NURS 311 Management of Complex
Patient Care
Closed fractures - ANS Fracture that does not disrupt the skin
Directions of fracture lines - ANS Linear
Oblique
Transverse
Longitudinal
Spiral
Types of displaced fractures - ANS Comminuted or oblique
Types of nondisplaced fractures - ANS Transverse, spiral, or greenstick
Comminuted Fracture - ANS Downward force, many fractures; bones can look like gravel
Avulsion Fracture - ANS An injury in which soft tissue is torn completely loose or is hanging as a flap; can
take bone with it
Greenstick Fracture - ANS bending and incomplete break of a bone; most often seen in children; We see
this in kids because bones haven't developed fully
Impacted Fracture - ANS broken bone ends are forced into each other
commonly occurs when one attempts to break a fall
,Pathological fracture - ANS breaking of diseased, weakened bone from the stress of normal everyday
activities
Spiral fracture - ANS Ragged break occurs when excessive twisting forces are applied to a bone
Clinical Manifestations of a fracture - ANS - Immediate localized pain
- Decrease in function
- Inability to bear weight or use affected part
- Guarding
- Bone deformity (obvious or not)
Steps of Bone Healing - ANS 1 = bleeding at broken ends of the bone with subsequent hematoma
formation
2 = organization of hematoma into fibrous network
3 = Invasion of osteoblasts, lengthening of collagen strands, and deposition of calcium
4 = Callus formation: new bone is built up as osteoclasts destroy dead bone
5 = Remodelling is accomplished as excess callus is reabsorbed and trabecular bone is laid down
BOICR
Fracture Assessment - ANS 1) ABC's
2) Focused assessment (neurovascular assessment)
3) Check for any post-op infections. Check if there is any drainage or bleeding.
Neurovascular Assessment - ANS Peripheral vascular assessment and peripheral neurological assessment
Peripheral Vascular Assessment - ANS - Colour
, - Temperature
- Capillary refill
- Peripheral pulses (do them together)
- Edema
(colour, sensation, warmth, movement)
Peripheral Neurological Assessment - ANS - Sensation (tell me when you can feel me touch your toes
while eyes closed)
- Motor function (squeeze hands, push up against using your food)
- Pain (remember bowel care)
Complications of fractures - ANS Direct - complication of fracture
Indirect - nerve around it
Infection - osteomyelitis (bone can start to die because ischemia) Make sure osteomyelities doesn't
become chronic
Venous Thrombosis - ANS Venous stasis caused by incorrectly applied casts or traction; local pressure on
a vein; immobility
Fat Embolism Syndrome - ANS Fat droplets leak from fractured bone and embolize to the lungs
Pulmonary fat emboli alter pulmonary hemodynamics and pulmonary vascular permeability
- Chest pain, headache, occurs 24-48 hours after surgery, sense of apprehension
Compartment Syndrome - ANS A condition in which increased pressure within a limited space
compromises circulation, resulting in in ischemia & necrosis of tissues within that space
Patient Care
Closed fractures - ANS Fracture that does not disrupt the skin
Directions of fracture lines - ANS Linear
Oblique
Transverse
Longitudinal
Spiral
Types of displaced fractures - ANS Comminuted or oblique
Types of nondisplaced fractures - ANS Transverse, spiral, or greenstick
Comminuted Fracture - ANS Downward force, many fractures; bones can look like gravel
Avulsion Fracture - ANS An injury in which soft tissue is torn completely loose or is hanging as a flap; can
take bone with it
Greenstick Fracture - ANS bending and incomplete break of a bone; most often seen in children; We see
this in kids because bones haven't developed fully
Impacted Fracture - ANS broken bone ends are forced into each other
commonly occurs when one attempts to break a fall
,Pathological fracture - ANS breaking of diseased, weakened bone from the stress of normal everyday
activities
Spiral fracture - ANS Ragged break occurs when excessive twisting forces are applied to a bone
Clinical Manifestations of a fracture - ANS - Immediate localized pain
- Decrease in function
- Inability to bear weight or use affected part
- Guarding
- Bone deformity (obvious or not)
Steps of Bone Healing - ANS 1 = bleeding at broken ends of the bone with subsequent hematoma
formation
2 = organization of hematoma into fibrous network
3 = Invasion of osteoblasts, lengthening of collagen strands, and deposition of calcium
4 = Callus formation: new bone is built up as osteoclasts destroy dead bone
5 = Remodelling is accomplished as excess callus is reabsorbed and trabecular bone is laid down
BOICR
Fracture Assessment - ANS 1) ABC's
2) Focused assessment (neurovascular assessment)
3) Check for any post-op infections. Check if there is any drainage or bleeding.
Neurovascular Assessment - ANS Peripheral vascular assessment and peripheral neurological assessment
Peripheral Vascular Assessment - ANS - Colour
, - Temperature
- Capillary refill
- Peripheral pulses (do them together)
- Edema
(colour, sensation, warmth, movement)
Peripheral Neurological Assessment - ANS - Sensation (tell me when you can feel me touch your toes
while eyes closed)
- Motor function (squeeze hands, push up against using your food)
- Pain (remember bowel care)
Complications of fractures - ANS Direct - complication of fracture
Indirect - nerve around it
Infection - osteomyelitis (bone can start to die because ischemia) Make sure osteomyelities doesn't
become chronic
Venous Thrombosis - ANS Venous stasis caused by incorrectly applied casts or traction; local pressure on
a vein; immobility
Fat Embolism Syndrome - ANS Fat droplets leak from fractured bone and embolize to the lungs
Pulmonary fat emboli alter pulmonary hemodynamics and pulmonary vascular permeability
- Chest pain, headache, occurs 24-48 hours after surgery, sense of apprehension
Compartment Syndrome - ANS A condition in which increased pressure within a limited space
compromises circulation, resulting in in ischemia & necrosis of tissues within that space
