I. Musculoskeletal Disorders: Fractures & Care
Key Terms

Fracture: A break or crack in the bone.

Crepitus: A grating sound created by the rubbing of bone fragments.

Osteomyelitis: An infection of the bone beginning as inflammation secondary to
infectious organisms.

Compartment Syndrome: Occurs when pressure within muscle compartments
compromises circulation, leading to an ischemia-edema cycle.
Fracture Classification

Closed (Simple): No break in the skin.

Open (Compound/Complex): Skin integrity is disrupted; graded 1 (minimal) to 3
(excessive damage to skin, muscle, nerves, and vessels).

Comminuted: Bone is broken into mini-fragments.

Spiral: Occurs from a twisting motion; often associated with physical abuse.

Greenstick: Fracture on one side that doesn't extend through the bone; most common in
children.
Nursing Interventions for Acute Fractures

Emergency Care: Keep the patient NPO until evaluated; stabilize joints above and
below the injury using a splint.

Elevation & Ice: Elevate the limb above the heart and apply ice.

Neurovascular Checks: Perform hourly; monitor the 6 Ps: Pain, Pallor, Paralysis,
Paresthesia, Pulselessness, and Poikilothermia (inability to regulate temperature).

Cast Care:
o
Plaster Casts: Handle with palms, not fingertips, until dry (24-72 hours) to
prevent denting.
o
Education: Do not stick foreign objects inside; use a hair dryer on a cool setting
for itching.
o
Assessment: There should be room for one finger between the skin and the cast.
Traction & Immobilization

Skin Traction (e.g., Buck's): Primary purpose is to decrease muscle spasms and
immobilize before surgery.

Skeletal Traction: Screws are inserted into the bone (e.g., Halo); uses heavier weights
(15-30 lbs).
o
Pin Care: Performed 1-2 times daily; monitor for "tenting" (skin rising at the pin
site).

External Fixation: Uses percutaneous pins and a rigid external frame; allows for early
mobility.
Critical Complications

Compartment Syndrome:
o
Pathophysiology: Increased pressure causes capillary dilation and histamine
release, leading to more edema and nerve pressure.
o
Signs: Pain unrelieved by medication/elevation; paresthesia (early sign);
pulselessness (late sign).
o
Action: Notify the provider immediately; keep the extremity at heart level (not
above) to improve arterial pressure; prepare for a fasciotomy.

Fat Embolism:
o
Pathophysiology: Fat globules from bone marrow enter the vasculature, usually
12-48 hours after a long bone fracture.
o
Signs: Dyspnea, tachypnea, and cutaneous petechiae (pinpoint hemorrhages on
the neck/chest), which distinguishes it from a pulmonary embolism.
Study Tip: Hip Replacement Precautions

Positioning: Keep the hip in abduction when turning; use an abduction pillow.

Restrictions: Avoid flexing the hip greater than 90 degrees; do not cross legs or sit in
low chairs.
II. Acute Respiratory Disorders
Diagnostic Procedures

Arterial Blood Gases (ABGs): Collected in a heparinized syringe, placed on ice, and
pressured for 5 minutes (20 if on anticoagulants).

Bronchoscopy: Visualizes the larynx, trachea, and bronchi.
o

Nursing: Maintain NPO until the gag reflex returns.
Thoracentesis: Surgical perforation of the chest wall to remove fluid or air.
o
Positioning: Sitting upright with arms supported on an over-bed table.
Pneumonia & Atelectasis

Atelectasis: Collapse of alveoli, often post-op due to shallow breathing.
o
Prevention (ICOUGH): Incentive spirometry, Coughing/deep breathing, Oral
care, Understanding, Get moving, Head of bed elevated.

Pneumonia: Inflammation of lung parenchyma.
o
Geriatric Note: Confusion from hypoxia is the most common manifestation in
older adults.
o
Nursing: Always obtain sputum cultures before starting antibiotics.
Pulmonary Embolism (PE)

Risk Factors: Immobility, oral contraceptives, surgery (orthopedic), and tobacco use.

Manifestations: Anxiety ("feeling of impending doom"), chest pain, and hemoptysis.

Nursing: Position in High-Fowler’s; monitor PT/INR for Warfarin or aPTT for Heparin.

Dietary Note: Patients on Warfarin must maintain a consistent intake of Vitamin K
(green leafy vegetables) and avoid grapefruit juice.
Chronic Obstructive Pulmonary Disease (COPD)

Types:
o
Chronic Bronchitis ("Blue Bloaters"): Airway inflammation and
hypersecretion of mucus.
o
Emphysema ("Pink Puffers"): Loss of lung elasticity and destruction of alveoli;
results in "trapped air" and a barrel chest.

Nursing: Maintain O2 saturation between 88-93% because COPD patients are
stimulated to breathe by low O2 levels, not high CO2.

Breathing Techniques: Diaphragmatic breathing and pursed-lip breathing (breathe in
through the nose, out through the mouth like whistling).
Asthma

Pathophysiology: Intermittent, reversible airflow obstruction caused by inflammation or
airway hyper-responsiveness.

Status Asthmaticus: A life-threatening episode unresponsive to common treatment;
prepare for emergency intubation and epinephrine.

Medication Tip: Use bronchodilators (Albuterol) for acute attacks and antiinflammatories (Corticosteroids) for long-term prevention. Rinse mouth after steroid
inhalers to prevent thrush.
III. Acid-Base Balance & ABG Interpretation
Normal Values:

pH: 7.35 – 7.45

PaCO2: 35 – 45 mmHg

HCO3: 22 – 26 mEq/L
Condition
pH
Primary Cause/Feature
Common Signs
Respiratory
Low
High PaCO2 (>42);
Mental changes,
Acidosis
(<7.35)
Hypoventilation
tachycardia
Respiratory
High
Low PaCO2 (<35);
Alkalosis
(>7.45)
Hyperventilation
Metabolic
Low
Low HCO3 (<22); Kidney injury;
Acidosis
(<7.35)
Diarrhea
Metabolic
High
High HCO3 (>26);
Symptoms related to low
Alkalosis
(>7.45)
Vomiting/Suction
calcium
Lightheadedness, tingling
Headache, drowsiness
IV. COVID-19 Management

Transmission: Droplet, contact, and potentially airborne; highly contagious.

Infection Control: Use standard, contact, droplet, and airborne precautions; observed
donning and doffing of PPE reduces contamination risk.


Supportive Therapy:
o
Self-proning to improve oxygenation.
o
Prone ventilation (12-16 hours/day) for intubated patients.
Medical Management: Remdesivir and corticosteroids (for hospitalized patients
requiring supplemental O2).

Discharge Criteria: Fever-free for 24 hours without medication and resolution of
symptoms or 10 days since onset.