Med Surg Test 3 Study Guide Fractures 12% What is the difference between an open and closed fracture? Open fracture: bone breaks through the epidermis at any point during the event of trauma Closed fracture: bone breaks but remains internal through the event of trauma What is the priority assessment for the patient with a fracture? PMS = Perfusion, movement, sensation We want to be sure to check PMS distally to the injury to see if there is any neurovascular compromise. We also want to prioritize the patient’s hemodynamic status if they’ve lost blood. - Blood infusion, blood pressure support, catch and treat shock What is included in a neurovascular assessment? How do you know where to perform a neurovascular assessment at (like which location on the body) A neurovascular assessment includes: - Look at the tissues for their color/pallor to check for inadequate perfusion Ask about feelings of tingling, lack of sensation, pain in injury and in distal extremity “Did you hit your head?” - A neuro assessment to make sure they’re alert and oriented ROM to check movement/limitations What are early and late signs of neurovascular compromise? REMEMBER the 6s Ps: paresthesia, pallor, pain, pressure, paralysis, and pulselessness Early Signs: 1. Paresthesia: tingles and pain 2. Pallor: skin look pale 3. Pain: the pain may be inconsistent/oddly more severe in comparison to the actual injury 4. Pressure: feelings of pressure d/t inflammation that is excessive and inconsistent Late Signs: Compartment syndrome can happen in later stages, and you’ll see the below indicators. 5. Paralysis: inability to move the extremity 6. Pulselessness: unable to find a pulse in the extremity - What interventions would the nurse implement to prevent neurovascular compromise? - NSAIDs/antiinflammatory medications to reduce inflammation that puts pressure on nerves and can cause perfusion complications Get a Hx of the event to ensure no foul play at hand/risk of additional trauma post-discharge Head to Toe Assessment to find early signs of neurovascular compromise Monitor skin integrity/turning q2h at least Assessing sometimes every hour to catch early Educate on signs of PMS issues, what to look for, and when to call the doctor/tell the nurse about issues Use splints as appropriate to support the extremity Elevate limb (mostly to prevent compartment syndrome) How does a neurovascular assessment support the complication of acute compartment syndrome? How are the interventions different? Do you understand the nursing process for the following complications related to fractures? In other words, who is at risk and what would they look like (assessment), what interventions would you implement to prevent and treat (planning/implementation), and how do you know if your interventions worked (evaluation). Infection/Osteomyelitis: Assessment: - Raised WBC (leukocytosis) Fever Flushed Green exudate Erythema
