Orthopaedic Trauma
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Transcript of Orthopaedic Trauma
Orthopaedic Orthopaedic TraumaTrauma
ObjectivesObjectives
Identify significant findings for Identify significant findings for emergent and urgent care of emergent and urgent care of orthopaedic trauma patientsorthopaedic trauma patients
Discuss at least 4 methods of Discuss at least 4 methods of fracture fixationfracture fixation
List nursing interventions typical List nursing interventions typical to trauma patientsto trauma patients
Question AQuestion A
Dan is a 26-year old who presents in the Dan is a 26-year old who presents in the ED with an open fracture of the left ED with an open fracture of the left femur following an ATV accident. What femur following an ATV accident. What would be the initial treatment?would be the initial treatment?
a. Irrigate the wound and initiate a. Irrigate the wound and initiate antibiotic antibiotic
therapy.therapy.
b. Administer tetanus prophylaxis.b. Administer tetanus prophylaxis.
c. Check the ABCc. Check the ABC’’s and maintain c-spine s and maintain c-spine
immobilization.immobilization.
d. Prepare patient for transfer to the d. Prepare patient for transfer to the OR.OR.
Answer # AAnswer # A
Dan is a 26-year old who presents Dan is a 26-year old who presents in the ED with an open fracture in the ED with an open fracture of the left femur following an of the left femur following an ATV accident. What would be the ATV accident. What would be the initial treatment?initial treatment?
c. Check the ABCc. Check the ABC’’s and maintain s and maintain
c-spine immobilization.c-spine immobilization.
Trauma Statistics Trauma Statistics
Every 6 minutes, Every 6 minutes, someone in America someone in America dies from trauma: dies from trauma:
Motor vehiclesMotor vehicles
FarmFarm
FallsFalls
Gunshot woundsGunshot wounds
Trauma StatisticsTrauma Statistics 5th leading cause 5th leading cause of deathof death
Leading killer of Leading killer of Americans < 45 yrs Americans < 45 yrs of ageof age
1 in 4 (59 Million) 1 in 4 (59 Million) Americans injured Americans injured annuallyannually
36 Million ED 36 Million ED visits visits
Bimodal distributionBimodal distribution High energy High energy injuries in 16-35 injuries in 16-35 y.o.y.o.
Low energy Low energy injuries in injuries in elderly 70 + y.o.elderly 70 + y.o.
Following head Following head injuries, pelvic injuries, pelvic fractures are most fractures are most common cause of common cause of traumatic deathtraumatic death
Mechanism of Injury:Mechanism of Injury:Energy ExchangeEnergy Exchange
Kinetic/Kinetic/MechanicalMechanical
ThermalThermal
ChemicalChemical
ElectricalElectrical
RadiantRadiant
Oxygen deprivationOxygen deprivation
Mechanism of InjuryMechanism of Injury
Penetrating TraumaPenetrating Trauma
High velocity missiles (bullets) = High velocity missiles (bullets) = crush/stretchcrush/stretch
Low velocity stab wounds = Low velocity stab wounds = shearing/stretchshearing/stretch
High pressure injection = High pressure injection = explosion/tearingexplosion/tearing
Mechanism of InjuryMechanism of Injury
Blunt TraumaBlunt Trauma
Compression/impact= compressed/shortenCompression/impact= compressed/shorten
Shearing=tearing/Shearing=tearing/ dissectiondissection
Torsion/twisting= dislocation/Torsion/twisting= dislocation/subluxationsubluxation
Tensile/traction= stretching/tearingTensile/traction= stretching/tearing
Mechanism of InjuryMechanism of Injury Motor vehicle accidentsMotor vehicle accidents
FallsFalls
Pedestrian/Bikes/Skateboards/ScootersPedestrian/Bikes/Skateboards/Scooters
Non-accidental; self-inflictedNon-accidental; self-inflicted
Shaken babyShaken baby
DivingDiving
Gun Shot WoundsGun Shot Wounds
SubluxationSubluxation
Displacement of bone from its normal Displacement of bone from its normal joint position to the extent that joint position to the extent that articulating surfaces partially articulating surfaces partially loose contactloose contact
Commonly due to direct blow, Commonly due to direct blow, indirect force or severe twisting, indirect force or severe twisting,
Subluxation: Subluxation: InterventionsInterventions
Immediate closed Immediate closed reduction by reduction by trained trained personnelpersonnel
Question # 1Question # 1
The partial disruption of The partial disruption of articulating surfaces is articulating surfaces is known as:known as:
c. subluxationc. subluxation
DislocationDislocation
Complete separation or displacement Complete separation or displacement of articulating surfaces:of articulating surfaces: Urgent reduction required Urgent reduction required Blood supply to boneBlood supply to bone Nerve or vessel injuryNerve or vessel injury
Dislocation: Dislocation: InterventionsInterventions
Reduction (return to normal anatomic Reduction (return to normal anatomic alignment)alignment) ManuallyManually Regional block Regional block General anesthesiaGeneral anesthesia
Open Reduction Internal FixationOpen Reduction Internal Fixation
Radial Head DislocationRadial Head Dislocation
Radial dislocation Radial dislocation may be caused by a may be caused by a sudden pull on a sudden pull on a child's arm or child's arm or hand. For first hand. For first aid, immobilize aid, immobilize the arm and take the arm and take the child to the the child to the doctor's office or doctor's office or emergency room. emergency room.
Subluxation & Subluxation & Dislocation: Nursing Dislocation: Nursing
DiagnosisDiagnosis Peripheral Peripheral neurovascular neurovascular dysfunction, risk fordysfunction, risk for
Injury, risk forInjury, risk for
Tissue perfusion, Tissue perfusion, ineffective; ineffective; peripheralperipheral
Physical mobility, Physical mobility, impaired impaired
Question # 2Question # 2
A comminuted fracture may be classified A comminuted fracture may be classified as an injury in which:as an injury in which:
a. bone protrudes through the skin a. bone protrudes through the skin
surfacesurface
b. tendons and ligaments are disruptedb. tendons and ligaments are disrupted
c. the ends of bone are impacted into c. the ends of bone are impacted into one one
anotheranother
d. bone is fractured into two or more d. bone is fractured into two or more
fragments.fragments.
Answer # 2Answer # 2
A comminuted fracture may be A comminuted fracture may be classified as an injury in which:classified as an injury in which:
d. bone is fractured into two or d. bone is fractured into two or more more
fragments.fragments.
FracturesFractures
A break or A break or disruption disruption in the in the continuity continuity of a boneof a bone
Fractures: Fractures: Clinical ManifestationsClinical Manifestations
PainPain EdemaEdema DiscolorationDiscoloration Inability to Inability to functionfunction
Obvious deformityObvious deformity CrepitusCrepitus Muscle spasm Muscle spasm Protruding bone Protruding bone
Fractures: Fractures: DiagnosticsDiagnostics
Radiologic examsRadiologic exams Plane filmsPlane films
X-ray a joint X-ray a joint above and below above and below injuryinjury
CT scanCT scan
MRIMRI
FracturesFractures
Predisposing factors:Predisposing factors: OsteoporosisOsteoporosis Risk-taking behaviorsRisk-taking behaviors
Mechanical overload to bone Mechanical overload to bone
Simplest method of classification is based Simplest method of classification is based on boneon bone’’s relationship to the environment:s relationship to the environment: OpenOpen ClosedClosed
Fractures: Fractures: ClassificationsClassifications
Fractures: Fractures: ClassificationsClassifications
ComminutedComminuted Displaced/Non-Displaced/Non-displaceddisplaced
Complete/Complete/
IncompleteIncomplete AvulsionAvulsion CompressionCompression BuckleBuckle ButterflyButterfly
PathologicPathologic ArticularArticular TransverseTransverse ObliqueOblique SpiralSpiral Stellate Stellate Fatigue/StressFatigue/Stress SegmentalSegmental
Fractures: Fractures: ClassificationsClassifications
Fractures: Fractures: ClassificationsClassifications
Fractures: Fractures: ClassificationsClassifications
Fractures : Fractures : Classification by Joint Classification by Joint
InvolvementInvolvement Intraarticular: fracture extends Intraarticular: fracture extends into the jointinto the joint
Intracapsular: fracture within joint Intracapsular: fracture within joint capsulecapsule
Extracapsular: fracture extends Extracapsular: fracture extends outside capsuleoutside capsule
Supracondylar: above condyle(s)Supracondylar: above condyle(s)
Fractures: Fractures: GradingGrading
Grade I Grade I wound < 1cm; minimal contaminationwound < 1cm; minimal contamination
Grade IIGrade II wound > 1 cm; moderate wound > 1 cm; moderate contaminationcontamination
Grade III Grade III wound > 6-8 cm; extensive damage to wound > 6-8 cm; extensive damage to soft tissue, nerve, and tendon; soft tissue, nerve, and tendon; high degree of contamination high degree of contamination
Question # 3 Question # 3
Andrew has sustained an open book Andrew has sustained an open book fracture of the pelvis after being fracture of the pelvis after being pinned under his tractor. What life-pinned under his tractor. What life-threatening situation is causing his threatening situation is causing his unstable BP?unstable BP?
a. Compartment syndromea. Compartment syndrome
b. Overinflation of MAST trousersb. Overinflation of MAST trousers
c. Incorrect application of c. Incorrect application of external fixationexternal fixation
d. Retroperitoneal hemorrhage d. Retroperitoneal hemorrhage
Answer # 3Answer # 3
Andrew has sustained an open Andrew has sustained an open book fracture of the pelvis book fracture of the pelvis after being pinned under his after being pinned under his tractor. What life-threatening tractor. What life-threatening situation is causing his situation is causing his unstable BP?unstable BP?
d. Retroperitoneal hemorrhage d. Retroperitoneal hemorrhage
Fractures: Emergency Fractures: Emergency ManagementManagement
Primary assessment for potentially Primary assessment for potentially life-threatening injurieslife-threatening injuries
Fracture management often secondaryFracture management often secondary Most fractures not life threateningMost fractures not life threatening Stabilize extremityStabilize extremity Cover wounds, open fractures with Cover wounds, open fractures with sterile saline dressingsterile saline dressing
Principles of Open Principles of Open Fracture ManagementFracture Management
Treat open fractures as emergenciesTreat open fractures as emergencies
Culture wounds prior to cleansingCulture wounds prior to cleansing
Remove particulate matter in open fracture Remove particulate matter in open fracture by copious lavage and debridementby copious lavage and debridement
Cover exposed fracture fragments with a Cover exposed fracture fragments with a sterile dressingsterile dressing
Debride devitalized tissueDebride devitalized tissue
Principles of Open Principles of Open Fracture Management Fracture Management
(cont.)(cont.) Obtain x-rays of affected and Obtain x-rays of affected and amputated partsamputated parts
Stabilize fractures with appropriate Stabilize fractures with appropriate materialsmaterials
Provide adequate soft tissue coverageProvide adequate soft tissue coverage
Administer antibiotic coverage and Administer antibiotic coverage and tetanus prophylaxistetanus prophylaxis
Orthopaedic EmergenciesOrthopaedic Emergencies
Spine fracturesSpine fractures
Open book pelvic Open book pelvic fracturesfractures
Dislocated jointDislocated joint ElbowElbow KneeKnee
Fracture Management: Fracture Management: GoalsGoals
Prevent complicationsPrevent complications
Return to maximal functionReturn to maximal function
Achieve best possible cosmetic resultAchieve best possible cosmetic result
Remember ABCRemember ABC’’ss
C-spine precautionsC-spine precautions
AssessmentAssessmentRadiographic Radiographic AssessmentAssessment
C-spineC-spine ChestChest PelvisPelvis
Neurovascular Neurovascular AssessmentAssessment
Upper extremityUpper extremity RadialRadial MedianMedian UlnarUlnar
Lower extremityLower extremity PeronealPeroneal TibialTibial
Occult InjuriesOccult Injuries Head injury- thoracic injuryHead injury- thoracic injury Facial fractures- neck injury & Facial fractures- neck injury & airway occlusionairway occlusion
Rib fracture - pleural injuryRib fracture - pleural injury Sternal bruise-cardiac Sternal bruise-cardiac contusion, aortic tearcontusion, aortic tear
Lap belt injuries- spine Lap belt injuries- spine
and abdominal injuryand abdominal injury
Occult Injuries (cont.)Occult Injuries (cont.)
Extremity injury- compartment Extremity injury- compartment syndromesyndrome
Open book pelvic injuryOpen book pelvic injury Benign to life-threatening (hemorrhage)Benign to life-threatening (hemorrhage) Urgent external fixationUrgent external fixation Nerve damageNerve damage Bladder ruptureBladder rupture
Spine fracture-ileus, neuro deficitSpine fracture-ileus, neuro deficit
Fracture HealingFracture Healing Hematoma formationHematoma formation
1 to 3 days1 to 3 days Granulation Granulation
3 days to 2 weeks3 days to 2 weeks Callus formationCallus formation
2 to 6 weeks2 to 6 weeks Consolidation/Consolidation/Ossification Ossification 3 weeks to 6 3 weeks to 6 monthsmonths
RemodelingRemodeling
WolfWolf’’s Laws Law Bone remodels in Bone remodels in response to response to stressstress
Factors Affecting Factors Affecting Fracture HealingFracture Healing
Trauma severityTrauma severity
Type of boneType of bone
ImmobilizationImmobilization
InfectionInfection
Local pathologyLocal pathology
Avascular Avascular necrosis (AVN)necrosis (AVN)
Intra-articular Intra-articular fracturefracture
Systemic factorsSystemic factors OsteoporosisOsteoporosis
Fracture ManagementFracture Management Closed ReductionClosed Reduction
Manual manipulation to restore alignment of Manual manipulation to restore alignment of bone endsbone ends
Casts/Splints/Sling/SwatheCasts/Splints/Sling/Swathe
TractionTraction
External FixationExternal Fixation
Open Reduction Internal Fixation (ORIF)Open Reduction Internal Fixation (ORIF) Surgical realignment of fragmentsSurgical realignment of fragments Internal placement of pins, wires, plates, Internal placement of pins, wires, plates, screws, intramedullary rods, nails, screws, intramedullary rods, nails,
Closed ReductionClosed Reduction CastingCasting
Immobilize and Immobilize and support injured, support injured, deformed, and deformed, and postoperative postoperative extremitiesextremities
Protect realigned Protect realigned bonebone
Promote healing and Promote healing and early weight bearingearly weight bearing
Serial casting to Serial casting to prevent or correct prevent or correct deformitiesdeformities
Closed ReductionClosed Reduction
Complications of Complications of CastsCasts Compartment Compartment syndromesyndrome
Cast syndrome Cast syndrome (superior (superior mesenteric artery mesenteric artery syndrome) syndrome)
Question #4Question #4
Nursing assessment of skin traction Nursing assessment of skin traction such as Bucksuch as Buck’’s, Russells, Russell’’s or Bryants or Bryant’’s s traction includes:traction includes:
a. neurovascular assessmenta. neurovascular assessment
b. pin careb. pin care
c. alignment of balanced suspensionc. alignment of balanced suspension
d. prevention of skin breakdownd. prevention of skin breakdown
Nursing assessment of skin Nursing assessment of skin traction such as Bucktraction such as Buck ’’s, Russels, Russelll ’’s or Bryants or Bryant’’s traction s traction includes:includes:
a. neurovascular assessmenta. neurovascular assessment
d. prevention of skin breakdownd. prevention of skin breakdown
Answer #4Answer #4
TractionTraction
Application of a Application of a pulling force to an pulling force to an injured or diseased injured or diseased part of the body or part of the body or an extremity while an extremity while a countertraction a countertraction pulls in the pulls in the opposite directionopposite direction
Countertraction is Countertraction is usually the patienusually the patientt ’’s body s body
Traction: Types Traction: Types
ManualManual
Use of hands to exert pulling forceUse of hands to exert pulling force
SkinSkin
Pulling force directly to the skinPulling force directly to the skin
SkeletalSkeletal
Traction forces directly to the boneTraction forces directly to the bone
Traction: PurposesTraction: Purposes Reduce, realign, Reduce, realign, and promote healing and promote healing of fractured bonesof fractured bones
Decrease muscle Decrease muscle spasmspasm
ImmobilizationImmobilization
Treat deformitiesTreat deformities
Rest jointsRest joints
Treat dislocations Treat dislocations and subluxationsand subluxations
Reduce deformitiesReduce deformities
Prevent Prevent contracturescontractures
Expand joint spaceExpand joint space
Traction: Traction: ClassificationsClassifications
SkinSkin CervicalCervical
SidearmSidearm
Pelvic sling Pelvic sling
BuckBuck’’ss
Bryant (pediatrics)Bryant (pediatrics)
RussellRussell’’s s
Traction: Traction: ClassificationsClassifications
SkeletalSkeletal Halo vestHalo vest
Steinman pin or Steinman pin or Kirschner wire with Kirschner wire with balanced suspension balanced suspension (Thomas splint with (Thomas splint with Pearson attachment) Pearson attachment) or BB (Bohler or BB (Bohler Braun) frame Braun) frame
Traction PrinciplesTraction Principles
Maintain prescribed line of pullMaintain prescribed line of pull
Maintain continuous pullMaintain continuous pull
Prevent frictionPrevent friction
Identify and maintain Identify and maintain countertraction countertraction
Traction:Traction: Nursing Diagnosis Nursing Diagnosis
Activity intoleranceActivity intolerance
Breathing pattern, Breathing pattern, ineffectiveineffective
ConstipationConstipation
Disuse syndrome, high Disuse syndrome, high risk forrisk for
Diversional activity Diversional activity deficitdeficit
HopelessnessHopelessness
Impaired physical Impaired physical mobilitymobility
Loneliness, risk for Loneliness, risk for
Pain (acute or Pain (acute or chronic)chronic)
PowerlessnessPowerlessness
Traction: Nursing Traction: Nursing Diagnosis (cont.)Diagnosis (cont.)
Peripheral neurovascular dysfunction, high risk Peripheral neurovascular dysfunction, high risk forfor
Skin integrity impairment , high risk forSkin integrity impairment , high risk for
Sleep pattern disturbance Sleep pattern disturbance
Thought process alteration Thought process alteration
Tissue perfusion alteration venousTissue perfusion alteration venous
Urinary eliminationUrinary elimination
External FixationExternal Fixation
A versatile method of immobilization A versatile method of immobilization that employs percutaneous that employs percutaneous transfixing pins/wires in bone transfixing pins/wires in bone attached to a rigid external frameattached to a rigid external frame
Allows wide range of anatomic Allows wide range of anatomic correction both congenital and correction both congenital and acquiredacquired
External FixationExternal Fixation Types of fixationTypes of fixation
circular framecircular frame semicircular semicircular frameframe
unilateral frameunilateral frame bilateral bilateral quadrilateral quadrilateral frameframe
Pin care Pin care
External Fixation: External Fixation: Indications Indications
Acute trauma to bones with/without segmental Acute trauma to bones with/without segmental lossloss
Limb length discrepanciesLimb length discrepancies
Infected and non-infected long bone union and Infected and non-infected long bone union and non union; osteomyelitisnon union; osteomyelitis
Angulation and soft tissue deformitiesAngulation and soft tissue deformities
Correction of chronic or residual deformitiesCorrection of chronic or residual deformities
External Fixation:External Fixation:Complications Complications
Pin tract infections (most common)Pin tract infections (most common)
Loss of alignment or correctionLoss of alignment or correction
Joint stiffnessJoint stiffness
ContracturesContractures
Delayed healingDelayed healing non-unionnon-union mal-unionmal-union
External Fixation:External Fixation:Nursing DiagnosisNursing Diagnosis
Body image disturbanceBody image disturbance
Disuse syndrome, risk forDisuse syndrome, risk for
Impaired adjustmentImpaired adjustment
Impaired mobilityImpaired mobility
Impaired skin integrity, risk forImpaired skin integrity, risk for
External Fixation:External Fixation:Nursing Diagnosis (cont.)Nursing Diagnosis (cont.)
Infection, risk forInfection, risk for
Injury, risk forInjury, risk for
PainPain
Peripheral neurovascular Peripheral neurovascular dysfunction, risk fordysfunction, risk for
Sleep pattern disturbanceSleep pattern disturbance
ORIFORIF
ORIF: Nursing DiagnosisORIF: Nursing Diagnosis
Disuse syndrome, high risk forDisuse syndrome, high risk for
Impaired adjustmentImpaired adjustment
Impaired physical mobilityImpaired physical mobility
Impaired skin integrity, high risk forImpaired skin integrity, high risk for
Infection, high risk forInfection, high risk for
ORIF: Nursing Diagnosis ORIF: Nursing Diagnosis (cont.)(cont.)
Pain (acute or chronic)Pain (acute or chronic)
Preoperative position injury, Preoperative position injury, risk forrisk for
Peripheral neurovascular Peripheral neurovascular dysfunction, high risk for dysfunction, high risk for
Sleep pattern disturbance Sleep pattern disturbance
Question # 5Question # 5
Fracture management requires astute Fracture management requires astute attention to infection control attention to infection control practices. Which nursing assessment practices. Which nursing assessment is paramount in determining if is paramount in determining if wound/bone sepsis is developing? wound/bone sepsis is developing?
a. vital signsa. vital signsb. restlessnessb. restlessnessc. meticulous wound carec. meticulous wound cared. maintenance of fracture d. maintenance of fracture managementmanagement
Answer # 5Answer # 5
Fracture management requires Fracture management requires astute attention to infection astute attention to infection control practices. Which nursing control practices. Which nursing assessment is paramount in assessment is paramount in determining if wound/bone sepsis determining if wound/bone sepsis is developing? is developing?
a. vital signsa. vital signs
Fracture Management:Fracture Management:Nursing ConsiderationsNursing Considerations
Skin-Tissue Perfusion Skin-Tissue Perfusion Risk for peripheral neurovascular Risk for peripheral neurovascular dysfunctiondysfunction
DVTDVT PEPE SCD-LMWHSCD-LMWH Pressure ulcersPressure ulcers
Heels/Sacrum/EarsHeels/Sacrum/Ears Fracture blistersFracture blisters
Fracture Management:Fracture Management:Nursing ConsiderationsNursing Considerations
NutritionNutrition Increased needsIncreased needs NPONPO Ulcer prophylaxisUlcer prophylaxis Banana bagBanana bag Consider DTConsider DT’’s s Smoking decreases healing time Smoking decreases healing time (tibias) (tibias)
Fracture Management:Fracture Management:Nursing ConsiderationsNursing Considerations
MobilityMobility Prevent wrist or Prevent wrist or foot dropfoot drop
Reduce edemaReduce edema Prevent Prevent contracturescontractures
Prevent deformity Prevent deformity and disability and disability
Fracture Management:Fracture Management:Nursing ConsiderationsNursing Considerations
Self-ConceptSelf-Concept Body imageBody image Limb lossLimb loss DisfigurementDisfigurement DependenceDependence
Fracture Management:Fracture Management:Nursing ConsiderationsNursing Considerations
Elimination Elimination Ileus secondary to medications, Ileus secondary to medications, anesthesiaanesthesia
ConstipationConstipation UTIUTI
Fracture Management:Fracture Management:Nursing ConsiderationsNursing Considerations
Infection Infection Open fracturesOpen fractures Wound contaminationWound contamination OsteomyelitisOsteomyelitis Gas GangreneGas Gangrene
Trauma PreventionTrauma Prevention
Seat belt usageSeat belt usage Child restraintsChild restraints Booster seatsBooster seats DUIDUI MADD/SADDMADD/SADD Speed limit Speed limit adherenceadherence
Home safetyHome safety
Question # 2Question # 2
A comminuted fracture may be classified A comminuted fracture may be classified as an injury in which:as an injury in which:
a. bone protrudes through the skin a. bone protrudes through the skin
surfacesurface
b. tendons and ligaments are disruptedb. tendons and ligaments are disrupted
c. the ends of bone are impacted into c. the ends of bone are impacted into one one
anotheranother
d. bone is fractured into two or more d. bone is fractured into two or more
fragments.fragments.
Answer # 2Answer # 2
A comminuted fracture may be A comminuted fracture may be classified as an injury in which:classified as an injury in which:
d. bone is fractured into two or d. bone is fractured into two or more more
fragments.fragments.
Question # 3 Question # 3
Andrew has sustained an open book Andrew has sustained an open book fracture of the pelvis after being fracture of the pelvis after being pinned under his tractor. What life-pinned under his tractor. What life-threatening situation is causing his threatening situation is causing his unstable BP?unstable BP?
a. Compartment syndromea. Compartment syndrome
b. Overinflation of MAST trousersb. Overinflation of MAST trousers
c. Incorrect application of c. Incorrect application of external fixationexternal fixation
d. Retroperitoneal hemorrhage d. Retroperitoneal hemorrhage
Answer # 3Answer # 3
Andrew has sustained an open Andrew has sustained an open book fracture of the pelvis book fracture of the pelvis after being pinned under his after being pinned under his tractor. What life-threatening tractor. What life-threatening situation is causing his situation is causing his unstable BP?unstable BP?
d. Retroperitoneal hemorrhage d. Retroperitoneal hemorrhage
Question #4Question #4
Nursing assessment of skin traction Nursing assessment of skin traction such as Bucksuch as Buck’’s, Russells, Russell’’s or Bryants or Bryant’’s s traction includes:traction includes:
a. neurovascular assessmenta. neurovascular assessment
b. pin careb. pin care
c. alignment of balanced suspensionc. alignment of balanced suspension
d. prevention of skin breakdownd. prevention of skin breakdown
Nursing assessment of skin Nursing assessment of skin traction such as Bucktraction such as Buck ’’s, Russels, Russelll ’’s or Bryants or Bryant’’s traction s traction includes:includes:
a. neurovascular assessmenta. neurovascular assessment
d. prevention of skin breakdownd. prevention of skin breakdown
Answer #4Answer #4
Question # 5Question # 5
Fracture management requires astute Fracture management requires astute attention to infection control attention to infection control practices. Which nursing assessment practices. Which nursing assessment is paramount in determining if is paramount in determining if wound/bone sepsis is developing? wound/bone sepsis is developing?
a. vital signsa. vital signsb. restlessnessb. restlessnessc. meticulous wound carec. meticulous wound cared. maintenance of fracture d. maintenance of fracture managementmanagement
Answer # 5Answer # 5
Fracture management requires Fracture management requires astute attention to infection astute attention to infection control practices. Which nursing control practices. Which nursing assessment is paramount in assessment is paramount in determining if wound/bone sepsis determining if wound/bone sepsis is developing? is developing?
a. vital signsa. vital signs
Personal measures I take to reduce the Personal measures I take to reduce the risk of trauma include:risk of trauma include:a. always wear a lap shoulder restraint when a. always wear a lap shoulder restraint when driving or riding in the front seat of a driving or riding in the front seat of a motor vehiclemotor vehicle
b. thoroughly obeying all traffic regulationsb. thoroughly obeying all traffic regulations
c. driving within the posted speed limitc. driving within the posted speed limit
d. not drinking and driving; being a d. not drinking and driving; being a designated driver in a groupdesignated driver in a group
e. taking a break every two hours when e. taking a break every two hours when drivingdriving
f. getting adequate rest and not being f. getting adequate rest and not being fatigued at the wheelfatigued at the wheel
Question #7Question #7