CC2 Exam 2
fracture *** break in the bone, can be caused by trauma or pathological conditions (osteoporosis)
- open: goes through skin
- closed: skin in tact
- pathological: d/t bone weakness from disease
- transverse: straight across
- oblique: slanted across
- spiral: twisting, abuse
- comminuted: break into multi
- greenstick: 1 side bent, other side broken, common with children
- fissure: hairline
fracture clinical manifestations *** - pain (immobilization, ice, elevate with analgesics)
- muscle spasms (d/t pulling forces and not being aligned)
- deformity (internal rotation/shortened extremity)
- crepitus
- local swelling and discoloration/loss of function
- ecchymosis (bleeding under tissue)
- SQ emphysema (late finding)
fractures prioritization *** maintain abcs! perfusion
- monitor for bleeding
- pain, sensation, temp, cap refill, movement
- check both pulses at same time
,stabilize
- splint injury including joints distal/proximal to fracture site and minimize movement
- open fracture: cover with sterile dressing, elevate above heart, ice, admin abx
assess neuro status- before and after splinting
remove clothing/jewelry
elevate above heat and apply ice
- elevate for first 24-48 hrs after cast applied - peak inflammation
MOA? may need tetanus shot
keep warm
pain: pain meds, nonpharm pain management
fractures complication *** infection: osteomyelitis esp in open, culture before abx
impaired circulation
- dependent edema, diminished pulses, cool/pale
DVT/PE
- enoxaparin, positive d-dimer they have a clot, SCDs
embolism: admin anticoagulants, PT, ROM
fat embolism: petechial hemorrhage on chest/abdomen, fat breaks off in BM and travels to vessels in
lungs, manifests as PE, more frequent in older adults
- change in LOC, restless,
- provide oxygen, steroids, vasopressors, pain, anxiety meds, fluid
- HIGH MORTALITY rate
compartment syndrome: EMERGENCY
- decreased compartment size (tight splint/cast), loosen or remove
- increased compartment size (swelling or bleeding), treat with fasciotomy
- check 5P'S: pallor, pain, pulses, paresthesia, paralysis, pressure
,- neuro checks!
fractures nursing interventions *** - RICE: rest, ice, compress, elevate
- fluids, analgesics, antibitoics, muscle relaxants, anticoagulants
- keep pt warm!
- 5 P's: pain, pulse, pallor, paresthesia, paralysis
- hemorrhage: watch for bruising and swelling
- prep pt for immobilization device
(cast= effective bc patient can't remove, weights = equal on both sides, skeletal traction - pin sites = one
cotton swab per pin = clear drainage expected)
open reduction internal fixation *** - done in OR
- hardware placed, after bone heals can be removed
- monitor after surgery, skin, neuro, DVT prophylaxis, infection, mobility
external fixation *** - used when patient may not be able to have surgery right away
- located outside skin, pins and wires without incision
- monitor skin, infection, elevate, pin site care, dvt prophylaxis
- be careful with moving patient with external fixation
closed reduction *** traction: pulling force promotes alignment of injured area
- skin: decrease muscle spams, use prior to surgery, cant exceed 10 lbs
- skeletal: rod inserted into bone, weight applied, antibiotics, keep weights off floor, rope free of knots,
monitor pin sites for redness or drainage
- assess neuro status, perfusion, pain, sensation, numbness/tingling, temperature of extremity, check
pulses at same time, paralysis and paresthesia, cap refill
, amputations prioritization *** ABCs- circulation/perfusion/bleeding
- skin color., cap refill
- circulation distal to injury
- stop bleeding, apply pressure
- elevate above heart
- no longer than 24-48 hrs after surgery
insert 2 large bore IVs 18 or larger
fluids
vitals and pain
- admin pain meds
determine if limb is salvageable
- if detached, wrap in sterile gauze, put in sealed bag, stick in ice water and sent with pt
surgical methods
- open: active infection, skin flap not sutured over limb, closed later so infection can drain
- closed: skin flap is sutured over limb closing site
amputations evaluation *** is blood flowing to distal portion of extremity (angiography, doppler US,
ankle brachial index)
- 5 Ps will be off
- cap refill
are blood vessels damaged
- doppler
after completing interventions send pt to OR
postop care of amputations *** - hypovolemia: PRIORITY, measure pulses most proximal at same time
- hemodynamics: change in vitals
fracture *** break in the bone, can be caused by trauma or pathological conditions (osteoporosis)
- open: goes through skin
- closed: skin in tact
- pathological: d/t bone weakness from disease
- transverse: straight across
- oblique: slanted across
- spiral: twisting, abuse
- comminuted: break into multi
- greenstick: 1 side bent, other side broken, common with children
- fissure: hairline
fracture clinical manifestations *** - pain (immobilization, ice, elevate with analgesics)
- muscle spasms (d/t pulling forces and not being aligned)
- deformity (internal rotation/shortened extremity)
- crepitus
- local swelling and discoloration/loss of function
- ecchymosis (bleeding under tissue)
- SQ emphysema (late finding)
fractures prioritization *** maintain abcs! perfusion
- monitor for bleeding
- pain, sensation, temp, cap refill, movement
- check both pulses at same time
,stabilize
- splint injury including joints distal/proximal to fracture site and minimize movement
- open fracture: cover with sterile dressing, elevate above heart, ice, admin abx
assess neuro status- before and after splinting
remove clothing/jewelry
elevate above heat and apply ice
- elevate for first 24-48 hrs after cast applied - peak inflammation
MOA? may need tetanus shot
keep warm
pain: pain meds, nonpharm pain management
fractures complication *** infection: osteomyelitis esp in open, culture before abx
impaired circulation
- dependent edema, diminished pulses, cool/pale
DVT/PE
- enoxaparin, positive d-dimer they have a clot, SCDs
embolism: admin anticoagulants, PT, ROM
fat embolism: petechial hemorrhage on chest/abdomen, fat breaks off in BM and travels to vessels in
lungs, manifests as PE, more frequent in older adults
- change in LOC, restless,
- provide oxygen, steroids, vasopressors, pain, anxiety meds, fluid
- HIGH MORTALITY rate
compartment syndrome: EMERGENCY
- decreased compartment size (tight splint/cast), loosen or remove
- increased compartment size (swelling or bleeding), treat with fasciotomy
- check 5P'S: pallor, pain, pulses, paresthesia, paralysis, pressure
,- neuro checks!
fractures nursing interventions *** - RICE: rest, ice, compress, elevate
- fluids, analgesics, antibitoics, muscle relaxants, anticoagulants
- keep pt warm!
- 5 P's: pain, pulse, pallor, paresthesia, paralysis
- hemorrhage: watch for bruising and swelling
- prep pt for immobilization device
(cast= effective bc patient can't remove, weights = equal on both sides, skeletal traction - pin sites = one
cotton swab per pin = clear drainage expected)
open reduction internal fixation *** - done in OR
- hardware placed, after bone heals can be removed
- monitor after surgery, skin, neuro, DVT prophylaxis, infection, mobility
external fixation *** - used when patient may not be able to have surgery right away
- located outside skin, pins and wires without incision
- monitor skin, infection, elevate, pin site care, dvt prophylaxis
- be careful with moving patient with external fixation
closed reduction *** traction: pulling force promotes alignment of injured area
- skin: decrease muscle spams, use prior to surgery, cant exceed 10 lbs
- skeletal: rod inserted into bone, weight applied, antibiotics, keep weights off floor, rope free of knots,
monitor pin sites for redness or drainage
- assess neuro status, perfusion, pain, sensation, numbness/tingling, temperature of extremity, check
pulses at same time, paralysis and paresthesia, cap refill
, amputations prioritization *** ABCs- circulation/perfusion/bleeding
- skin color., cap refill
- circulation distal to injury
- stop bleeding, apply pressure
- elevate above heart
- no longer than 24-48 hrs after surgery
insert 2 large bore IVs 18 or larger
fluids
vitals and pain
- admin pain meds
determine if limb is salvageable
- if detached, wrap in sterile gauze, put in sealed bag, stick in ice water and sent with pt
surgical methods
- open: active infection, skin flap not sutured over limb, closed later so infection can drain
- closed: skin flap is sutured over limb closing site
amputations evaluation *** is blood flowing to distal portion of extremity (angiography, doppler US,
ankle brachial index)
- 5 Ps will be off
- cap refill
are blood vessels damaged
- doppler
after completing interventions send pt to OR
postop care of amputations *** - hypovolemia: PRIORITY, measure pulses most proximal at same time
- hemodynamics: change in vitals
