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66 Cards in this Set
- Front
- Back
Define fracture?
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a break or disruption in the continuity of a bone
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What are 2 classifications of fractures?
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complete
incomplete |
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Define complete fracture?
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the break is across the entire width of the bone in such a way that the bone is divided into two distinct sections
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Define incomplete fracture?
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the fracture does not divide the bone into two portions because the break is through only part of the bone
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A fracture is described by the extent of associated soft-tissue damage as?
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open (compound)
closed (simple) |
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What is an open or compound fracture?
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skin surface broken causing an external wound...
Grade 1 is the least severe injury... Grade II open fracture is accompanied by skin and muscle contusions... Grade III there is damage to skin, muscle, nerve tissue, and blood vessels; the wound is more than 2.4 to 3.2 inches in diameter |
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What is a closed (simple) wound?
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does not extend through the skin and therefore has no visible wound
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What are common types of fractures (8)?
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closed, nondisplaced
open, compound comminuted, fragmented displaced oblique spiral impacted greenstick |
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What are some causes of fractures?
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pathologic (spontaneous)
fatigue (stress) compression |
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What causes pathologic or spontaneous fractures?
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minimal trauma to a bone that has been weakened by disease...may be a result of bone cancer or osteoporosis
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What causes fatigue or stress fractures?
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excessive strain and stress on the bone
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What causes compression fractures?
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produced by a loading force applied to the long axis of cancellous bone...commonly occur in vertebrae of clients with osteoporosis
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Within 48 to 72 hours after an injury, a _______ forms at the site of the fracture because bone is extremely _____.
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hematoma
vascular |
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Blood supply to and within the bone usually _____ because of an injury, which causes an area of bone ____.
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diminishes
necrosis |
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After a bone injury, cells start to die which prompts the migration of 1_____ and 2_____ as part of the inflammatory process. This then prompts the formation of 3_____, providing the foundation for bone healing. This can take anywhere from 4____ days to 5___ weeks.
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1 fibroblasts
2 osteoblasts 3 fibrocartilage 4 three 5 two |
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As a result of _____ and _____ proliferation, the fracture site is surrounded by new vascular tissue known as a _____. Takes 2 to 6 weeks.
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vascular
cellular callus |
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Callus formation is the beginning of a _______ union.
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nonbony.
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As healing continues, it is transformed from a loose, fibrous tissue into bone. How long does this take?
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within 3 weeks to 6 months
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What happens to callus before the final phase of bone healing begins?
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excess callus is resorbed
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During the final phase of healing, consolidation, and remodeling, bone continues to be ______ and deposited in response to stress, reshaping to meet mechanical demands. This process may start as early as ___ weeks after fracture and can continue for up to ____ year.
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resorbed
six one |
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In young, healthy adult bone, healing takes about ___
weeks. |
six
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An older person has reduced bone mass, so healing takes about ___ to ____ months.
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three
six |
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Besides age, what are other factors that affect healing?
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severity of trauma
type of bone injured severity of trauma type of bone injured inadequate immobilization infections at the fracture site ischemic or avascular necrosis (AVN) |
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What elements are necessary for new bone production?
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calcium
phosphorus vitamin D protein |
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The loss of ____ during menopause is detrimental to new bone formation
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estrogen
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How does peripheral vascular diseases (arteriosclerosis) affect bones?
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reduces arterial circulation
to bone...bone receives less oxygen and lesser amounts of nutrients |
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What are compartments?
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sheaths of inelastic fascia that support and partition muscles, blood vessels, and nerves in the body
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What is acute compartment syndrome (ACS)?
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a serious condition in which increased pressure (can be from internal or external source) within one or more compartments causes massive compromise of circulation to the area
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What are the most common sites for ACS in clients experiencing musculoskeletal trauma?
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compartments in the lower leg....
dorsal and volar compartments of the forearm |
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What are examples of external compartment pressure?
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tight, bulky dressings and casts
(loosen bandage or tape to relieve...request an order to have cast cut...sometimes order not needed depending on hospital protocol) |
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What is a common source of internal pressure?
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blood or fluid accumulation
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Acute compartment syndrome can be found in what kinds of cases?
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musculoskeletal
severe burns extensive insect bites massive infiltration of IV fluids (edema increases pressure in one or more compartments) |
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What is the primary pathophysiologic changes of increased compartment pressure referred to as?
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ischemia-edema cycle
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Explain the pathophysiology of ACS?
1______ within viable muscle dilate, which raises capillary pressure. Capillaries then become more permeable because of the release of 2_____ by the ischemic muscle tissue. As a result, 3____ _____ leak into the interstitial fluid space, and edema occurs. Edema causes pressure on 4____endings and subsequent pain. Blood flow to the area is reduced, and further 5_____ results. Sensory deficits, such as 6_____) generally appear before changes in vascular or motor signs. The color of the tissue, and pulses begin to 7______, but rarely disappear; the affected area is usually palpably tense, and 8____ can be elicited with passive motion of extremity. If condition is not treated, what symptoms can occur 9 (five answers)? |
1 Capillaries
2 histamine 3 plasma proteins 4 nerve 5 ischemia 6 paresthesia 7 weaken 8 pain 9 cyanosis tingling numbness paresis severe pain |
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ACS is not common, but an emergency when it does occur. Neuromuscular damage is irreversible within how many hours?
The limb can become useless within how many hours after onset? |
four to six hours after onset
24 to 48 hours |
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For high-risk patients, what is monitored singly or continuously?
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compartment pressures
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What does continuous monitoring require placement of?
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wick or slit-tip catheter connected to a transducer and is recommended for comatose or unresponsive high-risk clients
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How is a fasciotomy performed to verify ACS?
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an incision is made through the skin and subcutaneous tissues into the fascia of affected compartment
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How does a fasciotomy relieve the pressure?
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restores circulation to affected area
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How is the open wound treated following fasciotomy?
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open wound is packed and dressed on a regular basis until secondary closure occurs, usually in 4 to 5 days...then the surgeon usually debrides the wound and may apply a skin graft to promote healing
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What are uncommon problems associated with compartment syndrome?
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infection
persistent motor weakness in affected extremity contracture myoglobinuric renal failure extreme cases may require amputation |
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Infection from necrotic tissue may become severe enough that _____ of the limb is warranted.
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amputation
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____ _____ from injured nerves is not reversible, and the client may require braces or other orthotic devices for assistance in movement.
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Motor weakness
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Which contractures of the forearm can begin within 12 hours or pressure increase?
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Volkmann's
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Volkmann's contractures of the forearm result from?
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shortening of ischemic muscle and from nerve involvement.
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What is rhabdomyolysis?
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muscle tissue breakdown
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Rhabdomyolysis can cause?
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myoglobinuric renal failure which is potentially fatal...commonly occurs when large or multiple compartments are involved
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Myoglobinuric renal failure occurs because injured muscle tissue releases _____ into circulation, where it can occlude distal convoluted tubule and precipitate acute _____ failure (exact mechanisms unknown)
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myoglobulin (muscle protein)
renal (may have a direct toxic effect on kidneys) |
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With myoglobinuric renal failure, damaged muscle cells also release 1_____, which cannot be excreted because of renal failure...this may result in 2_____ which may cause dysrhythmias and cardiac arrest
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1 potassium
2 hyperkalemia |
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Since bone is very vascular, trauma to can sever adjacent arteries and cause ______ which may result in ______ shock
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hemorrhage
hypovolemic |
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Clinical finding for increased compartment pressure is?
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none
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Clinical finding for increased capillary permeability is?
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edema
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Clinical finding for release of histamines is?
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increased edema
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Clinical finding for increased blood flow to area is?
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pulses present
pink tissue |
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Clinical finding for pressure on nerve endings is?
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pain
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Clinical finding for increased tissue pressure is?
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referred pain to compartment
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Clinical finding for decreased tissue perfusion is?
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increased edema
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Clinical finding for decreased oxygen to tissues is?
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pallor
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Clinical finding for increased production of lactic acid is?
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unequal pulses
flexed posture |
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Clinical finding for anaerobic metabolism?
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cyanosis
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Clinical finding for vasodilation is?
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increased edema
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Clinical finding for increased blood flow is?
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tense muscle swelling
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Clinical finding for increased tissue pressure is?
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tingling
numbness |
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Clinical finding for increased edema is?
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paresthesia
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Clinical finding for muscle ischemia is?
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severe pain unrelieved by medication
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Clinical finding for tissue necrosis is?
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paresis/paralysis
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