NSG 430 TOPIC 7
1. To check motor function of upper extremities...: Abduct fingers, opposethumb and small
finger, flex and extend wrist
2. To check motor function of lower extremities...: Dorsiflexion, plantar flexion;touch web
space between great and 2nd toe; stroke plantar surface
3. Preoperative patient teaching for fractures: Immobilization & Assistive de-vices
Expected activity limitations Assure that needs will be metPain medication
4. Complications of immobility: ConstipationRenal calculi
Cardiopulmonary deconditioningMonitor for VTE
5. How to prevent cardiopulmonary deconditioning post-op fracture sx: Havepatient sit on
side of bed and dangle legs
Have patient perform standing transfers
6. may be used to allow for the reinfusion of the patient's own blood: bloodsalvage and
autotransfusion
7. Cast Care Patient and Caregiver teaching: Apply ice for 1st 24 hoursElevate above heart
for 1st 48 hours
Exercise joints above and below cast Use hair dryer on cool setting for itching
Check with health care provider before getting wet
8. Cast Care DOs: Dry thoroughly after getting wet Report increasing pain despite
elevation, ice, and analgesia
Report swelling associated with pain and discoloration OR movement
9. Cast Care DON'Ts: Elevate if compartment syndrome suspectedGet plaster cast wet
Remove padding
Insert objects inside castBear weight for 48 hours
Cover cast with plastic for prolonged period
10. Direct complications of fractures: Bone infectionBone nonunion or malunion
Avascular necrosis
11. Indirect complications of fractures: Compartment syndromeVTE
Fat embolism Rhabdomyolysis Hypovolemic shock
12. Measures to prevent infection and osteomyelitis in open fractures: Aggres-sive surgical
debridement
Wound may be closed Closed suction drainageSkin grafting
Antibiotics: irrigation, impregnated-beads, and IV
, 13. Early signs of compartment syndrome: Pain, Pressure, Paresthesia
14. Late sings of compartment syndrome: Pallor, Paralysis, Pulselessness
15. If compartment syndrome is suspected...: Do not elevate extremity aboveheart- KEEP
FLAT
Do not apply cold compresses or ice
16. Treatment of compartment syndrome: Surgical decompression (fasciotomy)or in worse
cases amputation
17. Prevention of DVT: Prophylactic anticoagulant drugs for 10 to 14 daysAntiembolism
stockings
Intermittent pneumatic compression devicesExercises
18. Prevention of Fat Embolism Syndrome: Careful immobilization and handlingof long bone
fractures
Reposition as little as possible prior to immobilization and stabilization to preventdislodging
fat droplets into circulation
19. S/S of fat embolism in the lungs: Chest pain, tachypnea, cyanosis, dyspnea,apprehension,
tachycardia, hypoxemia, and changes in mental status due to poor O2 exchange
Petechiae on the neck, anterior chest wall, axilla, head
20. Labs with fat embolism: Fat cells in blood, urine, or sputumDecreased PaO2 to less than
60 mm Hg
Decreased platelet count, hematocrit levelsIncreased ESR
21. Reducing fall risk: Wear functional, nonskid, hard-soled shoesRemove throw rugs
Ensure adequate lighting
Maintain clear path to bathroom for nighttimeAvoid walking on uneven or wet surfaces
22. bone fracture that breaks through the skin: Open fracture
23. one in which the bone is broken, but there is no open wound in the skin: -
Closed fracture
24. bone ends are out of normal alignment: displaced fracture
25. bone ends retain their normal position: non-displaced fracture
26. Manifestations of fractures: Edema and swellingPain and tenderness
Muscle spasmDeformity Contusion
Loss of functionCrepitation Guarding
27. Nonsurgical, manual realignment of bone fragmentsTraction and countertraction applied
1. To check motor function of upper extremities...: Abduct fingers, opposethumb and small
finger, flex and extend wrist
2. To check motor function of lower extremities...: Dorsiflexion, plantar flexion;touch web
space between great and 2nd toe; stroke plantar surface
3. Preoperative patient teaching for fractures: Immobilization & Assistive de-vices
Expected activity limitations Assure that needs will be metPain medication
4. Complications of immobility: ConstipationRenal calculi
Cardiopulmonary deconditioningMonitor for VTE
5. How to prevent cardiopulmonary deconditioning post-op fracture sx: Havepatient sit on
side of bed and dangle legs
Have patient perform standing transfers
6. may be used to allow for the reinfusion of the patient's own blood: bloodsalvage and
autotransfusion
7. Cast Care Patient and Caregiver teaching: Apply ice for 1st 24 hoursElevate above heart
for 1st 48 hours
Exercise joints above and below cast Use hair dryer on cool setting for itching
Check with health care provider before getting wet
8. Cast Care DOs: Dry thoroughly after getting wet Report increasing pain despite
elevation, ice, and analgesia
Report swelling associated with pain and discoloration OR movement
9. Cast Care DON'Ts: Elevate if compartment syndrome suspectedGet plaster cast wet
Remove padding
Insert objects inside castBear weight for 48 hours
Cover cast with plastic for prolonged period
10. Direct complications of fractures: Bone infectionBone nonunion or malunion
Avascular necrosis
11. Indirect complications of fractures: Compartment syndromeVTE
Fat embolism Rhabdomyolysis Hypovolemic shock
12. Measures to prevent infection and osteomyelitis in open fractures: Aggres-sive surgical
debridement
Wound may be closed Closed suction drainageSkin grafting
Antibiotics: irrigation, impregnated-beads, and IV
, 13. Early signs of compartment syndrome: Pain, Pressure, Paresthesia
14. Late sings of compartment syndrome: Pallor, Paralysis, Pulselessness
15. If compartment syndrome is suspected...: Do not elevate extremity aboveheart- KEEP
FLAT
Do not apply cold compresses or ice
16. Treatment of compartment syndrome: Surgical decompression (fasciotomy)or in worse
cases amputation
17. Prevention of DVT: Prophylactic anticoagulant drugs for 10 to 14 daysAntiembolism
stockings
Intermittent pneumatic compression devicesExercises
18. Prevention of Fat Embolism Syndrome: Careful immobilization and handlingof long bone
fractures
Reposition as little as possible prior to immobilization and stabilization to preventdislodging
fat droplets into circulation
19. S/S of fat embolism in the lungs: Chest pain, tachypnea, cyanosis, dyspnea,apprehension,
tachycardia, hypoxemia, and changes in mental status due to poor O2 exchange
Petechiae on the neck, anterior chest wall, axilla, head
20. Labs with fat embolism: Fat cells in blood, urine, or sputumDecreased PaO2 to less than
60 mm Hg
Decreased platelet count, hematocrit levelsIncreased ESR
21. Reducing fall risk: Wear functional, nonskid, hard-soled shoesRemove throw rugs
Ensure adequate lighting
Maintain clear path to bathroom for nighttimeAvoid walking on uneven or wet surfaces
22. bone fracture that breaks through the skin: Open fracture
23. one in which the bone is broken, but there is no open wound in the skin: -
Closed fracture
24. bone ends are out of normal alignment: displaced fracture
25. bone ends retain their normal position: non-displaced fracture
26. Manifestations of fractures: Edema and swellingPain and tenderness
Muscle spasmDeformity Contusion
Loss of functionCrepitation Guarding
27. Nonsurgical, manual realignment of bone fragmentsTraction and countertraction applied
