Med Surge - Test 4 #1-9

Front 1

what is a fracture?

what is it caused by?

what is it AKA:

Back 1

a break or disruption in the continuity of the bone

by trauma, bone decalcification, or disease.


a bone break and bone fracture are the same thing

Front 2

what is a tendon?

Back 2

connected muscle to bone

Front 3

what is a strain AKA:


what is a strain?

Back 3

muscle pull


an excessive stretching of a muscle or tendon when it is weak or unstable

Front 4

what is a ligament?

Back 4

connects bone to bone

purpose is for skeletal alignment

Front 5

what is a sprain?

Back 5

excessive stretching of a ligament

Front 6

Assessment that the nurse would implement in relationship to a fracture
-what do you do first?

Back 6

-assess any injured extremity first, then go head to toe.

Front 7

-what assessment does the pt not need to be awake for that you can assess? ]

what happens if there is nerve impingement?

Back 7

a reflex.

if you have nerve impingement, you will have a delayed reflex (it won’t be brisk)

Front 8

-pelvic bone: has a lot of blood. what medical complication could you have:

Back 8

hemorrhage (decreases blood volume) which can cause a hypovelmic shock

Front 9

How do you check for crepitation?

Back 9

put hand over kneecap and ask them to rotate leg. you can feel the cracking

Front 10

Assessment of a fracture
-what are the 3 "E"s

Back 10

Erythema, edema, ecchymosis

The more minor the injury, you may just have erythemia. the more severe the injury you will have ecchymosis.

ecchymosis: (you had to have something significant happen to rupture vessels)

Front 11

Assessment of a fracture

ask about the type of fracture which helps in developing an individualized plan of care. asking about events leading to the injury helps identify what?

Back 11

which forces have been experienced and which body systems or parts of the body to assess

Front 12

Assessment of a fracture

-what do you assess for movement?

Back 12

ask the pt to gently move the involved body part or area distal (below) the injury. if pain occurs – stop!

Front 13

Assessment of a fracture

-when the affected part is moved, assess for crepitus - which is what??

Back 13

a grating sound created by bone fragments

Front 14

Assessment of a fracture

-if the skin is intact (closed fracture), the area over the fracture may be ________, why?

Back 14

ecchymotic (bruised) from bleeding into the underlying soft tissues

Front 15

Assessment of a fracture

assess what? (5)

Back 15

skin color and temperature,
sensation,
mobility,
pain,
pulses distal (below) the fracture site

Front 16

Assessment of a fracture

if the fracture involves an extremity, check for what?

Back 16

the nail for cap refill

Front 17

Assessment of a fracture

-CSM is huge when evaluating neurovascular assessment (what does it stand for?)

Back 17

circulation,
sensation ,
movement

Front 18

Assessment of a fracture / Neurovascular assessment

skin color: how should you assess?

normal finding:

Back 18

inspect the area distal to the injury

(normal findings: no change in pigmentation compared with other parts of the body)

Front 19

Assessment of a fracture / Neurovascular assessment

skin temperature: how should you assess?

normal finding:

Back 19

palpate the area distal to the injury


(normal findings: skin is warm)

Front 20

Assessment of a fracture / Neurovascular assessment

movement: how should you assess?


normal finding?

Back 20

• movement: ask the patient to move the affected are or the area distal to the injury (active motion)

(normal findings: the pt can move without discomfort)

Front 21

Assessment of a fracture / Neurovascular assessment

sensation: what question could you ask to assess them?


normal finding?

Back 21

ask the pt if numbness or tingling is present (paresthesia)

(normal findings – no numbness or tingling)

Front 22

Assessment of a fracture / Neurovascular assessment

sensation: how should you assess?


normal finding?

Back 22

palpate with a paper clip

(normal finding: no difference in sensation in the affected and unaffected extremities.

Front 23

Assessment of a fracture / Neurovascular assessment

what does it mean if there is loss of sensation when palpating the patient with a paper clip?

Back 23

loss of sensation in these areas indicates perineal nerve or median nerve damage

Front 24

Assessment of a fracture / Neurovascular assessment

pulses: how should you assess?


normal finding?

Back 24

palpate the pulses distal to injury

(normal finding: pulses are strong and easily palpated no difference in the affected and unaffected extremities)

Front 25

Assessment of a fracture / Neurovascular assessment

capillary refill: how should you assess?

Back 25

press the nail beds distal to the injury until blanching occurs

(normal finding: blood returns within 3 sec)

Front 26

Assessment of a fracture / Neurovascular assessment

pain: what questions should you assess?

what is the pain normally described as in a patient with a fracture?

Back 26

ask the pt about the location, nature, and frequency of the pain

(normal finding: pain is usually localized and is often described as stabbing or throbbing.

Front 27

Assessment of a fracture / Neurovascular assessment

when assessing pain, what may indicate compartment syndrome?

Back 27

pain out of proportion to the injury and unrelieved by analgesics might indicate compartment syndrome

Front 28

-A fracture is classified by the

Back 28

extent of the break:

Front 29

-Complete fracture:

Back 29

the break is across the entire width of the bone in such a way that the bone is divided into 2 distinct sections

cover the wound

Front 30

-Incomplete fracture:

Back 30

the fracture does not divide the bone into 2 portions because the break is through only part of the bone

Front 31

-What is used to distinguish between open (compound) or closed (simple) fractures?

Back 31

the extent of soft tissue damage

Front 32

what is the difference between open (compound) or closed (simple) fractures?

Back 32

-the skin surface over the broken bone is disrupted in a compound fracture, which causes an external wound. these fractures are often graded on the extend of tissue damage. grade I is the least severe injury and skin damage is minimal. grade II, an open fracture is accompanied by skin and muscle contusions. the most severe injury is grade III, which there is damage to skin, muscle, nerve tissue, and blood vessels. a simple fracture does not extend through the skin and therefore has no visible wound

Front 33

-a fatigue (stress) fracture results from

example of pts you would see this in

Back 33

excessive strain and stress on the bone

(ex: recreational and professional athletes)

Front 34

What type of fracture

a fracture that does not extend through the skin and therefore has no visible wound

(retain the normal alignment of the bones or fragments)

Back 34

also called simple fracture.

closed / nondisplaced

Front 35

What type of fracture

a fracture in which the skin surface over the broken bone is disrupted, causing an external wound

Back 35

-open / compound

Front 36

What type of fracture

a type of fracture that involves fragmentation of the bone

Back 36

comminuted / fragmented

Front 37

What type of fracture

produce new and abnormal bone arrangements

Back 37

displaced

Front 38

What type of fracture

occur when one end of the bone receives sudden torsion or twisting while the other end is fixed or stabilized

Back 38

oblique

Front 39

What type of fracture

have an S-shaped separation. they are common in football and skiing, sports in which the foot is firmly planted when the body is suddenly rotated in an opposing direction

Back 39

spiral

Front 40

What type of fracture

can result from a fall from a height, which causes a long bone to receive, directly on its long axis, a force of such magnitude that the osseous tissue is compressed. this stress telescopes one part of the bone on the other

Back 40

impacted

Front 41

What type of fracture

incomplete breaks in bones that have not completely ossified, such as the bones of adolescents. this injury occurs more frequently in the convex bone surface, while the concave surface remains intact. (only 1 side of the shaft is broken)

Back 41

greenstick

Front 42

What type of fracture

the bone breaks but the skin remains intact

Back 42

closed (simple fracture):

Front 43

What type of fracture

broken ends of the bone penetrate the skin

Back 43

open (coumpound fracture

Front 44

What type of fracture

the broken bone fragments into more than 2 pieces

Back 44

communited

Front 45

What type of fracture

ends of the broken bone are driven into each other

Back 45

impacted

Front 46

What type of fracture

incomplete break in the bone where one side splinters, leaving the other side bent or intact

Back 46

greenstick

Front 47

What type of fracture

bone is fractured through and through, the skin has been penetrated. bad fracture. risk for osteomyelitis is great.. bone itself, from the inside out, punctures the skin

Back 47

compound

Front 48

What type of fracture

fracture does not go all the way through the bone

Back 48

greenstick

Front 49

What type of fracture

broken into pieces, no skeletal stability

Back 49

communited

Front 50

What type of fracture

think old person. bone on bone. the bone broke into it self.

ex someone who jumps off a building. old people who fall and their wrist compresses

Back 50

impacted

Front 51

What type of fracture

skin is intact, bone is fractured

Back 51

simple

Front 52

What type of fracture

fracture does not go all the way through the bone

Back 52

greenstick

Front 53

Assessment of a fracture

THINK CSM

-C: CIRCULATION (assess what?)
-S: SENSATION (assess what? )
-M: motion (how do you assess)

Back 53

C: CIRCULATION (assess pulse)
-S: SENSATION (assess numbness and tingling?) ask pt if they can feel you touch them? numbness and tingling tells you about intermittent neuronal pathway interruption)
-M: motion (move fingers)

Front 54

Assessment of a fracture

stabilize the bone in the position that it is in.

true or false

Back 54

true we don’t mess with it. you can have them very gently move their fingers

Front 55

Assessment of a fracture

make sure they can bring thumb and forefinger together , why?

Back 55

tells them about ulnar and radial nerve

Front 56

open and compound fracture are the same thing: think __________from the moment the injury happens to the moment you discharge.

what are you monitoring?

Back 56

temp, CBC.. your bone marrow is the sweetest, warmest, blood filled area for bacteria

Front 57

stress fractures can’t be seen with the naked eye.

true or false?

when you press on the bone, what will it feel like?

Back 57

true

tender

Front 58

What type of fracture?

a bone break in which the adjacent fragmented ends of the fractured bone are wedged together.


(old lady falling on wrist)

Back 58

impacted

Front 59

-osteoarthritis patients are at risk for what kind of fracture?

Back 59

bone on bone fracture (impacted fracture)

Front 60

what kind of fracture

commonly seen in children; gymnastic is the #1 cause of injury..soccer is next..they usually heal quickly in a cast

Back 60

Greenstick fracture

Front 61

What kind of fracture

usually seen with abuse from twisting. older adult can get one by stepping into a hole and twisting leg

Back 61

spiral

Front 62

-compression fracture: think _____

Back 62

elderly

Front 63

factors that affect healing (6)

Back 63

-if one has reduced bone mass, healing time is lengthened
-severity of the trauma
-type of bone injured
-how the fracture is managed
-infections at the fracture site
-ischemic or avascular necrosis (blood supply to the bone is disrupted, leading to the death of a bone)

Front 64

bone healing can be affected by.........

bone formation and strength rely on what?

Back 64

the aging process

adequate nutrition (calcium, vitamin D, protein and phosphorus are needed for new bone formation)

Front 65

factors that affect healing

-for women, the loss of estrogen after menopause decreases what

Back 65

the bodys ability to form new bone tissue

Front 66

factors that affect healing

chronic diseases affect the rate at which bone heals. peripheral vascular disease such as arteriosclerosis do what

Back 66

reduce arterial circulation to the bone, therefore the bone receives less oxygen and fewer nutrients which are needed for repair

Front 67

-circulation impairment & peripheral nerve damage: can result from tightness of the cast

Back 67

teach the pt to assess for circulation at least daily, including the ability to move the area distal to the extremity, numbness, and increased pain. the pt with a cast may be immobilized for a prolonged period so assess for complications of immobility, such as skin breakdown, pneumonia, atelectasis, thromboembolism, and constipation. before the cast is removed, inform the pt that the cast cutter will not injure the skin but heat may be felt during the procedure

Front 68

factors that affect healing

-because of prolonged immobilization, a joint may become contracted in a fixed stated so what may develop from lack of weight bearing.

what can result from lack of exercise

Back 68

osteoarthritis and osteoporosis

muscle can also atrophy

Front 69

factors that affect healing

-infection: most often results from

Back 69

the breakdown of skin under the cast (pressure necrosis).

if pressure necrosis occurs, the pt reports what??



a hot spot under the cast and the cast may feel warmer in the affected area. teach the pt and family to smell the area for mustiness or an unpleasant odor that would indicate infected material. if the infection progresses, a fever may develop

Front 70

what is included in assessment of a newly casted patient?

-elevation of the casted extremity reduces what?

Back 70

edema but may impair arterial circulation to the affected limb. therefore, neurovascular assessment of the limb distal to the cast is important

Front 71

what is included in assessment of a newly casted patient?

check to ensure what?

-monitor neurovascular status how often?

Back 71

-check to ensure that the cast is not to tight and frequently monitor neurovascular status, usually every hour for the first 24 hrs after application if the pt is hospitalized

Front 72

Newly casted patient

-ice may be applied ________ reduce swelling and inflammation

Back 72

for the first 24-36 hrs to

Front 73

Newly casted patient

-once the plaster cast is dry, inspect it how often for drainage, cracking, crumbling, alignment, drainage and fit

Back 73

at least once every 8 hrs for

Front 74

-watch for cast syndrome (superior mesenteric artery syndrome):

-what is it?

Back 74

partial or complete upper intestinal obstruction results in abdominal distention, epigastric pain, nausea and vomiting.

Front 75

initial care of a fractured bone

remove patient's clothing to inspect the affected area while supporting the area above and below the injury.

remove the patient's shoes
T or F

Back 75

False..removing the shoes can increase trauma

Front 76

initial care of a fractured bone

apply direct pressure where?

Back 76

on the area if there is bleeding and pressure over the proximal arterty nearest the fracture

Front 77

initial care of a fractured bone

keep the patient warm and in what position

Back 77

supine

Front 78

initial care of a fractured bone

check the neurovascular status of the area distal to the extremity..what does this include

Back 78

temperature
color
sensation
movement
cap refill

Front 79

initial care of a fractured bone

immobilize the extremity by splinting...include joints above and below the fracture site

-what should you do after splinting?

Back 79

recheck circulation after splinting

Front 80

-once the plaster cast is dry, inspect how often for drainage, cracking, crumbling, alignment, and fit
-assess for drainage on the cast

Back 80

at least once every 8 hrs

Front 81

assessment of a newly casted patient -watch for cast syndrome (superior mesenteric artery syndrome)

what is it?

Back 81

partial or complete upper intestinal obstruction results in abdominal distention, epigastric pain, nausea and vomiting.

Front 82

For _______ fractures, splint the extremity and cover the wound with a sterile dressing, if available.

Back 82

compound

Front 83

The threat of OSTEOMYELITIS is very great with a __________fracture!

Back 83

compound

Front 84

WHAT does ORIF mean

Back 84

open reduction with internal fixation – one of the most common methods of reducing and immobilizing a fracture.

Front 85

ORIF
-what are the 2 benefits of this

Back 85

-open reduction allows the surgeon to directly view the fracture site and it permits early mobilization

Front 86

ORIF
-what does the phyisican use?

Back 86

-internal fixation uses metal screws, pins, rods, plates, or prostheses to immobilize the fracture during healing
-after the bone achieves union, the metal hardware may be removed, depending on the type of fracture

Front 87

what does reduction of a bone mean

Back 87

restoring bone to proper alignment

Front 88

What is meant by the term manual reduction of a fracture?

Back 88

Manual manipulation usually under anesthesia to restore the bone to proper alignment. (closed reduction) Cast is applied after

Front 89

manual reduction of a fracture

-what does the surgeon do?

Back 89

-while applying a manual pull, or traction, on the bone, the health care providers moves the bone ends so that they realign. anesthesia or analgesia is typically used during this procedure to decrease pain. an x-ray shows that the bone ends are approximated (aligned) before the bone is immobilized

Front 90

external fixation
-what is it?

Back 90

:system in which pins or wires are inserted through the skin and affected bone and then connected to a rigid external frame. after a fixator is removed, the pt may be placed in a cast until healing is complete

Front 91

external fixation
-what is a disadvantage?

Back 91

-a disadvantage of external fixation is an increased risk for pin site infection. pin site infections can lead to osteomyelitis which is serious and hard to treat

Front 92

external fixation

monitor the patient's pin site for what?

Back 92

-in the first 48-72 hrs, clear fluid drainage or weeping is expected


..there is a big chance for DVT

Front 93

external fixation

-because pins go through the skin and into the bone, risk for infection is high. what should you monitor

Back 93

the pin sites at least every 8-12 hrs for drainage, color, odor, and severe redness which indicate inflammation and possibly infection

Front 94

external fixation

complications:

Back 94

infection,
fat embolism,
compartment syndrome (compress nerves and vessels)

avascular necrosis,

pulmonary embolism

Front 95

complications from external fixation

Back 95

-fat embolism and pulmonary embolism go together. before a pulmonary embolism you had to have something somewhere else (usually DVT)

Front 96

Basics of cast care and nursing assessment related to it

-with a plaster cast, warn the patient about what

Back 96

the heat that will be felt immediately after the wet cast is applied

-do not cover the new cast. allow for air-drying

Front 97

Basic of cast care and nursing assessment related to it

turn him or her every 1-2 hours to allow what

Back 97

air to circulate and dry all parts of the cast

Front 98

Basic of cast care and nursing assessment related to it

-if the doctor requests that the cast be elevated to reduce swelling, use what kind of pillow?

Back 98

a cloth covered pillow instead of one encased in plastic, which would cause the cast to retain heat and prevent drying

Front 99

Basic of cast care and nursing assessment related to it

-check to ensure that the cast is not to tight and frequently monitor neurovascular status how often

Back 99

, usually every hour for the first 24 hrs after application if the pt is hospitalized

Front 100

DO NOT cover a new cast, it must DRY


If cast is still wet, when positioning the patient, use only ______

Back 100

the palms of your hands to prevent indentations and resulting areas of pressure on the skin

Front 101

Traction devices

-traction is the application of what?

what is the purpose? (5)

Back 101

a pulling force to a part of the body

provide reduction, alignment, and rest. it’s also used to decrease muscle spasm (thus relieving pain) and prevent or correct deformity and tissue damage.

Front 102

Traction devices
-Implementation

maintain what?

how should the weights hang?

Back 102

proper body alignment


freely
Do NOT remove or lift weights without an Order! -weight must hang freely. weight pulls bone away from the other bone

Front 103

Traction
Bucks / Skin traction
-what does it inovlve?

Back 103

the use of a Velcro boot (Bucks traction), belt, or halter, which is usually secured around the leg.

Front 104

Traction
Bucks / Skin traction

what is the primary purpose?

Back 104

to decrease painful muscle spasms that accompany fractures.

Front 105

Traction
Bucks / Skin:

the weight is used as a pulling force and is limited to how many pounds

Back 105

limited to 5-10 lbs to prevent injury to the skin.

Front 106

Traction
Bucks / Skin:
what does the physician do with your skin?


seen in what types of surgery?

Back 106

use skin of leg that you compress and pull. your pulling this skin which is shifting the bone in hopes to realign the bone

we use theses types of traction of hip surgery / done in hip fracture

Front 107

in skeletal traction, what does the surgeon use?

Back 107

pins, wires, tongs, or screws are surgically inserted directly into bone

Front 108

skeletal traction
-using pins, wires, tonges, screws allow what

Back 108

the use of longer traction time and heavier weights, usually 15-30 lbs.

Front 109

skeletal traction aids in what?

Back 109

bone realignment.

Front 110

skeletal traction
-pin site care is an important part of nursing management to prevent infection

used for what kind of fractures?

Back 110

communited

Front 111

skeletal traction
-also used for 2 other deformities of the foot

Back 111

-bunions and hammer toes too keep them aligned while calcium forms and then you pull the wire out.

Front 112

traction devices
-inspect the skin how often?

Back 112

-inspect the skin every 8 hrs for signs of irritation or inflammation.

when possible, remove the belt or boot that is used for skin traction every 8 hrs to inspect under the device

Front 113

traction devices

-if the pt reports severe pain from muscle spasm, the weights may be too heavy or the pt may need realignment.

Back 113

-assess neurovascular status of the affected body part to detect circulatory compromise and tissue damage

Front 114

traction devices
-the circulation is monitored how often

Back 114

every hour for the first 24 hrs after traction is applied and then every 4 hours thereafter

Front 115

traction devices
- inspect area for redness, drainage, pain, indications of infection > osteomyelitis!
-if you see purulent matter, get a culture right away, and then call a doc.

Back 115

surgeon will dictate plans of care