Orthopedics: NCLEX Questions 100%
Correct!!
Fractures
• Signs and symptoms - ANSWERo Continuous pain; unnatural movement; deformity
is possible
o Shortening of the extremity b/c of muscle spasm
o Crepitus may occur from bones grating together
o Swelling and discoloration—worry about compartment syndrome
Fractures
• Treatment - ANSWERo Immobilize the bond ends plus the adjacent joints
otherwise causes continuous damage to occur
o To prevent further injury—support fracture above and below the site; and move
extremity as little as possible
o A splint will help prevent fat emboli and muscle spasm
o With an open fracture you want to cover it, preferably with something sterile b/c at
high risk for infection
o Neurovascular checks are done such as pulses,
color,
movement,
sensation,
capillary refill, and temp—
these are VERY important
Fracture Complications - ANSWERShock b/c bleeding can occur
Fracture
o Compartment syndrome - ANSWER• This is when a fracture has not been
elevated and has not had ice packs;
fluid accumulates in the tissue and impairs tissue perfusion. The muscle becomes
swollen and hard and the pt complains of severe pain that is not relieved with pain
meds
• Unpredictable; pain is DISPROPORTIONATE to the injury
• If undetected may result in nerve damage and possible amputation
, • Common areas that this occurs are
forearms and quadriceps;
can get it without a fracture
Treatment
• Loosen the cast/bi-valve the cast;
only remove case if have bad neuro checks
• Fasciotomy will cut down to the tissue to relieve pressure
***be careful of the answer remove cast***
• Orthopedic nurses have cast cutters ready available; instruct the pt the cast saw
does not touch the skin, but it does vibrate
Fracture
o Fat embolism - ANSWER• Seen with long bones and crushing injuries; symptoms
will depend on where it goes in the body
• Petechiae or rash over the chest;
conjunctival hemorrhages
• Occur in young males more b/c they are risk takers
• Snow storm on CXR (patchy infiltrates); usually occurs in the first 36 hours
Fracture Healing concerns - ANSWER• Delayed union—healing doesn't occur at a
normal rate
• Non-union: failure of bone ends to unite; may require bone grafting from person or
cadaver
s/s of both: persistent discomfort and movement
• Cast care - ANSWERo Ice packs on sides NOT on top especially first 24 hours b/c
cast is still wet
o No indentations
o Use palm of hands for 1st 24hours b/c cast material is wet
o Keep uncovered and dry
o Do not rest on hard surface or sharp edge
o Cover cast close to the groin with plastic to prevent infection; be mindful of
underlying diseases with cast care
Elevate and neurovascular checks
• If pt complains of pain, neurovascular checks and if pain meds are not helping think
compartment syndrome
Correct!!
Fractures
• Signs and symptoms - ANSWERo Continuous pain; unnatural movement; deformity
is possible
o Shortening of the extremity b/c of muscle spasm
o Crepitus may occur from bones grating together
o Swelling and discoloration—worry about compartment syndrome
Fractures
• Treatment - ANSWERo Immobilize the bond ends plus the adjacent joints
otherwise causes continuous damage to occur
o To prevent further injury—support fracture above and below the site; and move
extremity as little as possible
o A splint will help prevent fat emboli and muscle spasm
o With an open fracture you want to cover it, preferably with something sterile b/c at
high risk for infection
o Neurovascular checks are done such as pulses,
color,
movement,
sensation,
capillary refill, and temp—
these are VERY important
Fracture Complications - ANSWERShock b/c bleeding can occur
Fracture
o Compartment syndrome - ANSWER• This is when a fracture has not been
elevated and has not had ice packs;
fluid accumulates in the tissue and impairs tissue perfusion. The muscle becomes
swollen and hard and the pt complains of severe pain that is not relieved with pain
meds
• Unpredictable; pain is DISPROPORTIONATE to the injury
• If undetected may result in nerve damage and possible amputation
, • Common areas that this occurs are
forearms and quadriceps;
can get it without a fracture
Treatment
• Loosen the cast/bi-valve the cast;
only remove case if have bad neuro checks
• Fasciotomy will cut down to the tissue to relieve pressure
***be careful of the answer remove cast***
• Orthopedic nurses have cast cutters ready available; instruct the pt the cast saw
does not touch the skin, but it does vibrate
Fracture
o Fat embolism - ANSWER• Seen with long bones and crushing injuries; symptoms
will depend on where it goes in the body
• Petechiae or rash over the chest;
conjunctival hemorrhages
• Occur in young males more b/c they are risk takers
• Snow storm on CXR (patchy infiltrates); usually occurs in the first 36 hours
Fracture Healing concerns - ANSWER• Delayed union—healing doesn't occur at a
normal rate
• Non-union: failure of bone ends to unite; may require bone grafting from person or
cadaver
s/s of both: persistent discomfort and movement
• Cast care - ANSWERo Ice packs on sides NOT on top especially first 24 hours b/c
cast is still wet
o No indentations
o Use palm of hands for 1st 24hours b/c cast material is wet
o Keep uncovered and dry
o Do not rest on hard surface or sharp edge
o Cover cast close to the groin with plastic to prevent infection; be mindful of
underlying diseases with cast care
Elevate and neurovascular checks
• If pt complains of pain, neurovascular checks and if pain meds are not helping think
compartment syndrome
