Level 3 (Exam 4)- Musculoskeletal Trauma, Fractures, Complications of Fractures

Pathophysiology

what is a fracture and how are they classified

• a disruption or break in bone continuity

• Classification

  • Complete or incomplete

  • open or closed

  • stable or unstable

Pathophysiology

Describe the 6 types of fractures

• transverse = straight across

• spiral =

• greenstick = split or bent

• comminuted = crumbled

• oblique = across / down the bone

• pathologic = diseased bone fracture

Manifestations

what are the manifestations of a bone fracture

• edema / swelling

• pain

• muscle spasm

• deformities

• confusion

Risk Factors

what are the risk factors to fractures

Rationale:

• elderly

• post menopause

• high risk activities

Rationale:

post menopausal women are more at risk due to the development of osteoporosis. As a result, their bones are weaker and will break.

Pathophysiology

what are the stages of bone healing

Rationale:

1. fracture hematoma- a blood clot forms at the fracture

2. granulation tissue-

3. callus formation- C.T. forms a callous at the end parts of the fracture

4. ossification- the bone hardens

5. consolidation and remodeling- the callous is reformed and the bone has shape again

Nurse Interventions

why is fracture reduction like manipulation, reduction and traction devices important nursing interventions for fractures

these intervention keep the bone aligned properly

Nurse Interventions

Give examples of fracture immobilization tools / interventions

• external cast = a physical cast placed over the fracture

• internal or external fixation = using pins to immobilize the fracture

• maintenance traction = (bucks traction) used in the hospital to immobilize the fracture

Nurse Interventions

What interventions are needed if a patient has open fractures

Rationale:

• surgical detriment

• tetanus / antibiotics

Rationale:

fractures that have open wounds are at increase risk for infection. Cleaning and admin of drug therapy early reduce the risk of infection development.

Nurse Interventions

After a fracture has be immobilized. what should nurse do to prevent complications

Rationales

• The nurse should do neuro checks every hour

• turn every 2 hours

• keep the cast dry

• elevate above the head

Rationale:

1. to make sure they don’t have nerve damage and have good blood flow

2. to reduce pressure injuries risk

3. protect skin integrity / infection

Treatment

what is a skin traction boot

Rationale:

A skin traction boot is a immobilization device were weights are hanging off the end of the bed.

Rationale:

• the weights must never touch the ground because the tension is what helps immobilize and align the fracture to heal properly

• it also helps reduce muscle spasms

Treatment

A nurse just finished obtaining report on a patient who fell 6 stories. The patient has a fracture on the right femur. The nurse is notified that the patient is on a Skeletal Traction Bed Frame. An order is placed for 10lbs to hang from the traction device. The nurse notes that the patient’s device only has 2lbs. What should the nurse do?

Rationale:

Contact the HCP

Rationale:

In order for the traction device to work, tension must be created. Improper weight will reduce said tension and prevent the immobilization/ alignment needed to heal the fracture. Contact the HCP to correct the weight.

Nurse Intervention

If a patient is on alignment devices to correct the fracture, what should the nurse do to reduce infection

Rationale:

pin care everyday

Rationale:

pins are breaking skin integrity. Break in skin integrity can lead to infection at the points of entry

Nurse Education

what education should the nurse provide to the patient who has a cast

Rationale:

DO NOT

• get it wet

• remove padding

• insert objects

• put lotion in the cast

• bear weight

• cover it with plastic

Rationale:

adding water to the internal section of the cast / objects can increase the risk for infection due to breaks in skin integrity

DO

• keep it dry

  • cover it before showering

  • use a blow dryer to dry the cast after showering

• elevate above the heart for the first 48 hours

• move the extremities

• report odor, drainage, pain, swelling, discoloration of finger/toes, tingles

• educate the patient to do their cast and fracture appointment follow ups

Rationale:

Keeping the inside of the cast reduces the risk of infection

Risk Factors

what are the risk factors to have an amputation for

• middle / older adults = PVD, atherosclerosis, DM

• young adults = trauma (vets)

• osteomyelitis

• frostbite

Diagnostics

What are the diagnostics needed to determine if a patient might need an amputation

Rationale:

• X ray

• CT or MRI

• vascular studies

Rationale:

1. CT and X rays can help determine if osteomyelitis is present. The disease increase the risk for amputation

2. vascular studies show how far down the blood travels and help the doctor determine how much to cut

Nurse Interventions

A nurse is caring for a patient who will undergo surgery to amputate his left leg. What should the nurse educate / tell the patient prior to the start of the surgery

• get consent prior to start of the surgery

• explain the reason for the amputation

Nurse Intervention

A nurse is caring for a patient post-op from surgery. The patient underwent a left leg amputation. The nurse assess the incision site and notes lots of bright red blood saturating the gauze. What should the nurse do first.

Rationale:

Contact the HCP

Rationale:

the sutures may have opened up and caused hemorrhage. Circulation is being compromised . The patient needs to return to the operating room to fix the sutures. Life threatening

Nurse Intervention

What should the nurse assess after an amputation surgery

Rationale:

• do circulation checks

• do neuro checks

Rationale:

1. circulation checks establish good perfusion or lack there of

2. to monitor for neuro damage or compartment syndrome

Pathophysiology

Compartments syndrome is a decrease in pressure within a compartment that decompresses blood vessels, nerves, and/or tendons in the leg, arm, and shoulder.

 

True

False

Rationale:

False

Rationale:

Compartment syndrome is an increase in pressure directly related to tissue swelling.

Pathophysiology

What is phantom leg syndrome

Rationale:

Pain in a missing body part

Rationale:

the nerves are severed at the site of amputation. The brain is still sending signals to that area indicating pain

Treatment

A patient states “i got my amputation surgery 3 weeks ago, but I’m feeling pain where my leg use to be” What should the nurse do?

Give the pain medication

Risk Factor

what increases the risk to develop compartment syndrome

• trauma

• tight dressing or cast

• hemorrhage into compartment

Manifestations

What are the 6 Ps of compartment syndrome

1. pain

2. pallor

3. pressure

4. paresthesia

5. paralysis

6. pulseless

Rationale:

If a patient complains of any of these signs, then they are at risk for compartment syndrome. Notify the provider ASAP.

Diagnostic

what test is used before and after exercise to determine compartment syndrome risk

intercompartment pressure test

Treatment

A patient is at risk for compartment syndrome. What surgical treatment must be done

Rationale:

fasciotomy

Rationale:

this procedure relieves pressure caused by the syndrome. If not done, then the patient might need an amputation