Unit 5 Objectives, Msk, Sutter Extended

Front 1

How much time does each healing phase take to complete?

Back 1

10% - Inflammatory
25% - Restorative
70% - Remodeling
(Inflammatory & Restorative overlap by approx. 5%)
(Restorative & Remodeling overlap by approx. 15%)

Front 2

What healing phase is most common for bone re-injury?

Back 2

During the remodeling phase because the brace/cast is usually off by that time & the child may overdo it.

Front 3

What are the affects of immobilization?

Back 3

*Sensory deprivation leads to
isolation and helplessness

*Language delay

*Gross motor delay

*Social delay - limited
interaction out of their
normal routine (confined to
bed, hospital or home)

*Behavioral issues:
depression, aggression, anger

Front 4

Plan of care for the immobilized child.

Back 4

* Make sure child is well medicated

* Transport child by stretcher, stoller, wagon, etc... from confines of room to provide for mobilization despite restrictions.

* Change position of bed in room to alter monotony of immobilization

Front 5

Plan of care for the immobilized child (con't)
Ndx: Impaired physical mobility

Back 5

* Instruct child in use of assisstive devices to facilitate independent mobility

* Encourage activities that require mobilization.

* Promote own care as much as possible

* Give child choices throughout the day.

Front 6

Plan of care for the immobilized child (con't)
Ndx: Risk for impaired skin integrity

Back 6

* Use pressure reducing devices to promote skin integrity.

* Change position in bed frequently (unless contraindicated) to prevent dependent edema & stimulate circulation

* Protect pressure points on body.

* Make sheets smooth

* Gently massage only healthy skin w/lubricant to keep skin soft.

Front 7

Stages of bone healing

Stage 1: Hematoma formation
Card 1 of 3

Back 7

Imapact:
* Fracture
* Injury to soft tissue
* Periosteal tissue torn
* Vessels rupture

Front 8

Stages of bone healing

Stage 1: Hematoma formation
Card 2 of 3

Back 8

3-5 minutes:
--Bleeding from bone and tissues into area between and around bone fragmnets

Front 9

Stages of bone healing

Stage 1: Hematoma formation
Card 3 of 3

Back 9

First 24 hours:
--Hematoma forms and clots

--Fibrin assists in clotting
periosteal membrane to aid in repair

--Clot provides fibrin
network for cellular invasion

--Granulation tissue forms
by fibroblasts and new capilaries

--Osteoblastic activity
stimulated

Front 10

Stages of bone healing

Stage 2: Celular proliferation
Card 1 of 3

Back 10

After 24 hours:
--Blood supply increases, bringing available Ca, phos & fibroblast

--Cells proliferate at ends
of bone fragments and
differentiate into cartilage & connective tissue

Front 11

Stages of bone healing

Stage 2: Celular proliferation
Card 2 of 3

Back 11

Next few days:
--Hematoma becomes granulation tissue, which forms into a framework for bone-forming substances

--Fibroblasts convert to
osteoblasts(bone forming cells)

Front 12

Stages of bone healing

Stage 2: Celular proliferation
Card 3 of 3

Back 12

2-3 days:
--Halisteresis (softening of bone ends) 1/8 to 1/4 inch and absorption of bone cells.

Front 13

Stages of bone healing

Stage 3: Callus formation
Card 1 of 3

Back 13

6-10 days:
--Fibroblasts form in granulation tissue

--Form bone in areas adjacent to surfacce of bone shaft

--Form carilage at surfaces
more distal to blood supply

Front 14

Stages of bone healing

Stage 3: Callus formation
Card 2 of 3

Back 14

6-10 days (con't):
--Provisional callus develops

--Bridging fracture ends

--Holds bone together but
will not support body
weight

Front 15

Stages of bone healing

Stage 3: Callus formation
Card 3 of 3

Back 15

14-21 days:
--True cllus develops, seen
on radiographs
--Forms more than needed, but
with remodeling, excess callus absorbs

--Cartilage differentiates to
bone tissue

Front 16

Stages of bone healing

Stage 4: Ossification
Card 1 of 3

Back 16

3-10 weeks:
--Callus forms into bone,
which grows beneath
periosteum of fragments

--Fuses fracture defect by
knitting fragments together

--Also called the union stage

Front 17

Stages of bone healing

Stage 5: Consolidation and
Remodeling

Back 17

After 9 months:
--Bone marrow cavity restored

--Compact bone formed
according to stress patterns

--Remodeling according to
Wolff's law - Fracture line always visible on x-rays

Front 18

Identify the fracture

Back 18

Greenstick
Complete (oblique)
Buckle/torus
Bend/plastic

Front 19

Name some fracture complications.

Back 19

--ORIF used to prevent complications and to prevent limb shortening

--Compartment syndrome

--Infection

--Neurovascular compromise

--Movement and function is compromised to the area

Front 20

Describe the nursing care of casts.

Back 20

--Monitor for edema, in case the affected limb swells beyond the limits of the cast.

--The five P’s of ischemia.
* Pain, especially w/passive ROM
* Pallor
* Pulselessness (a dismal and late sign)
* Paresthesia
* Paralysis

--Check for foul smells or “hot spots” on the cast that could indicate infection

--Handle wet cast w/palms of hands to avoid dimpling and creating pressure points within the cast.

Front 21

Describe the purpose of Buck's traction.

Back 21

--A type of skin traction with the legs in an exteded position.

--Used primarily for short-term immobilization, such as pre-op management of a child w/a dislocated hip

--Used for correcting contractures or bone deformaties (Legg-Calve)

--Pull straight down towards end of bed

Front 22

Describe the purpose of Dunlop's traction.

Back 22

--The arm is suspended horizontally, using either skin or skeletal attachment.

--To realign a broken humerus

Front 23

Describe the purpose of Russell's traction.

Back 23

--Uses skin tractions on the lower leg and a padded sling under the knee.

--This combination of pulls allows realignment of the lower extremity & immobilizes the hip & knee in a flexed position.

Front 24

What are the nursing interventions for muscle spasms?

Back 24

--Use of antispasmodics: drug of choice is valium for relief of muscle spasms in acute fractures.

--Can even premedicate for spasms. Very painful.

--Assess for lack of pain relief after pain meds- it may be spasms.

Front 25

What is the interdisciplinary approach to long-term care of the immobilized child?

Back 25

--Physical Therapist

--Occupational Therapist to assisst w/ADL's

--Child life specialist

--Child psychologist

Front 26

What is the interdisciplinary approach to long-term care of the immobilized child's family?

Back 26

--Home visits by social worker to determine needs of immobilized child.

--Info on respite care

--Indiv. & group counseling

--Parent support groups

Front 27

Develop a teaching plan for adolescent girls re: Scoliosis prevention.

Back 27

--Early detection is key

--Healthy diet balanced in vitamins & minerals most importantly Ca & magnesium.

--Bone strengthening exercises to build bone density.

--Bracing when appropriate

Front 28

What is post-op nursing care for a child who has had a spinal fusion to stabalize scoliosis?

Back 28

--Log roll when changing position to avoid damage to the fusion.
(EXCEPTION - Luque procedure pts are kept flat for 12 hrs)

--Skin care and integrity

--Neuro status of extremities requires SPECIAL attention to monitor for delayed paralysis that might require another surgery.

--Monitor for paralytic ileus.

--Pain management

--Encourage exercise by having pt contract& relax thigh & calf muscles periodically.

Front 29

Name the four stages of bone healing.

Back 29

Stage 1 - Hematoma Formation

Stage 2 - Cellular Proliferation

Stage 3 - Callus Formation

Stage 4 - Ossification

Stage 5 - Consolidation & Remodeling