Assessment
What descriptions should a patient tell you about their discomfort?
location, severity, duration, characteristics, radiation, weakness in legs
List 5 early complications that occur with fracture:
1. Shock
2. fat embolism syndrome
3. compartment syndrome
4. VTE
5. disseminated intravascular coagulation
*Shock can occur as a result of the patient going hypovolemic resulting from hemorrhage. It is important to act fast to stop the bleeding, even when the skin does not break. Fat embolism syndrome occurs with the fat emboli entering the circulation after orthopedic trauma occurs; with this, small blood vessels that supply the lungs, brain, kidneys, and other organs are occluded. Pressure that builds up within the muscle compartment is compartment syndrome This can restrict blood flow and lead to muscle damage, nerve damage, and tissue death. VTE is associated with lower skeletal muscle contractions and bed rest; finally, disseminated intravascular coagulation results in widespread hemorrhage and mini clots with ischemia*
This condition is characterized by pain radiating from an inflamed nerve and is often caused by lumbosacral strain or disc problems.
What is sciatica?
*Sciatica occurs when the sciatic nerve is compressed or irritated often due to a herniated disc or spinal stenosis. It causes radiating pain from the lower back down the leg, sometimes accompanied by numbness or weakness.*
Used to manage fractures with soft tissue damage and to correct defects, treat nonunion and lengthen limbs
What is an External Fixator?
Pain, Poikilothermia, pallor, pulseness, paresthesia, paralysis
What are the 6 P's?
What additional assessments are part of the preoperative evaluation for patients undergoing foot surgery?
assess gait, balance, neurovascular status; consider need for assistance post-op
a " popping sound"
What is the distinct difference between collateral ligament injuries and cruciate ligament injuries?
*Both lateral/medial collateral ligaments and the anterior/posterior cruciate ligaments provide stability to the knee. Injury occurs when a person’s foot is planted into the ground and a force acts upon the knee. The popping sound is the most distinct sign that an acl injury has occurred, which is not heard as often with collateral ligament injuries.*
Caused by repetitive overhead motion, this syndrome impairs rotator cuff movement and may lead to muscle atrophy or a rotator cuff tear.
What is impingement syndrome?
*Impingement syndrome is often seen in people who do repeat overhead activities (athletes, painters, flight attendants). It leads to inflammation, limited range of motion, and pain, especially when lifting the arm.*
Must be continuous/ never interrupted, good body alignment/center of bed when applied, and weights must hang freely with ropes unobstructed.
What are principles of effective tracion?
*Traction is the use of a pulling force to promote and maintainn alignment to an injured body part*
Patient education, treatment regimens, relieve pain, improve bowel elimination, prevent injury
What are the nursing interventions for osteoporosis?
*osteoporosis is the most common bone disease in the world. It occurs in one in every 3 women and one in every men over the age of 50*
What concurrent health conditions need to be considered when assessing and creating interventions for the the patient?
Diabetes, heart disease, COPD, infection, and disability
This is important in healing fractures, and this complication can occur if this action is not performed.
What is reduction?
*Reduction involves the realignment of broken bones to their proper position. If not done right away, avascular necrosis can occur. This is because the fracture occludes blood vessels supplying the bone and causing death of the bone cells.*
This bone disease is characterized by low bone mineral density, often seen in small-framed, postmenopausal women, and increases fracture risk
What is osteoporosis?
*Osteoporosis weakens bones and makes them more prone to fractures. It’s common in older adults, especially women after menopause due to decreased estrogen and calcium absorption.*
The preferred method of fracture immobilization in acute care settings and for initial treatment?
*Splints are often used for sprains, tendon injuries and other soft tissue injuried and they allow for natural swelling*
the outcome of a dislocation or subluxation if it is not reduced immediately
avascular necrosis
*AVN is the death of bone cells due to a loss of blood supply*
When assessing a fracture, what early complication can occur after orthopedic trauma that occurs especially in long bones?
what is fat embolism syndrome?
*Fat embolism syndrome is more common in long bones. Looking for manifestations of hypoxia, petechial rash, and neurologic compromise can reveal fat embolism syndrome. Fat embolism syndrome is a significant early complication to look for 24-72 hours after trauma*
In what instance would you not want to place the limb on a pillow?
What is amputation.
*You would not want to place the residual limb on a pillow following an amputation because a flexion contracture of the hip may occur. Contracture can interfere with proper gait and prosthetic fitting and make overall mobility more difficult.*
This infection of the bone can be bloodborne or result from direct contamination and may require IV antibiotics for 3-6 weeks and surgical debridement.
What is osteomyelitis?
*Osteomyelitis is a very serious bone infection that can occur after surgery, trauma, or via the bloodstream. It requires aggressive treatment, including long-term IV antibiotics and sometimes surgery to remove infected tissue.*
Used to immobilied a reduced fracture, correct/prevent a deformity, and supports or stabilizes the joint?
What are casts?
*Casts are rigid external immobilization devices and must fit the limb correctly for support and to prevent complications*
List the pharmacological and non-pharmacological treatment for a rotator cuff injury.
What is rest, NSAID's, PT, injection of corticosteroid into joint, & surgical intervention
* rotator cuff injury is a tear that connects one of the rotator muscles to the humoral head. It is caused by acute or chronic stress on the joint or can be age related.*
When assessing a patient with low back pain, the nurse should observe this aspect of movement, as it can reveal muscle weakness, imbalance, or neurologic involvement.
What is gait?
*Assessing a patient’s gait helps identify abnormalities in movement, balance, and posture. In cases of low back pain, observing how the patient walks can provide clues about nerve involvement, muscle weakness or compensation due to pain. This is a key part of the physical assessment!*
A 30-year-old male basketball player twisted his ankle severely while playing a game in the park. He heard a popping sound and immediately felt intense pain and instability in his ankle. Examination revealed significant swelling, bruising, and inability to bear weight on the injured foot. Grade the degree and tell whether this was a strain or a sprain.
what is 3rd degree sprain?
*A strain is an injury to the muscle or tendon because of overstretching, overuse, or excessive stress, while a sprain is an injury to the tendons and ligaments that surround the joint. Sprains are caused by a twisting motion or hyperextension instead of that overstretching motion. In the third degree, both strains and sprains present with severe pain, edema, and loss of function.*
This common foot condition causes pain with the first steps in the morning and is due to inflammation of the fascia supporting the foot.
What is plantar fasciitis?
*Plantar fasciitis is inflammation of the thick band of tissue that runs across the bottom of the foot. It often causes sharp heel pain that’s worse in the morning but improves with movement and stretching. Treatment includes supportive footwear, stretching exercises and sometimes corticosteroid injections.*
Compartment syndrome, pressure ulcer formation, disuse syndrome.
What are potential complications of casts?
What is an appropriate nursing intervention for a patient with a bone fracture? Why is it important?
Frequent neurovascular assessments, it helps detect signs of compartment syndrome or impaired blood flow