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Questions and Answers
In the context of fracture etiology, which of the following mechanisms is LEAST likely to result in a complete bone disruption, assuming standard bone density and physiological conditions?
In the context of fracture etiology, which of the following mechanisms is LEAST likely to result in a complete bone disruption, assuming standard bone density and physiological conditions?
- Severe twisting forces applied along the longitudinal axis of a long bone.
- Crushing injury involving significant compressive forces.
- Repetitive, submaximal muscle contractions during high-intensity interval training. (correct)
- High-velocity direct trauma, such as a motor vehicle accident.
A 'midshaft' fracture is classified based on the configuration of the fracture line, such as transverse or oblique.
A 'midshaft' fracture is classified based on the configuration of the fracture line, such as transverse or oblique.
False (B)
A patient presents with a fracture where the bone has splintered into multiple fragments. Radiographic examination reveals more than three distinct fracture lines. Which of the following fracture classifications BEST describes this injury?
A patient presents with a fracture where the bone has splintered into multiple fragments. Radiographic examination reveals more than three distinct fracture lines. Which of the following fracture classifications BEST describes this injury?
- Comminuted fracture (correct)
- Butterfly fracture
- Segmental fracture
- Avulsion fracture
In a pediatric patient, which type of fracture is characterized by bending on one side of the bone with a fracture line on the opposite cortex?
In a pediatric patient, which type of fracture is characterized by bending on one side of the bone with a fracture line on the opposite cortex?
A stress fracture is typically the result of a single, high-impact traumatic event.
A stress fracture is typically the result of a single, high-impact traumatic event.
The clinical manifestation of bone fragment rubbing within the fracture site is known as ______.
The clinical manifestation of bone fragment rubbing within the fracture site is known as ______.
What is the primary physiological mechanism that leads to limb shortening in the context of a long bone fracture?
What is the primary physiological mechanism that leads to limb shortening in the context of a long bone fracture?
Which of the following BEST explains the rationale for assessing neurovascular status distal to a fracture site?
Which of the following BEST explains the rationale for assessing neurovascular status distal to a fracture site?
Covering an open fracture with a sterile dressing is intended to reduce the risk of hemorrhage.
Covering an open fracture with a sterile dressing is intended to reduce the risk of hemorrhage.
In the context of fracture management, what is the PRIMARY purpose of 'reduction'?
In the context of fracture management, what is the PRIMARY purpose of 'reduction'?
What is the primary biomechanical rationale for utilizing external fixators in the management of complex open fractures?
What is the primary biomechanical rationale for utilizing external fixators in the management of complex open fractures?
Fiberglass casts are contraindicated if the patient reports any skin irritation.
Fiberglass casts are contraindicated if the patient reports any skin irritation.
Why is pulselessness distal to a fracture an emergency?
Why is pulselessness distal to a fracture an emergency?
Which of the following is the MOST appropriate initial nursing intervention for a patient experiencing paresthesia distal to a long bone fracture?
Which of the following is the MOST appropriate initial nursing intervention for a patient experiencing paresthesia distal to a long bone fracture?
Elevating the affected area reduces pain by directly addressing the cause of the fracture.
Elevating the affected area reduces pain by directly addressing the cause of the fracture.
Which finding is MOST indicative of a potential infection at the pin sites of an external fixator?
Which finding is MOST indicative of a potential infection at the pin sites of an external fixator?
What is the primary pathophysiological mechanism underlying hypovolemic shock as an early complication of fractures, particularly pelvic fractures?
What is the primary pathophysiological mechanism underlying hypovolemic shock as an early complication of fractures, particularly pelvic fractures?
In the context of fat embolism syndrome (FES), which of the following clinical manifestations is the MOST specific and critical indicator of the syndrome's progression to severe organ dysfunction?
In the context of fat embolism syndrome (FES), which of the following clinical manifestations is the MOST specific and critical indicator of the syndrome's progression to severe organ dysfunction?
What is the PRIMARY goal of fasciotomy in the treatment of compartment syndrome?
What is the PRIMARY goal of fasciotomy in the treatment of compartment syndrome?
Which of the following interventions is MOST crucial in preventing deep vein thrombosis (DVT) and pulmonary embolism (PE) following a fracture?
Which of the following interventions is MOST crucial in preventing deep vein thrombosis (DVT) and pulmonary embolism (PE) following a fracture?
Delayed union and nonunion are synonymous terms, both indicating a complete failure of fracture healing.
Delayed union and nonunion are synonymous terms, both indicating a complete failure of fracture healing.
What is the primary pathophysiological mechanism underlying avascular necrosis (AVN) as a late complication of fractures?
What is the primary pathophysiological mechanism underlying avascular necrosis (AVN) as a late complication of fractures?
What is the primary goal of bisphosphonate therapy in fracture management, particularly in the elderly?
What is the primary goal of bisphosphonate therapy in fracture management, particularly in the elderly?
When providing pin care for a patient with skeletal traction, which of the following is the MOST important consideration to prevent infection?
When providing pin care for a patient with skeletal traction, which of the following is the MOST important consideration to prevent infection?
In skin traction the weights are attached to the bone.
In skin traction the weights are attached to the bone.
Following a hip arthroplasty, what specific movement should the nurse emphasize that the patient AVOID to prevent dislocation of the new prosthesis?
Following a hip arthroplasty, what specific movement should the nurse emphasize that the patient AVOID to prevent dislocation of the new prosthesis?
Continuous Passive Motion (CPM) machines are PRIMARILY used post-knee replacement to achieve which therapeutic outcome?
Continuous Passive Motion (CPM) machines are PRIMARILY used post-knee replacement to achieve which therapeutic outcome?
The primary purpose of using assistive devices, such as crutches or walkers, is to promote early weight-bearing on the affected extremity to stimulate bone healing.
The primary purpose of using assistive devices, such as crutches or walkers, is to promote early weight-bearing on the affected extremity to stimulate bone healing.
When educating a patient on crutch walking, what critical instruction should the nurse provide regarding the application of weight-bearing through the axillae?
When educating a patient on crutch walking, what critical instruction should the nurse provide regarding the application of weight-bearing through the axillae?
Match the following pain assessment terms with their descriptions:
Match the following pain assessment terms with their descriptions:
Which of the following actions would be most appropriate when providing care to a patient in skeletal traction?
Which of the following actions would be most appropriate when providing care to a patient in skeletal traction?
After a total hip arthroplasty, a patient is prescribed abduction pillows. The nurse should explain that the main purpose of these pillows is to:
After a total hip arthroplasty, a patient is prescribed abduction pillows. The nurse should explain that the main purpose of these pillows is to:
Which of the following is a critical aspect of cast care that the nurse should emphasize to the patient to prevent complications?
Which of the following is a critical aspect of cast care that the nurse should emphasize to the patient to prevent complications?
A patient with a lower extremity fracture is being discharged home with crutches. Which statement by the patient indicates a need for further teaching?
A patient with a lower extremity fracture is being discharged home with crutches. Which statement by the patient indicates a need for further teaching?
What are the '5 Ps' of neurovascular assessment?
What are the '5 Ps' of neurovascular assessment?
Muscle relaxants can be used as a definitive solution for fractures.
Muscle relaxants can be used as a definitive solution for fractures.
A patient reports severe pain unrelieved by opioid analgesics after sustaining a long bone fracture. Which of the following should the nurse suspect?
A patient reports severe pain unrelieved by opioid analgesics after sustaining a long bone fracture. Which of the following should the nurse suspect?
Early ambulation can prevent ______ in fracture patients.
Early ambulation can prevent ______ in fracture patients.
Which medication requires monitoring for signs and symptoms of bleeding?
Which medication requires monitoring for signs and symptoms of bleeding?
Closed reduction involves surgical realignment.
Closed reduction involves surgical realignment.
Which is an early sign or symptom of fat embolism syndrome (FES)?
Which is an early sign or symptom of fat embolism syndrome (FES)?
Name two early complications of fractures.
Name two early complications of fractures.
Which of the following is the 'best practice' for cleaning pin sites on a patient with an external fixator?
Which of the following is the 'best practice' for cleaning pin sites on a patient with an external fixator?
Match the following fracture types with their descriptions.
Match the following fracture types with their descriptions.
Flashcards
Fracture Definition
Fracture Definition
A complete or incomplete disruption in the continuity of a bone.
Swelling & Ecchymosis
Swelling & Ecchymosis
Swelling and bruising due to trauma and bleeding.
Shortening of Limb
Shortening of Limb
Muscles contract, pulling the limb shorter.
Crepitus
Crepitus
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Emergency Care: Closed Fracture
Emergency Care: Closed Fracture
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Emergency Care: Open Fracture
Emergency Care: Open Fracture
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Closed Reduction
Closed Reduction
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Open Reduction Internal Fixation (ORIF)
Open Reduction Internal Fixation (ORIF)
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External Fixators
External Fixators
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Neurovascular Assessment (5 P's)
Neurovascular Assessment (5 P's)
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Hypovolemic Shock
Hypovolemic Shock
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Fat Embolism Syndrome (FES)
Fat Embolism Syndrome (FES)
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Compartment Syndrome
Compartment Syndrome
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Delayed Union/Nonunion
Delayed Union/Nonunion
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Avascular Necrosis (AVN)
Avascular Necrosis (AVN)
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Complex Regional Pain Syndrome (CRPS)
Complex Regional Pain Syndrome (CRPS)
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Skin Traction (Buck's Traction)
Skin Traction (Buck's Traction)
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Skeletal Traction
Skeletal Traction
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Hip Replacement Precautions
Hip Replacement Precautions
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Crutches: How to Walk
Crutches: How to Walk
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Study Notes
- A fracture is a disruption in the continuity of a bone due to direct trauma, crushing, twisting forces, or extreme muscle contractions
- Fractures can cause edema, hemorrhage, joint dislocation, tendon rupture, nerve damage, and vascular injury
Types of Fractures
- Fractures can be categorized based on their location (proximal, midshaft, distal)
- Fractures are categorized based on their break pattern:
- Closed/Simple: Bone does not break the skin
- Open/Compound: Bone pierces through the skin, increasing the risk of infection
- Transverse: Straight across the bone shaft
- Spiral: Twists around the shaft of the bone
- Oblique: Occurs at an angle
- Comminuted: Bone splinters into fragments
- Greenstick: One side is broken, the other is bent, common in children
- Compression: Bone is pressed together, common in vertebrae fractures
- Impacted: Bone fragment is driven into another bone
- Avulsion: Bone fragment is pulled away by a tendon
- Pathologic: Due to disease such as osteoporosis or bone cancer
- Stress: Results from repeated bone loading, seen in runners and athletes
Clinical Manifestations of Fractures
- Pain: Continuous, severe until immobilized
- Swelling & Ecchymosis: Due to trauma and bleeding
- Shortening of Limb: Caused by muscle contraction
- Loss of Function: Depends on bone integrity
- Deformity: Due to displacement, angulation, or rotation
- Crepitus: Rubbing of bone fragments
Emergency Management of Fractures
- Closed Fractures:
- Immobilize the body part
- Apply adequate splinting
- Assess neurovascular status distal to the injury
- Open Fractures:
- Cover wound with sterile dressing
- Immobilize & splint the limb
- Assess neurovascular status
Medical Management of Fractures
- Reduction (Realigning the Bone):
- Closed Reduction: Manual manipulation and casting
- Open Reduction (ORIF): Surgical realignment with internal fixation using pins, screws, rods
- Immobilization (Prevent Movement Until Healing):
- Casts: Fiberglass or Plaster
- Splints & Braces
- External Fixators: Metal frame outside the body
- Traction: Skin & Skeletal
Nursing Management of Fractures
- Neurovascular Assessment (5 P's):
- Pain
- Pallor: Color change, poor circulation
- Pulselessness: No distal pulse indicates an emergency
- Paresthesia: Tingling, nerve damage
- Paralysis: Loss of movement, late sign
- Pain Management:
- Administer Analgesics: Opioids, NSAIDs
- Elevate & Ice the Affected Area
- Monitor for Complications:
- Infection: Fever, purulent drainage
- Skin Breakdown: From casts, splints
- Edema & Circulatory Issues
Complications of Fractures
- Early Complications:
- Shock: Hypovolemic, from hemorrhage
- Fat Embolism Syndrome (FES): Fat globules enter circulation, causing respiratory distress, petechial rash, hypoxia, tachypnea, altered mental status. Treatment includes oxygen therapy, IV fluids, and corticosteroids
- Compartment Syndrome: Increased pressure within muscle compartments leads to ischemia, signs are the 5 P's, severe pain unrelieved by opioids; Treatment involves fasciotomy, a surgical release of pressure
- Deep Vein Thrombosis (DVT) & Pulmonary Embolism (PE): Prevention includes anticoagulants like Heparin and Enoxaparin, early mobilization, and compression devices
- Late Complications:
- Delayed Union & Nonunion: Failure to heal properly
- Avascular Necrosis (AVN): Bone dies due to lack of blood supply
- Complex Regional Pain Syndrome (CRPS): Chronic pain with swelling and skin changes
Medications for Fracture Management
- Analgesics: Acetaminophen, Ibuprofen, Morphine; used for pain management
- Anticoagulants: Heparin, Enoxaparin (Lovenox), Warfarin; Prevent DVT/PE
- Antibiotics: Cefazolin, Clindamycin; prevent infection in open fractures
- Muscle Relaxants: Cyclobenzaprine (Flexeril), Diazepam; reduce muscle spasms
- Bisphosphonates: Alendronate (Fosamax), Risedronate; Treat osteoporosis and prevent fractures
Traction Therapy
- Skin Traction (Buck's Traction): Used to stabilize fractures before surgery, weight limit of 5-10 lbs
- Skeletal Traction: Metal pins inserted into bone for long-term alignment, weight limit of 25-40 lbs
- Nursing Considerations:
- Pin care (cleaning) to prevent infection
- Maintain proper alignment and weights must hang freely
- Nursing Considerations:
Nursing Care for Joint Replacement (Arthroplasty)
- Hip Replacement:
- Prevent dislocation by avoiding flexion >90° and no leg crossing; Use abduction pillows to keep legs apart; Monitor for VTE, infection, and bleeding
- Knee Replacement:
- Use Continuous Passive Motion (CPM) machine; Encourage early ambulation with assistive devices
Patient Education for Fractures & Joint Replacement;
- Cast & Splint Care:
- Keep dry (unless fiberglass); Don't stick objects inside for itching; Report numbness, swelling or pain
- Use of Assistive Devices:
- Crutches: Move unaffected leg first, never press into axilla
- Walker: Move walker first, then step forward
- Cane: Use in opposite hand from injury
Summary of Nursing Priorities
- Assess for 5 P's (Neurovascular status)
- Pain management
- Monitor for complications (DVT, Fat Embolism, Infection, Compartment Syndrome)
- Provide education on mobility & assistive devices
- Promote early ambulation when possible
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