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84 Cards in this Set
- Front
- Back
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a disruption or break in the continuity of the structure of the bone is called
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fracture
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Causes of Fractures most commonly arise from TRAUMA such as
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MVA
falls blunt injuries penetrating injuries |
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Your PT can aquire fractures with what kinds of disease pathology
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osteoporosis
osteogenesis imperfecta |
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Fractures are classified by
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anatomical location of fracture on the involved bone as well as
appearance position and alignment of fracture and classical names |
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the pulling of tendons and ligaments is known as a
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avulsion
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when a piece of the peristeum is intact across the fracture and either external or internal fixation has rendered the fragments stable you have what kind of fracture
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stable fracture
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a simple fracture that has nothing piercing through the skin is known as a
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closed fracture
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name some areas where possible fractures can occur
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all skeletal areas
Upper extremity Lower extremity pelvic and hip fracture spine face/skull |
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What is the biggest concern for fractures in PEDIATRICS
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concern with fractures along the growth plate (epiphysis of long bone seperated by the parent bone by cartilage)
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what kind of fracture encompasses proximal third of the femur and extends to 5cm below the lesser trochanter
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hip fracture
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also known as a compound fracture where bone communicating to the external enviroment/piercing through the skin
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open fracture
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what is most associated with decrease of blood flow to an area
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avascular necrosis
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a grossly displaced fracture and site has poor fixation is known as what kind of fracture
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unstable fracture
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a period of bone healing lasting 3-4 days where a fever of 100 degrees is a symptom
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inflammatory
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a period of healing taking 3-21 days where you feel better and revasculation occurs
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restorative
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Your PT is having external rotation and shortening of affected extremity with symptoms of muscle spasm, severe pain and tenderness at fracture site
DECREASED BF TO AREA |
Hip Fracture
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the longest period of healing where scarring occurs usualloy 21 days to 1-2 years , excess bone tissue is reabsorbed and union is completed.
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Remodeling
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What are the stages of healing of a fracture
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Bleeding to Hematoma
Granulation Tissue Callus Formation Osteoblastic Proliferation Bone Remodeling Bone Healing Complete |
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what kind of fracture has NO DEFORMITY
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Simple fracture
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crepitation is also known as
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degrading bone
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echymosis is also known as
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bruising
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When your PT has a blood test for a diagnosis of a fracture, you are looking for ...
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a decrease in H AND H
A increase in ESR - erthrocyte sedimentation rate |
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Your PT has his fracture stabilized with splinting, traction or casting -
closed reduction w/ or without anesthesia is called |
Non Surgical Management
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a non surgical realignment of bone fragments to their previous anatomic position. performed under local or general anesthesia. healing soon occurs
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closed reduction
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open reduction internal fixation ORIF , early initiation of ROM is indicated.
t/f |
true
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the correction of alignment through a surgical incision with or without internal fixation ORIF. (rods, screws)
problems with infection and anesthesia complications |
open reduction
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minimal blood loss, early ambulation and rehab, maintains alignment in fractures unsatable, open fractures promotes optimal healing and easy access to open wound cleansing are all examples of the advantages of
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external fixation
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a major disadvantage of external fixatation is pin tract infection and possible infection of BONE MARROW known as
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osteomyelitis
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What are the FIVE P's when doing a neurovascular assessment
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PAIN
PALLOR PARESTHESIA PULSELESSNESS PARALYSIS |
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The ABC approach to emergency care is
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AIRWAY
BLEEDING CARDIOVASCULAR |
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What are the EMERGENCY care steps
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Abc's
control bleeding montior Vital signs and pulse ox splint joints for fractures assess NV elevate extremity do not sraighten extremity do not manipulate protruding bones apply ice to area xray of area and tests tetanus if open wound |
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What is the most major complication of fractures where decreased vasculization to area occurs (vascular compromise)
the upper arm and lower legs are the most common site |
acute compartmental syndrome
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a major complication of fracture where an infection of the bone / marrow is known as
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osteomyelitis
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a major complication of fracture where muscle breakdown leading to renal failure is known as
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thabdomyolsis
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malunion or no union of fracture may lead to
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deformity
nerve damage |
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a major complication of fracture charaterized by presecence of systemic fat globules from fractures that are distributed into tissues and organs after skeletal surgery.
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FES Fat Embolism Syndrome
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a blood clot that forms in a vein deep in the body most often occurs in the deep veins of legs - eitehr above or below knee.
the blood clot can break free (EMBOLI) and become lodged in bc of lungs causing PULMONARY EMBOLISM |
DVY
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The most common cause of DVT where A blood clot that becomes lodged in the lung
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P.E.
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a Risser or Body Jacket or Halo cast are all types of
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Body Casts
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the best cast choice for children, dries quicker than plastic, mroe durable, lightweight and waterproof
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synthetic casts
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extreme apprehension and a feeling of doom with signs of dyspnea (Difficult breathing) SOB and chest pain
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Fat Embolism Syndrome and
Pulmonary Embolism |
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how do you treat FES and PE
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give oxygen, treat system
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Immediate Post Care of CASTING includes
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secure drying
avoid stress to cast protect rough edges keep extremity elevated maintain ice to fracture avoid contact directly with cast move joints below and above cast |
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Your PT wants to have his cast dried - what do you do?
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keep blankets directly off cast
maintain air flow around cast asess for skin burns no stress on cast while drying do not move cast until dried cool blow dry NEVER HOT /WARM blot dry with towel air circulation maintained |
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when you waterproof adhesive tape or moleskin around edge of cast, replace when needed, to protect skin you are
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pedaling cast
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how does pedaling the cast protect skin when protecting rough edges of cast
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decrease rubbing of cast on skin
decrease increase pressure on outer surfaces of skin |
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a walking cast is designed to have WEIGHT BEARING on it
t/f |
true
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what vibrates rapidly back and forth, designed to not cut skin when taking off cast
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oscillating cast saw
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when you have a HIP SPICA cast - what are some primary care interventions for it
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keep clean and dry
asesss for tightness and compression in chest and bowel area asess urinary/bowel movements daily asess pulses distal and extremities distal to casted area. do not use bar to move pt |
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what applies a forward pulling force on the fractured extremity to attain realignment
line of pull distal to the fracture or injury - towards the weights. |
traction
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what pulls in a backward force on the rractured extremity - the line of pull is above the fracture or injury toward sthe body
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counter-traction
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the forces between that of traction and counter traction
ex) patients bed |
Frictional Force
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for short term treatment - 48 to 72 hours until pt placed in skeletal traction or has surgery
to maintain alignment , assist in reduction of fracture, diminish muscle spasms traction weight 5-10 lbs |
skin traction
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treatment for longer periods then skin traction in order to align injured bones and joints - treat joint contractures and congenital hip dysplasia
problem is INFECTION pin is inserted into bone to allign and immobilize the injured body part |
skeletal traction
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a surgical incision with internal fixation devices to realign fracture and contain boney fractures is known as a
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ORIF
Open Reduction Internal Fixator |
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To prevent muscle spasm
immobolize a joint or body part reduce fracture or dislocation treat a joint pathologic condition provide immbolization prevent./correct deformity allow position and alignment exapand a joint during arthroscopic procedures or major joint reconstruction |
Purpose of TRACTION
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For patients POST-OP CARE of fractures always :
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asess extremity,dressing,cast,traction,external fixation device
NV /VITALS asess post op complications |
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Your PT needs medication for post op fracture care - you would give him
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analgesics
muscle relaxants Tetanus immunization post open surgery antibiotic therapy |
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Fluid intake for post-op careof fractured patient is fluid intake of
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2000-3000 ml day or 2-3 L
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high fiber diets vitamins b,c,d and calcium supplements and protein 1 gram is good nutritional therapy for
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repair of injured tissue and bone
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Rn diagnosis of fracture - PRIMARY is
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knowledge deficit
immobility pain risk of infection risk of impaired skin integrity |
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During what stage of clinical union may the patient be allowed limited mobility or cast removal!?
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Callus OSSIFICATION
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what is manually applied to the bone to restore position, length and alignment
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traction and counter traction
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what facilitates early ambulation which decreases risk of prolonged complicatons due to immobility and promotes fracture healing
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ORIF open reduction internal fixation
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the major disadvantage of skeletal traction is
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infection due to where the skeletal pin inserted and consequences of prolonged immobility
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countertraction is commonly supplied by the patients
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body weight
or elevating end of bed |
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a temporarary circumferential immobilization commonly treated for closed reduction is known as
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cast
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splint used for acute wrist injuries with swelling
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sugar tong splint
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circular cast extending from distal palmal area to proximal forearm -
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short arm cast
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commonly used to stable forearm or elbow fractures. extends to humerus, restricting motion in wrist and elbow
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long arm cast
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your PT cast is aplied to tightly and cast compresses the superior mesenteric artery against the dueodenum.
complains of nausteiousness, ab pressure |
cast syndrome
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a throrough neruovascular assessment consists of a
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peripheral vascular assesment :
COLOR, TEMP, CAP RFEFILL, PERIP PULSES AND EDEMA |
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A diminished or absent pulse distal to the injury can indicate
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vascular dysfunction and insufficeincy
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a warm extremity indicates
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poor venous return
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the final element of the neurovascular assessment - if unrelieved, indication is compartment syndrome
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pain
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the nurse indicates that the first sign of healing occurs with
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callus formation/ossification
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when adequate alignment cannot be obstained by other nonsurgical methods, you must have
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ORIF open reduction with internal fixation
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pain when extending fingers is indicative of
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compartment syndrome
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a patient with AKA should be instructed that the residual limb not be elevated because
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the flexed position can promote hip flexion contracture
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a patient with rhemuotoid arthritis is having a procedure that replaces the joint and improve function - what is it called
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arthroplasty
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after total hip replacement surgery it is important for your PT to NOT
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sit with legs crossed
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during the initial stage of cast care -elevation ABOVE THE LEVEL OF THE HEART is of primary importance in order to
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promote venous return
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a life threatening complication of a long bone fracture is
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Fat Embolism Syndrome FES
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advantage of external surgical device over traditional open reduction internal fixation (plates and screws)
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LESS BLEEDING!
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