Mobility

open fracture

skin tissue is involved and extends to the fractured bone

closed fracture

simple fracture that does not cause a break in the skin

complete fracture

occurs across the entire bone

incomplete fracture

occurs through only part of the bone

bone is still intact in someway

abduction pillow

keeps the hips in line with each other

what can pateints not be in an adduction position

they need to keep their hips in line

adduction keeps the legs together

causes/risk factors of fractures

motor vehicle accidents, falls, bone diseases, trauma, malnutrition

example of bone disease

osteoporosis: weak bone density

what diet is important to bone density/growth

calcium and vitamin D

what does vitamin D do to calcium

aids calcium to get into the bone

S/S of fractures

pain, inability to use extremity, inflammation, ecchymotic, poor pulses distal to fracture, paresthesia, issues with other systems

what does inability to use extremity mean in terms of fractures

you can use the extremity but cannot use it to its full potential

signs and cause of inflammation due to fractures

trauma

body responds with red blood cells to site

swelling

ecchymotic

bruising

blood vessels are released that caused bruising

poor pulses distal to fracture

check distal pulse to it make sure there is good blood flow all the way down the extremity

pulse distal to the hip that is fractured

pedal pulse do not choose the femoral pulse

paresthesia

numbness and tingling

irritation or breakage of the nerve

not a medical emergency

what is considered a medical emergency in terms of fractures

no feeling at all in the extremity

what other system is impacted by a broken hip

neurovascular and urinary tract

bladder is affected

if a broken bone punctures the bladder what happens

there will be pain

blood will be in the urine

what system is affected by broken ribs

can cause a collapse lung and affects the heart

what labs are taken for fractures

hemoglobin and hematocrit (H&H)

erythrocyte sedimentation rate (ESR)

white blood cell counts (WBC)

what happens to hemoglobin and hematocrit (H&H) when you have a fracture and why

labs go down

blood products are spread throughout the body meaning a loss of blood

what does erythrocyte sedimentation rate look at

how much inflammation is present in the body

what happens to the erythrocyte sedimentation rate lab when there is a fracture

it elevates/goes up

how to decrease inflammation when patient has a hip injury

give patient ibuprofen to get inflammation up

what does the white blood cell counts look at

infection

imaging of fractures

x-rays, CT scan, MRI

what do X-Rays do

snap of a picture, looks at the bone

what do you warn the patient about a CT scan

tight space, loud noises, patients has to be still

what do you need to be cautious of with CT scans

allergy to contrast dyes, pregnant

patient education of a MRI

tight space, loud noises, patient has to be still, no metals

what do you have to be cautious of when using a MRI

allergy to contrast dye or shellfish

pregnant

new tattos especially if they have red ink in it

examples of no metals

metal plates, pacemaker, jewelry

what happens when you go into a MRI with a tattoo with red ink in it

the skin burns off

complications of fractures

acute compartment syndrome, hemorrhage, fat embolism, venous thromboembolism, infection, delirium, dislocation, pneumothorax

nonsurgical interventions of fractures

closed reduction, immobilization, drug therapy, physical therapy

closed reduction

popping the bone back in place

why is closed reduction not recommended

if you pop the bone back in place there is nothing holding the bone in the socket which increases the risk of it happening again

types of immobilization

splint, orthopedic boots/shoes, cast, traction

splint

mostly used on children when the finger is broken

allows the bone the heal itself

orthopedic boot/shoe

takes pressure off of the foot when they walk

nurse interventions of orthopedic boots

allows good circulation and check for skin breakdown

what does a cast do and what do you look at

allows good circulation

look for pallor (color), wiggle room for fingers and toes

what do you not want to do with a cast

do not shove something in the cast to scratch the itchy area

examples of traction

buck’s, halo

buck’s traction

used for fractured hip or injury

halo traction

head

traction

temporary less thna 24 hours

provider orders how much weight to put on

freely hanging weight that’s not touching the floor

if you get an order do not take it off until time to take it off

never remove the traction and keep them in traction for too long

should not be painful and lengthens the leg

pulls leg to keep it straight until going into surgery

what happens if a patient in traction needs to void

put a bedpan

use 3 people: one person rolls the patient and the other slides in the bedpan

preoperative checklist

complete history and physical assessment, advanced directive or immediate relative, baseline labs, baseline imaging, NPO status, consent signed, preprocedural “time out”

what is preprocedural “time out”

surgeon will mark the area of surgery

inform the patient

going over consent

surgical interventions

preoperative care, intraoperative care, postoperative care

what are examples of intraoperative care

open reduction internal fixation

internal fixation vs external fixation

postoperative complications

acute compartment syndrome, hemorrhage, fat embolism, venous thromboembolism, infeciton, delirium, dislocation, other system issues

acute compartment syndrome

excess blood on the outside of the bone

edema

check for pain swelling and pulse

s/s of acute compartment syndrome

pain caused by pressure, extra fluid, low bp, high hr, elevated respiration, SPO2 drops, hemoglobin and hematocrit decreases

how to get rid of acute compartment syndrome

make an incision and drain it

s/s of hemorrhage

hemoglobin and hematocrit will drop

blood on dressing; excessive bleeding

fat embolism

part of fatty tissue breaks away of the rest of the tissue and floats away

how to get rid of a fat embolism

go in there surgicallly and take it out

cannot dissolve it

what do you monitor to prevent a fat embolism

O2 stats, respiration, ambulation, check vitals every 15 minutes

how do you know you have a fat embolism

chest x-ray

venous thromboembolism

blood clot, DVT, CVA

how to prevent venous thromboembolism

aspirin, compression stockings, walking/moving

what kind of fracture is more prone to blood clots

hip fracture

s/s of venous thromboembolism

redness, uncontrolled pain, warmth/hot to touch

why does body temperature goes up due to venous thromboembolism

decrease circulation to extremity

it is a medical emergency

infection

100.5 degrees or more fever

drainage

delirium

confusion, short term, coo coo

dislocation

with hip injuries you cannot lean forward or move at the waist because it is not in neutral position anymore

other system issues in postoperative procedures

constipation, urinary retention, in the upper extremity a lung could collapse or develop pneumonia

nursing priorities

mobility, perfusion, infection, comfort

goal of mobility

increase physical mobility and be free of complications associated with immobility

interventions of mobility

PT: ambulation

assistive equipment: crane, crutches, walker

nutrition: increase protein for energy and bone marrow production which increase red blood cells

goal of perfusion

prevent neurovascular compromise through adequate perfusion mobility and sensation

perfusion intervention

neurovscular assessment 5 Ps

neurovascular assessment

pain, pallor, pulseslessness, paresthesia, paralysis

goal of infection

free of wound or bone infection as evidenced by no clinical manifestations of infection

interventions of infection

monitor s/s of infection, aseptic technique, wash hands, antibiotic use, prevention of secondary infections (pneumonia, ambulate patient)

goal of comfort

minimal pain associated with fractuure and/or surgical procedure

interventions of comfort

morphine, hydromorphone, oxycodone/acetaminophen (percocet), NSAIDS, acetaminophen

levels of amputation

toe, syme, below the knee (BKA), above the knee (AKA)

what pulse do you check with a below the knee amputy

popliteal pulse (under the knee) or femoral pulse

assessment of ambutations

neurovascular, skin and psychosocial assessment

how do you perform a skin assessment for amputations

look at the residual limb or stump

check if incision is intact and no drainage

complications of amputation

hemorrhage, infection, phantom limb pain, neuroma, flexion contractions

phantom limb pain

still feel their leg

still have nerves from the amputated limb that is shoved up in the flap and sewed up

neuroma

growing of the nerves

nerve tumor

happens when the body is trying to grow the limb back on

flexion contractions

range of motion of the stump; reflex

nursing priorities of amputations

mobility, perfusion, infection, comfort, self esteem