodics (baclofen) and some antidepressants.
List 2 risk factors for carpal tunnel syndrome.
occupational injury - repetition activities (pinching, grasping, wrist flexion)
repetitive sports (tennis)
growth or lesion
rheumatiod arthritis, diabetes
After teaching a patient with a fractured humerus, the nurse assesses the patient’s understanding. Which dietary choice demonstrates that the patient correctly understands the nutrition needed to assist in healing the fracture?
Roast beef with low-fat milk and a vitamin C supplement
Vegetable lasagna with a green salad and a vitamin A supplement
Bacon, lettuce, and tomato sandwich with a vitamin B supplement
Baked fish with orange juice and a vitamin D supplement
Roast beef with low-fat milk and a vitamin C supplement
The patient with a healing fracture needs supplements of vitamins B and C and a high-protein, high-calorie diet. Milk for calcium supplementation and vitamin C supplementation is appropriate. Meat would increase protein in the diet that is necessary for bone healing. Fish, a sandwich, and vegetable lasagna would provide less protein.