NURSING 6202 - Final Exam Study Guide.

6202 Final Exam: Modules 13 & 14 + Cumulative

Fractures, Hip Surgery, and Amputations

Overview

 Fracture: disruption or break in the continuity of
bone structure
 Causes:
o Trauma
o Pathological (infection, steroids,
chemotherapy)

Fracture Classifications

 Closed (simple) or open (compound)
o Have they broken through the skin?
 Incomplete or complete
o Is the entire bone broken across or not?
 Displaced or non-displaced Clinical Manifestations:
o Is the bone still in good alignment or not
 Comminuted  Edema and swelling
o Multiple fragments of bone present o r/t to soft tissue injury that occurs
 Traumatic or pathologic  Pain and tenderness
 Anatomic location o On palpation
o Intra-articular or extra-articular  Muscle spasm
o Proximal, mid-shaft, distal of a long bone o As the body tries to keep bone in proper
alignment
Types of Fractures  Deformity
o Can be extremely obvious or not
 Transverse
 Ecchymosis/contusion
 Spiral
o Bruising as subQ blood gets to the surface
 Greenstick
o One side of bone bending, and the other  Loss of function
 Crepitation
side is splintered; typical in kids
o Crunchy sound heard when bony fragments
 Comminuted
 Oblique are moving around
o Very unstable o Fracture Healing Process
 Pathologic  Begins with hematoma formation (2-3 days)
 Stress  Granulation tissue-basis for new bone (3-14 days)
 Impacted  Callus formation (2 weeks); ossifies in 3 weeks-6
 Compression months
 Remodeling-callus reabsorbs (up to 1 year for
complete healing)
 Gradual weight bearing over time




Factors
That Influence Fracture Healing

, 6202 Final Exam: Modules 13 & 14 + Cumulative

 Age  Circulation (color)
 Infection o Distal pulses
 Nutrition o Temperature
 Electrical stimulation o Capillary refill time
o Can help with healing  Motion (mobility)
o Use small electrical currents to enhance o ROM distal to fracture
activity of calcium in the area o Muscle spasms
 Displacement  Sensation (neurologic injury)
 Site (poor blood supply) o Pain and/or acute tenderness
 Immobilization o Loss of sensation to body parts
o Patient taking splint off before they should
 Implants Alternate Neurovascular Assessment Methods

Fracture Healing  CTMPS
o Color, temperature, mobility, pain,
 Can take time – up to a year sensation
 Do x-ray to determine how much bony healing has  5 P’s of fracture assessment
occurred → if bone can maintain mild stress, they o Pain
will remove the cast o Pulselessness
 Fracture healing may o Pallor
o Not occur in the expected time – delayed o Paresthesia
union o Paralysis
o Not occur at all – nonunion
 Healing time increases with age Laboratory/Diagnostic

Fracture Assessment  Imaging: x-ray, CT, MRI
o Preferred method
 Healthy history o May need repeat studies or other types of
o Past health
imaging
o Meds  CBCs
o Surgery/treatments o Done with significant amount of
 General hemorrhage or inflammatory response
o Pain?  Electrolytes (↑ K+)
 Integumentary o d/t muscle tissue necrosis and leakage of K+
o Warm, bruised, pale? out of cells
 Cardiovascular  Urinalysis
o Perfusion? o Crushing injury – myoglobinuria
 Neurovascular  Arteriogram
o Sensory changes or paresthesias? o If pulses are not present
 Musculoskeletal
o Are they guarding or splinting/protecting Fracture Management
the region of the fracture?  Initial care:
 Examples of specific fracture findings: o ABCs
o Hip, proximal femur – shortening with
o Immobilize with cast or splint
external rotation of leg
 Compound fracture – sterile
o Femur (mid-shaft, distal) – possible
dressing on open wound (or
shortening with internal or external rotation cleanest material available)
of leg o Neurovascular exam
CMS (Neurovascular) Checks  Pharmacologic therapy: