Fractures

Question 1

FX

Answer 1

Disruption or break in continuity of structure or bone

Classification:

1. Open (compound) – Skin is broken and bone exposed
2. Closed (simple) – Skin is intact
3. Complete or incomplete
4. Direction of fracture – Linear, spiral, transverse, longitudinal
5. Displaced or nondisplaced

Question 2

Risk factors

Answer 2

FX risk factors:
1. Bone density

2. Trauma
3. Older age
4. Gender – women
5. Secondary conditions – CA, osteoporosis

Question 3

Clinical manifestations

Answer 3

CM:
1. Edema and swelling – Closed FXs can occlude circulation and cause nerve damage (compartment syndrome)

2. Pain/tenderness/spasm
3. Deformity
4. Ecchymosis, contusion (extravasation of blood in subcutaneous tissue)
5. Loss of joint/bone function
6. Crepitation

Question 4

Medical management

Answer 4

1. Determination of FX (XRAY, CT, MRI)
2. Put back in place and immobilize until healed
3. PT, OT required after healing
4. Casting – plaster or fiberglass
5. Traction
6. Internal fixation – rods, wires, and screws used to keep bone together
7. External fixation – pins or wires set in bone through skin above and below FX (connected to a ring or bar outside that holds pin in place)

Question 5

Nursing management

Answer 5

1. Assist with mobility
2. Monitor peripheral vascular status and warmth distal to FX
3. Monitor and treat pain/note changes
4. Provide proper alignment of affected area
5. Monitor area for bleeding and drainage
6. Note and report any significant changes
7. Maintain patency of drain if present
8. Care coordination – PT, OT, dietary

Question 6

Nursing management: Monitor for complications

Answer 6

1. INFECTION – Temp., maintain pin cleanliness (1/2 hydrogen peroxide)
2. CV deconditioning (due to prolonged bedrest) – Orthostatic hypotension, decreased lung capacity; Encourage movement and monitor for VT
3. NEUROMUSCULAR – Check color, warmth, sensation, edema, movement distal to area of repair; Keep elevated for first 48 hrs. and ice for first 24 hrs.
4. CONSTIPATION (due to immobility) – Force fluids and daily stool softener
5. RENAL CALCULI (due to bone demineralization) – Fluid intake 2,500 ml/day
6. SKIN – Pressure can be exerted over bony prominences causing skin breakdown; Move frequently, reposition

Question 7

Compartment syndrome

Answer 7

Condition by which swelling and increased pressure within a limited space presses on and compromises BVs, nerves, and tendons

Caused by:

1. Decreased compartment size – casting, dressings, splints, traction, or premature closing of the fascia
2. Increased compartment pressure – related to bleeding, inflammation, edema, or IV infiltration

6 P’s:

1. Pain distal to injury (not relieved by pain killers)
2. Pain on passive stretching through the compartment
3. Pressure on compartment
4. Paresthesia
5. Pallor, coolness, loss of color
6. Paralysis or loss of function
7. Pulselessness

Intervention:

1. Monitor site, perform neuromuscular checks
2. DO NOT elevate above heart level – decreases arterial perfusion
3. May have to split cast to relieve pressure
4. Ice will cause vasoconstriction – exacerbate the issue
5. Surgical decompression – monitor for infection

Question 8

Pt education

Answer 8

1. Pt pamphlet
2. When to report – increasing pain despite elevation/pain meds/ice, pain during movement, burning/tingling/sores/foul odor beneath cast, pain and discoloration of fingers/toes