NURS 121 Fractures

jasmine's version from 2016-02-10 15:07

Section 1

Question Answer
Closed FractureAlso called simple fracture; Bone breaks yet skin remains intact
Open FractureAlso called compound fracture; Bone breaks and protrudes through the skin; Client is at increased risk of osteomyelitis, or infection of the bone
Complete FractureInvolves the entire width of the bone
Greenstick FractureAlso called an incomplete fracture; Bone fragments are still partially joined; Occurs commonly in children
Displaced FractureAlso called an unstable fracture; Broken ends of bones move out of correct anatomical alignment; Requires immediate attention to prevent further damage to surrounding tissues
Non-displaced FractureAlso called stable fracture; Broken ends of bones remain aligned
Comminuted FractureBone fragments into many pieces; Common in individuals with brittle bones, such as clients with osteogenesis imperfecta
Avulsion FractureA fragment of bone is separated from the rest of the bone; May also involve displacement of surrounding tissues
Linear FractureFracture occurs parallel to the bone's axis
Transverse FractureFracture occurs at a right angle to the bone's axis
Oblique FractureFracture occurs diagonal to the bone's axis
Spiral FractureFracture spirals around the bone; Occurs as the result of a twisting force; Occurs commonly in children as a result of the porous nature of their bones and sports injuries
Impacted FractureAlso called a buckle fracture; Two ends of the bone are forced together; This is often seen with children's arm fractures and hip fractures
Pathologic FractureCaused by a disease that weakens the bone; Diseases could include osteoporosis, bone cancer, and osteogenesis imperfecta
Stress FractureCaused by small repetitive forces on the bone; Often caused by participation in sports or exercise
Compression FractureBone is crushed; Occurs most commonly in vertebrae; Common in clients with osteoporosis
Depression FractureBone is forced inward; Occurs commonly in skull fractures

Section 2

Question Answer
3 Fractures common in childrenGreenstick (incomplete fracture), Spiral, and Impacted (buckle fracture)
3 stages of the healing to a fractured boneInflammatory, reparative, and remodeling
Inflammatory stageDamage to bone, blood vessels, and surrounding tissues causes bleeding and the formation of a hematoma around th injury; Macrophages and neutophils enter the wound and degrade debris and bacteria in the area; This phase usually lasts until osteoblasts and endothelial cells begin to proliferate at the fracture site, usually a few days
Reparative stageFibroblasts, osteoblasts, and chondroblasts begin to secrete collagen to form fibrocartilage, which develops into a soft callus that joins the fractured bone; Endothelial cells begin to form blood vessels in the damaged area; Once the soft callus is formed, it is replaced by woven bone through endochondral ossification, which forms a hard callus; This woven bone is immature bone with a random collagen and bone structure; This phase usually lasts 6-8 weeks for relatively simple fractures
Remodeling stageWoven bone is replaced by highly organized lamellar bone; Lamellar bone is stronger and more compact with better blood circulation compared to woven bone; Because bones are being continually remodeled, bone fractures usually heal without a scar; However, it may be several years before the bone returns to its original strength
Compartment syndromeOccurs when edema and swelling cause increased pressure in a muscle compartment, leading to decreased blood flow and potential muscle and nerve damage; If ischemia to the compartment continues for a significant length of time, the muscles and nerves may die and the limb may need to be amputated
Deep Venous Thrombosis (DVT) Occurs when a blood clot or thrombus forms in one of the deep veins, usually the leg. (symptoms: redness, warmth, leg pain, cramping, swelling)
Fat embolism syndrome Occurs in conjunction with closed long bone or pelvic fractures. Fat released from bone marrow enter blood stream and become trapped in the pulmonary and dermal capillaries.
Open reduction and Internal fixation (ORIF) Surgical procedure used to internally repair a bone fracture.
Traction Used as use of weights, ropes, and pulleys to apply force to a fractured bone to maintain proper alignment of the bone for healing.
Non pharmacological pain management for clients with bone fractures RICE
R.I.C.E. Rest, Ice, Compression, Elevation
Children often recover quickly from fractures due to Bones have a rapid growth rate and the epiphyseal plates have not yet been sealed

Section 3

Question Answer
Non-unionFracture that shows no clinically significant progress toward complete healing for at least 3 months based on x-rays; this may occur at any point along the healing process
Delayed unionOccurs when the healing process takes significantly longer than expected, usually more than 3-6 months
MalunionOccurs when the bone fragments join in a position which is not anatomically correct
If the bone does not heal properly, it may be classified as:Non-union, delayed union, malunion
What are the 2 unions that may need surgical correctionNon-unions and malunions
Volkmann contractureA deformity of the wrist, hand, and fingers caused by ischemia (insufficient supply of blood to an organ, especially the heart) to the forearm, usually as a result of compartment syndrome
UnionA bone that fractures and undergoes normal healing
Intrascapular hip fractures Occurs at head or neck of the femur within the capsule of hip joint.
Extrascapular hip fracture Occurs within the trochanter region, between neck and diaphysis of femur.
Avascular necrosis Death of bone tissue due to lack of blood supply.
Hemiarthroplasty Replacement of ball, or head, of the femur
Arthroplasty Total hip replacement + acetabulum
Revision surgery Replacement of artificial joint

Section 4

Question Answer
Primary risk factors associated with bone fracturesAge, presence of bone disease, and poor nutrition
Mechanical painFractures
Risk factors for deep venous thrombosis Blood stasis in a vein; Blood vessel injury; and altered blood coagulation
Nursing implications for risk factors from blood stasis in a vein with fractures Immobility from casting and bed rest can decrease blood flow in the limb; Nurse should encourage early ambulation, active or passive exercises, and the use of compression stockings or boots to prevent this
Nursing implications for risk factors from blood vessel injury with fractures Blood vessels may be injured by the force that caused the fracture, by movement of the fractured bone, or during surgical repair of the bone, causing clots to form at the site of injury; Nurse should be aware of the location of potential blood vessel injuries so assessments can be targeted to the appropriate location
Nursing implications for risk factors from altered blood coagulation with fractures Excess blood loss from injury or surgery may cause the body to increase production of platelets and clotting factors; The presence of tissue debris or fat in the vein may also promote clot formation; Nurse should assess the client for coagulation disorders and monitor use of medications that alter blood clotting

Section 5

Question Answer
Specificity Theory States that pain is a specific sensation that uses sensory neurons separate from other sensations such as heat and cold.
Peripheral Theory States that all sensory nerve fiber endings are the same, pain is felt only when the fibers are stimulated, it’s brains responsibility to decipher differences in signals coming from the nerve fibers.
Gate control Theory (used most by nurses) Stimulation of small fibers (pain) causes gates to open, whereas stimulation of large fibers (heat, cold, mechanical) causes gates to close.
Nocicepetive pain Pain from external stimuli on an Uninjured fully functional nervous system and usually temporary unless underlying pain is not treated.
Neuropathic pain caused by nerve dysfunction.
Somatic pain Localized and sharp. From nociceptors located on the skin (cut or overstretched muscle)
Visceral Pain internal organs and linings of cavities and chest. Dull, deep, and aching. (opioid treatment)
Referred pain Sensed in the region other than the site of origin. When nerve fibers from injured region and other regions converge at the same location at the spine.

Section 6

Question Answer
Anti-depressants Setraline (Zoloft), Imimpramine
Anticonsulvants Gapapentin; An anti-epileptic medication, also called an anticonvulsant. It affects chemicals and nerves in the body that are involved in the cause of seizures and some types of pain. Used in adults to treat nerve pain caused by herpes virus or shingles (herpes zoster).
Antihypertensives Clonidine; Lowers blood pressure by decreasing the levels of certain chemicals in your blood. This allows your blood vessels to relax and your heart to beat more slowly and easily. Used to treat hypertension (high blood pressure)
Antipruritics Hydroxyzine; Reduces activity in the central nervous system. It also acts as an antihistamine that reduces the natural chemical histamine in the body; Histamine can produce symptoms of sneezing and runny nose, or hives on the skin. Used as a sedative to treat anxiety and tension
Corticosteroids Prednisone; It prevents the release of substances in the body that cause inflammation. It also suppresses the immune system; Used as an anti-inflammatory or an immunosuppressant medication; Treats many different conditions such as allergic disorders, skin conditions, ulcerative colitis, arthritis, lupus, psoriasis, or breathing disorders
Local anesthetics Lidocaine
S.H.A.R.E. Standardize critical content; Hardwire within your system; Allow opportunity to ask questions; Reinforce quality and measurement; and Educate and coach
Triple Aim Improve the health of a define population; Enhance the client care experience (including quality, access, and reliability), and Reduce/control the per capita cost of care
Pedagogy The study or science of teaching young
Andragogy The art and science of teaching adults
Geragogy Stimulating and helping older adults to learn
Cognitive domain (thinking) Comprehending, applying, analyzing, synthesizing, evaluating
Affective domain (feeling) Feelings, emotions, interests, attitudes, appreciations
Psychomotor domain (skill) Fine motor skills; Teaching such as how to administer insulin
Factors inhibiting learning Emotions, physiological events, cultural aspects, psychomotor ability