nur 1040 comp 9

Comminuted Fracture

The bone is shattered or crushed into multiple fragments. Often seen in high-impact trauma.

Open (Compound) Fracture

The fractured bone breaks through the skin. Extremely high risk for Osteomyelitis (bone infection).

Fat Embolism Syndrome (FES)

Fat globules from a long bone fracture (femur/pelvis) enter the blood and block pulmonary capillaries. Occurs 12-48 hours post-injury.

FES Classic Symptoms

1. Hypoxia/Dyspnea. 2. Neurological confusion/restlessness. 3. Petechial rash on the neck, chest, and axilla.

Compartment Syndrome (Pathophysiology)

Increased pressure within the muscle fascia compromises blood flow, leading to severe tissue ischemia and necrosis.

Compartment Syndrome (Early Sign)

Paresthesia (numbness/tingling) and pain that is out of proportion to the injury and UNRELIEVED by opioid medication.

Compartment Syndrome (Nursing Interventions)

Notify provider STAT. Keep the extremity at HEART LEVEL (do not elevate). Remove ice. Prepare for emergent fasciotomy.

The 5 P's of Neurovascular Assessment

Pain, Pallor, Pulselessness, Paresthesia, Paralysis.

Plaster Cast Application Rule

Handle a drying plaster cast with the PALMS of the hands only. Fingertips can create indentations that cause pressure ulcers on the skin.

Cast Care Teaching

Do not stick coat hangers or objects down the cast to scratch. Use a hair dryer on the COOL setting to relieve itching. Keep the cast dry.

Skin Traction (Buck's Traction)

Non-invasive traction applied to the skin via a boot/wrap. Used primarily to decrease muscle spasms prior to hip fracture surgery.

Skeletal Traction

Pins/wires are surgically inserted into the bone to realign fractures. Requires meticulous pin-site care with chlorhexidine/saline to prevent osteomyelitis.

Traction Golden Rule

Weights must ALWAYS hang freely and never touch the floor or bed. Never remove skeletal traction weights without a provider order.

Laminectomy / Spinal Fusion Post-Op Care

LOG-ROLL the patient using a draw sheet to maintain perfect spinal alignment. Assess for clear fluid drainage (CSF leak).

Sprain vs. Strain

Sprain = stretched/torn Ligament. Strain = stretched/torn Tendon or Muscle.

R.I.C.E. Protocol

Rest, Ice, Compression, Elevation. Used for acute soft tissue injuries (sprains/strains) for the first 48 hours.

Osteomyelitis

A severe infection of the bone. Requires 4 to 6 weeks of aggressive IV antibiotics (e.g., Vancomycin or Ceftriaxone) and possible surgical debridement.

Cyclobenzaprine (Flexeril)

A muscle relaxant used to treat muscle spasms. Causes significant drowsiness and dizziness (implement fall precautions).

NSAIDs (Ibuprofen, Naproxen) Nursing Implications

Give with food to prevent GI irritation. Monitor for signs of GI bleeding (dark tarry stools).

Enoxaparin (Lovenox)

Low-Molecular-Weight Heparin given post-orthopedic surgery to prevent DVT. Monitor for bleeding.

Rhabdomyolysis

Muscle breakdown from crush injuries releases myoglobin into the blood, which clogs the kidneys causing Acute Kidney Injury (AKI).