Complications of fractures

• Nerve/blood vessel damage
• infection
• shock
• non-union
• fat embolus
• pseudo-arthrosis
• avascular necrosis
• compartment syndrome

Fat embolus

•  danger with a fracture
• ball of fat released into blood supply

pseudo-arthrosis

• false union of the bone
• non-healing

avascular necrosis

• bone death
• due to circulation

Copartment syndrome

1. area inindated with fluid
2. stretches our compartments
3. causes pressure
4. can cute of blood supply
5. causes necrosis

compartment syndrome caused by

• trauma
• edema
• coagulopathies

Location of compartment syndrome

• usually leg or arm>though can occur anywhere

Compartment ( compartment syndrome)

• anatomical area confined by fascia

fascia

• connective tissue surrounding skeletal muscle

Pathology of compartment syndrome

• ↑ tissue pressure(edema)> ↓ tissue profusion> ↑tissue damage>venous return/circulation compromised

Dangers of compartment syndrome

• emergendy situation
• may reverse in 1st 6 hrs
• after> may amputate

S&S of compartment syndrome

• Pain W./ passive movement
• loss of peripheral pulse
• intense pain
• skin red/cold(polar coolness)
• progressive loss of motion/sensation    (PLISP)

treatment of compartment syndrome

• reduce edema if cought early
• elevate extremity
• surgical facsiotomy
• gentle ROM after treatment

simple fracture

skin intact

compound fracture

• break in skin
• bone protrusion
• blood loss significant

complicated fracture

• more injury to surrounding tissues
• could or couldnt break through the skin

complete fracture

• break through the entire bone

incomplete fracture

• hair line
• crack in the bone

over riding fracture

• compound or complicated fracture

comminuted fracture

• splintered/shattered bone

spiral/oblique fracture

impacted fracture

telescoping ??

depressed fracture

• forced inward
• mostly in skull
• causes increase in ICP

pathological fracture

• spontaneous-caused by certain disease
• happens with osteoporosis
• dont have to be doing anything-just breaks

stress fractures

• r/t activity> running, dancing etc.

S&S of fracture

• pain
• loss of function
• edema
• muscle spasms
• crepitus(bone against bone)
• inflammation
• ecchymosis
• decreased sensation(nerve damage)

crepitus

• crunching sound
• bone against bone
• would find in fracture or joints(???)

traction

• holding to surface by friction or pulling
• using direct tension

skin traction

• bucks traction/pelvic traction
• applied to clean dry skin>attached to ropes/pullys with harness

skeletal traction

• pins or wire surgically inserted in-2 bone
• weights attached by rope & pully

osteo myelitis

• infection in bone
• can be caused by ulcers, pin site

treatment :mandible break

• jaws wired together
• aspiration danger-keep wire cutters/suction @ bedside

treatment :clavicle fracture

• arm sling/immobilizer
• figure 8 bandage

treatment fractured ribs

• taped, straped, rib belt
• observe for difficult breathing

treatment for vertebra fracture

• body cast
• tongs
• halo vest

treatment for pelvis fracture

• internal/external fixation

nursing care fore ptnt. with traction

• maintain alignment
• adl's
• cms checks
• pin care

principles of effective traction

• splints/slings hang free
• ropes properly on pullys
• prescribed weight
• weights hang freely
• correct allignment

counter traction

• balance the pull

cast is used for what?

• maintain allignment during healing
• fiber glass or  plaster

nursing care for ptnt with cast:

• elevate extremity
• handle with palms of hand
• ice packs

complications with cast

• pressure to extremity from:
  • edema
  • dent in cast
  • poor alginment

process of bone healing

• callus formation

1st stage of bone healing

• stage of inflammation-1st 24-48 hrs
• bleeding occurs @ both bone ends
• clot formation
• fibrin establishes a network for healing

2nd state for bone healing

• 48-72 hrs.- cellular proliferation
• fibrin mesh is replaced by granulation tissue

3rd stage of bone healing

• 6-10 days-callus formation
• osteoblasts formed(new bone cells/CT tissue)
• bone held but not stable

4th stage of bone healing

• 2-4 weeks-callus ossification ( union)
• calcium and collagen strengthen the fracture area

5th stage of bone healing

• consolidation-remodeling
• depends on what bone is healing
• all "healthy bones" should be healed w/in 12 mo

arthritis

• variety of diseases characterized by pain & stiffness of musculoskelatal system
• # 1 cause of disability in the US

Infectious arthritis

• also septic arthritis
• caused by pathogens
• usually 1 jnt
• pain/redness/swelling
• treat with abx

traumatic arthritis

• caused by injury to jnt
• sports/dancing
• pain/heat/swelling
• treat by rest & immoblilize

metobolic arthritis

• also gout
• jnt inflammation
• cause by
  • deposit of uric acid crystals in jnt & CT
  • organ meats

osteoarthritis

• also DJD (dejenerative jnt. disease)
• progressive destruction of jnts
• from wear and tear of cartilage
• causes crepedus

rheumatoid arthritis

• system inflammatory disorder of CT
• chronic exacerbations and remissions
• most virulent form of arthritis

ankylosis

First stage of arthritis

Synovitis-inflammation of the synovial membrane=edema in the jnt.

2nd stage to arthritis

• pannus formation-
• layer of granulation tissue covering cartilage as a result of inflammation

3rd state of arthritis

• fibrous ankylosis-
• inflammation subsides and granulation tissue(pannus) is replaced by tough fibrous tissue
• inhibits jnt motion

4th stage of arthritis

• bony ankylosis
• fibrous tissue calcifies
• jnt fuses>no longer exists
• complete immobility

indidence of arthritis

• women 3x more than men
• any age- usually 25-45
• auto immune in nature

• antiinflammatories
• rest affected jnt
• muscle conditioning
• joint replacement

treatment of rhematoid arthritis

• relieve pain & discomfort with:
• balanced rest & exercise
• heat & cold therapies
• balanced diet
• jnt. replacement surgery
• drug therapy

djd seen in:

• mostly elderly
• obese
• athletes
• strenuous phys. trauma
• stressfull labor
• heredity

sprain

• injury to ligaments & surrounding tissues
• caused by wrenching/twisting
• s&s:
  • pain/muscle spasms
  • swelling
  • decreased motion
  • bruising

strain

• muscle injury
• caused by twisting/streching/wrenching/overuse

herepes simplex

•  HSV
• cold sores,fever blister, gingivostomatitis

symtoms of HSV

• vesicles on mouth/lips/genitals
• pain/burning/itching
• malaise
• crust over in 7-10 days

• treat symtoms-can only treat outbreaks
• keep clean/dry
• topical anesthetics
• anti-viryl- zovirax/valtrax

herpes zoster

• shingles
• reactivation of chicken pox virus
• Acute infection of the sensory nerve roots to the skin surface*

• immune suppresion
• most common in older adults

s&s of shingles(herpes zoster)

• blotchy @ effected area
• small red vesicles>can be painful
• N,V,anorexia
• contagious before vesicles crust over

• pruritis(itching)
• patchy,dry, red, scaly skin
• lesions
• skin thinckening w/ reacurring episodes

SLE

• Systemic lupus erythematosis
• chronic autoimmune inflammatory disease
• cause unknown-can be fatal

treatment of SLE

• Symptomatic, rest,nutrition*
• avoid overexposure to the sun
• MEDS:
  • anti inflammatories
  • steroids
  • chemo therapy

eczema

• inherited/chronic
• occurs in folds, face, and neck
• predisposing factors:
  • allergies
  • heredity
  • stress
  • hormone disorders

s&s of eczama

• pruritis
• patchy dry, red, scaly skin
• lesions, tiny vesicles or papules
• skin thickens with repeated occurances

leukoplakia

shiny with white patches on mucous membranes

pre- malignant

first degree burn

• superficial/minor/partial thickeness damage
• sunburn/hotwater
• erythema/heat/edema/no blisters
• heals in 1 week

second degree burns

• injury to epidermis and part of dermis(partial thickness)
• sever sunburn,scalding
• erythema,sub q edema,blisters,very painful
• chance of infection
• heals 10-14days

3rd degree burn

• full thickness-destruction of epidermis and dermis
• nerve,vessel,and bone damage
• not as painful until heals
• requires skin graph-cant regenerate
• charred black
• necrosis of tissue-eschar

eschar

• black,hard,scarred,leathery tissue
• dead skin

4th degree burn

• full thickness damage
• burn through bones, tendons etc.
• often requires amputate
• surface black w/ no pain
• extensive scarring

nursing care for burns

1. asess ABC's
2. assess for respiratory distress
3. pain relief-cool h20-(not many options)
4. fluid replacement
5. wound care

preventing complications of burns

• isolation
• pain relief
• assess for
  • contractures
  • infection
  • cyanosis
  • pedal pulses
  • swelling
  • circulation
  • pulses/feeling

wound care for burns

• remove body hair.clothing
• irragate
• debridement
• topical antimicrobial meds (silvadine)
• occlusive no stick dressing
• maybe surgery

autograph

alograph

from cadiver

hetro graph

• from family member

allergic reactions

• hyper immune response
• can effect any body part>frequently skin
• escessive immiune response>tissue injury

1st exposure allergic reaction

• develop antibodies

2nd exposure allergic reactions

• exaggerated immune response
• reaseases histamine
• causes
  • smooth musc. constriction(bronchospasm)
  • increase mucous production
  • increase vascular permeability

colloidal baths

• prepared by adding sodium bicarbonate,oil.or oatmeal to the water

tinea

• superficial fungal infection
• tinea corporis : ring worm
• "      " barbae : of head
• "      " pedis   : athletes foot
• "      " crums  : jock itch
• "      "  capitus: scalp

Moniliasis

• causes overgrowth of yeast
• thrush-yeast infection
• white discharge
• nystatin is drug of choice

cellulitis

• diffuse inflammation of skin & sub q. tissue
• insect bites....

sebacious cists

• acne vulgaris
• caused by
  •  hormone imblance
  • over active sebaceous glands

common allergies

• weat, eggs milk or dairy

rosacea

• erythmia flushing
• like little red mask
• chronic disease
• more common in men the women

psoriasis

• red,scaly patches
• keratinization(hardening of skin)
• elbows, knees, back,scalp

suborrhea

- psoriasis of scalp( shampoo for treating)

scleroderma*

• fibrosis and thickening of CT
• mummyfication of body

how to prevent decubitis ulcers*

• Change position
• massage around red area (not on top of)
• special mattress
• clean skin & linen>wrinkle free
• prevent friction
• nutrition
• elevating
• pad bony prominences