NSG-430 Exam 3 questions with correct
answers
fractures \- \ANSWERS✔✔ \-A \fracture \is \a \disruption \or \break \in \the \continuity \of \the \structure \of \bone.
-Although \traumatic \injuries \account \for \the \majority \of \fractures, \some \fractures \are \secondary \to \a \
disease \process \(such \as \pathologic \fractures \from \cancer \or \osteoporosis).
Complications \of \Fracture \Healing:
-Delayed \union:
•Fracture \healing \progresses \more \slowly \than \expected. \
•Healing \eventually \occurs.
-Nonunion:
•Fracture \fails \to \heal \despite \treatment. \
•No \x-ray \evidence \of \callus \formation.
-Malunion:
•Fracture \heals \in \expected \time \but \in \unsatisfactory \position, \possibly \resulting \in \deformity \or \
dysfunction.
-Angulation:
•Fracture \heals \in \abnormal \position \in \relation \to \midline \of \structure \(type \of \malunion).
-Pseudoarthrosis:
•Type \of \nonunion \occurring \at \fracture \site \in \which \a \false \joint \is \formed \with \abnormal \movement \
at \site.
-Refracture:
•New \fracture \occurs \at \original \fracture \site.
-Myositis \ossificans:
•Deposition \of \calcium \in \muscle \tissue \at \site \of \significant \blunt \muscle \trauma \or \repeated \muscle \
injury.
Clinical \Manifestations:
,-The \clinical \manifestations \of \fracture \include \immediate \localized \pain, \decreased \function, \and \
inability \to \bear \weight \on \or \use \the \affected \part.
-The \patient \guards \and \protects \the \extremity \against \movement.
-Obvious \bone \deformity \may \not \be \present.
-If \a \fracture \is \suspected, \the \extremity \is \immobilized \in \the \position \in \which \it \is \found. \
-Unnecessary \movement \increases \soft \tissue \damage \and \may \convert \a \closed \fracture \to \an \open \
fracture \or \create \further \injury \to \adjacent \nerves \and \blood \vessels.
Interprofessional \Care:
-The \overall \goals \of \fracture \treatment \are:
(1) \Anatomic \realignment \of \bone \fragments \through \reduction
(2) \Immobilization \to \maintain \realignment, \and
(3) \Restoration \of \normal \or \near-normal \function \of \the \injured \part.
Clo
traction \- \ANSWERS✔✔ \-Traction \is \used \to:
(1) \Prevent \or \reduce \pain \and \muscle \spasm \(e.g., \whiplash, \unrepaired \hip \fracture)
(2) \Immobilize \a \joint \or \part \of \the \body
(3) \Reduce \a \fracture \or \dislocation \
(4) \Treat \a \pathologic \joint \condition \(e.g., \tumor, \infection)
-Traction \devices \apply \a \pulling \force \on \a \fractured \extremity \to \attain \realignment, \while \
countertraction \pulls \in \the \opposite \direction.
-The \two \most \common \types \of \traction \are \skin \traction \and \skeletal \traction.
Skin \Traction:
-Skin \traction \is \generally \used \for \short-term \treatment \(48 \to \72 \hours) \until \skeletal \traction \or \
surgery \is \possible.
-Tape, \boots, \or \splints \are \applied \directly \to \the \skin \to \maintain \alignment, \primarily \to \help \
diminish \muscle \spasms \in \the \injured \extremity.
,-The \traction \weights \are \usually \limited \to \5 \to \10 \lbs \(2.3 \to \4.5 \kg).
-A \Buck's \traction \boot \is \a \type \of \skin \traction \used \preoperatively \for \the \patient \with \a \hip \fracture \
to \reduce \muscle \spasms \
Buck's \traction \is \used \to \immobilize \a \fracture, \prevent \hip \flexion \contractures, \and \reduce \muscle \
spasms.
-In \skin \traction, \regular \assessment \of \the \skin \is \a \priority \because \pressure \points \and \skin \
breakdown \may \develop \quickly. \
-Assess \key \pressure \points \every \2 \to \4 \hours.
Skeletal \Traction:
-Skeletal \traction, \generally \in \place \for \longer \periods \than \skin \traction, \is \used \to \align \injured \
bones \and \joints \or \to \treat \joint \contractures \and \congenital \hip \dysplasia.
-It \provides \a \long-term \pull \that \keeps \the \injured \bones \and \joints \aligned.
-To \apply \skeletal \traction, \the \surgeon \inserts \a \pin \or \wire \into \the \bone, \and \weights \are \attached \
to \align \and \immobilize \the \injured \body \part.
-Weight \for \skeletal \traction \ranges \from \5 \to \45 \lbs \(2.3 \to \20.4 \kg).
-The \use \of \too \much \weight \can \result \in \delayed \union \or \nonunion.
-The \major \complication
vertebral \immobilization \- \ANSWERS✔✔ \-The \body \jacket \brace \is \used \for \immobilization \and \
support \for \stable \spine \injuries \of \the \thoracic \or \lumbar \spine. \
-The \brace \goes \around \the \chest \and \abdomen, \extending \from \above \the \nipple \line \to \the \pubis.
-After \application \of \the \brace, \assess \the \patient \for \the \development \of \superior \mesenteric \artery \
syndrome \(cast \syndrome).
•This \condition \occurs \if \the \brace \is \applied \too \tightly, \which \results \in \compression \of \the \superior \
mesenteric \artery \against \the \duodenum.
•The \patient \generally \complains \of \abdominal \pain, \abdominal \pressure, \nausea, \and \vomiting.
•Assess \the \abdomen \for \decreased \bowel \sounds \(a \window \in \the \brace \may \be \left \over \the \
umbilicus).
•Treatment \includes \gastric \decompression \with \a \nasogastric \(NG) \tube \and \suction.
-Assessment \also \includes \monitoring \respiratory \status, \bowel \and \bladder \function, \and \areas \of \
pressure \over \the \bony \prominences, \especially \the \iliac \crest. \
, -The \brace \may \need \to \be \adjusted \or \removed \if \any \complications \occur.
lower \extremity \immobilization \- \ANSWERS✔✔ \-After \the \application \of \a \lower \extremity \cast \or \
dressing, \the \extremity \should \be \elevated \on \pillows \above \heart \level \for \the \first \24 \hours.
-After \the \initial \phase, \a \casted \extremity \should \not \be \placed \in \a \dependent \position \because \of \
the \possibility \of \excessive \edema.
-After \cast \application, \observe \for \signs \of \compartment \syndrome \and \increased \pressure, \especially \
in \the \heel, \anterior \tibia, \head \of \fibula, \and \malleoli. \
-This \increased \pressure \is \manifested \by \pain \or \burning \in \these \areas.
-Prefabricated \knee \and \ankle \splints \and \immobilizers \are \used \in \many \settings.
-This \type \of \immobilization \is \easy \to \apply \and \remove, \which \permits \close \observation \of \the \
affected \joint \for \signs \of \swelling \and \skin \breakdown.
-Depending \on \the \injury, \removal \of \the \splint \or \immobilizer \facilitates \ROM \of \the \affected \joint \and \
faster \return \to \function.
external \fixation \- \ANSWERS✔✔ \-An \external \fixator \is \a \metallic \device \composed \of \metal \pins \that \
are \inserted \into \the \bone \and \attached \to \external \rods \to \stabilize \the \fracture \while \it \heals.
-The \external \fixator \is \attached \directly \to \the \bones \by \percutaneous \transfixing \pins \or \wires.
-It \can \be \used \to \apply \traction \or \to \compress \fracture \fragments \and \immobilize \reduced \fragments \
when \the \use \of \a \cast \or \other \traction \is \not \appropriate.
-The \external \device \holds \fracture \fragments \in \place \similar \to \a \surgically \implanted \internal \device.
-External \fixation \is \often \used \in \an \attempt \to \salvage \extremities \that \otherwise \might \require \
amputation.
-Because \the \use \of \an \external \device \is \a \long-term \process, \ongoing \assessment \for \pin \loosening \
and \infection \is \critical.
-Infection \(indicated \by \exudate, \erythema, \tenderness, \and \pain) \may \require \removal \of \the \device.
-Pus \oozing \out \of \the \hole, \redness, \swelling, \elevated \temperature, \and \elevated \WBC \indicates \
infection
-Instruct \the \patient \and \caregiver \about \meticulous \pin \care.
-Although \each \physician \has \a \protocol \for \pin \care \cleaning, \chlorhexidine \2mg/ml \is \often \used.
-Water \and \peroxide \is \used \for \pin \site \care