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Fractures (Open, Closed, Fat Embolus) for Certified Emergency Nursing (CEN)

Fractures (Open, Closed, Fat Embolus) for Certified Emergency Nursing (CEN)

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Study Tools For Fractures (Open, Closed, Fat Embolus) for Certified Emergency Nursing (CEN)

Types of Fractures (Image)

Compound Fracture Before and After Repair (Image)

Displaced Fracture with Dislocation (Image)

Hip Fracture Presentation (Image)

Rib Fracture Xray (Image)

Facial Fractures (Image)

Types of Fractures (Image)

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Outline

Fractures (Open, Closed, Fat Embolus)

Definition/Etiology:

Closed Fracture (Simple fracture) – break in the bone but the skin and surrounding tissue remain intact (CLOSED)
Open Fracture (Compound fracture) – break in the bone but the skin and surround tissue are compromised (OPEN)
Fat Embolism – characterized by systemic dissemination of fat emboli within the system circulation. Orthopedic trauma is the usual cause

Pathophysiology:

Fracture – A break in the bone is usually caused by trauma/injury such as MVA, MCC, falls, etc.
Fat embolus – Fat particles are released from the bone during the time of the fracture and enter the microcirculation, causing damage to the capillary beds.
Usually, a fracture of the long bone or pelvis.

Route of the fat embolus:

Lungs
Brain
Eyes

Clinical Presentation:

Open fractures are at increased risk of neurovascular compromise, hemorrhage and INFECTION!
Usually occur from high velocity injuries
Skin will be open, extremity usually deformed
Distracting injuries so don’t forget your ABCs, then address the fracture

Collaborative Management:

Fractures:

X-ray (of course)
CT may be helpful if it is a joint such as an ankle.
CTA used to identify vascular injury if pulses are diminished
Stabilize injury (splint/pillow/cast/etc)
Check for distal pulses and sensation for baseline neurovascular status
Hemodynamic monitoring
Pain management
Lifesaving tetanus
Open fracture – Get those antibiotics on board.

Fat Embolus:

Diagnosis based on hx of traumatic fx and symptoms
Symptomatic treatment
Good Oxygenation
Albumin binds to fatty acids
stabilization of the fracture

Evaluation | Patient Monitoring | Education:

Closed fracture? Splint it and forget it. (Rarely requires more than outpatient follow up and pain management)

Watch for swelling (especially after splinting) due to risk for compartment syndrome

Open fracture? Hanging out for the night

Ortho consult, surgical consult
Open fractures may need reduced to take pressure off open area
Monitor for signs of infection

Linchpins: (Key Points)

Either fracture can have neurovascular compromise
Open fractures have higher risk of infection
Surgical consult needed on open fractures

Fat Embolus Triad:

Respiratory Changes (hypoxia, dyspnea)
Neurologic Changes (Altered Mental Status)
Dermatological Changes (Petechial Rash)

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Transcript

For more great CEN prep, got to the link below to purchase the “Emergency Nursing Examination Review” book by Dr. Laura Gasparis Vonfrolio RN, PHD
https://greatnurses.com/

References:

Adeyinka, A., & Pierre, L. (2018). Fat embolism.
Shaikh, N. (2009). Emergency management of fat embolism syndrome. Journal of Emergencies, Trauma and Shock, 2(1), 29.
Sheehy, S. B., Hammond, B. B., & Zimmermann, P. G. (2013). Sheehy’s manual of emergency care. 7th ed. / St. Louis, Mo., Elsevier/Mosby.
Sop, J. L., & Sop, A. (2017). Open Fracture Management.

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Study Plan Lessons

05.01 Pancreatitis and Large Bowel Obstruction for CCRN Review

Acute Respiratory Distress Syndrome (ARDS) for Progressive Care Certified Nurse (PCCN)

AIDS Case Study (45 min)

Airway Suctioning

Anemia for Progressive Care Certified Nurse (PCCN)

Anesthetic Agents

Anesthetic Agents

ARDS Case Study (60 min)

ARDS causes Nursing Mnemonic (GUT PASS)

Artificial Airways

Aspiration for Certified Emergency Nursing (CEN)

Assessment for Myasthenic Crisis Nursing Mnemonic (BRISH)

Asthma for Certified Emergency Nursing (CEN)

AVPU Mnemonic (The AVPU Scale)

Azithromycin (Zithromax) Nursing Considerations

Brain Death v. Comatose

Carbon Dioxide (Co2) Lab Values

Chest Tube Management

Chest Tube Management Case Study (60 min)

Chronic Obstructive Pulmonary Disease (COPD) Case Study (60 min)

Chronic Obstructive Pulmonary Disease (COPD) for Certified Emergency Nursing (CEN)

Cirrhosis Case Study (45 min)

Cold Temperature-related Emergencies for Certified Emergency Nursing (CEN)

Complications of Immobility

Coronavirus (COVID-19) Nursing Care and General Information

Day in the Life of a Med-surg Nurse

Diabetes Insipidus Case Study (60 min)

Diabetes Mellitus Case Study (45 min)

Diabetic Ketoacidosis (DKA) Case Study (45 min)

Disseminated Intravascular Coagulation Case Study (60 min)

Dysrhythmias for Certified Emergency Nursing (CEN)

Enteral & Parenteral Nutrition (Diet, TPN)

Erythromycin (Erythrocin) Nursing Considerations

Fractures (Open, Closed, Fat Embolus) for Certified Emergency Nursing (CEN)

General Anesthesia

Head and Spinal Cord Trauma for Certified Emergency Nursing (CEN)

Heart Failure Case Study (45 min)

Heart Failure for Certified Emergency Nursing (CEN)

Hemorrhagic Fevers for Certified Emergency Nursing (CEN)

Histamine 1 Receptor Blockers

Hyperthyroidism Case Study (75 min)

Hypothermia (Thermoregulation)

Infectious Diseases: Influenza for Progressive Care Certified Nurse (PCCN)

Intraoperative (Intraop) Complications

Leukemia Case Study (60 min)

Levofloxacin (Levaquin) Nursing Considerations

Local Anesthesia

Malignant Hyperthermia

Meperidine (Demerol) Nursing Considerations

Metabolic Acidosis (interpretation and nursing diagnosis)

Miscellaneous Nerve Disorders

Moderate Sedation

Montelukast (Singulair) Nursing Considerations

Morphine (MS Contin) Nursing Considerations

Myocardial Infarction (MI) Case Study (45 min)

Nephrotic Syndrome Case Study (Peds) (45 min)

Neurological Disorders (Multiple Sclerosis, Myasthenia Gravis, Guillain-Barré Syndrome) for Certified Emergency Nursing (CEN)

Noncardiac Pulmonary Edema for Certified Emergency Nursing (CEN)

Nursing Care and Pathophysiology for Acquired Immune Deficiency Syndrome (AIDS)

Nursing Care and Pathophysiology for Anaphylaxis

Nursing Care and Pathophysiology for Asthma

Nursing Care and Pathophysiology for Influenza (Flu)

Nursing Care and Pathophysiology for Myasthenia Gravis

Nursing Care and Pathophysiology for Psoriasis

Nursing Care and Pathophysiology for Scleroderma

Nursing Care and Pathophysiology for Sepsis

Nursing Care and Pathophysiology for SIRS & MODS

Nursing Care and Pathophysiology of Acute Respiratory Distress Syndrome (ARDS)

Nursing Care and Pathophysiology of Chronic Kidney (Renal) Disease (CKD)

Nursing Care and Pathophysiology of Diabetic Ketoacidosis (DKA)

Nursing Care and Pathophysiology of Glomerulonephritis

Nursing Care and Pathophysiology of Pneumonia

Nursing Care Plan (NCP) & Interventions for Increased Intracranial Pressure (ICP)

Nursing Care Plan (NCP) for Activity Intolerance

Nursing Care Plan (NCP) for Acute Bronchitis

Nursing Care Plan (NCP) for Acute Kidney Injury

Nursing Care Plan (NCP) for Acute Respiratory Distress Syndrome

Nursing Care Plan (NCP) for Anaphylaxis

Nursing Care Plan (NCP) for Anemia

Nursing Care Plan (NCP) for Angina

Nursing Care Plan (NCP) for Aortic Aneurysm

Nursing Care Plan (NCP) for Aspiration

Nursing Care Plan (NCP) for Asthma / Childhood Asthma

Nursing Care Plan (NCP) for Blunt Chest Trauma

Nursing Care Plan (NCP) for Bowel Obstruction

Nursing Care Plan (NCP) for Brain Tumors

Nursing Care Plan (NCP) for Bronchoscopy (Procedure)

Nursing Care Plan (NCP) for Cardiogenic Shock

Nursing Care Plan (NCP) for Chronic Kidney Disease

Nursing Care Plan (NCP) for Chronic Obstructive Pulmonary Disease (COPD)

Nursing Care Plan (NCP) for Congestive Heart Failure (CHF)

Nursing Care Plan (NCP) for Cushing’s Disease

Nursing Care Plan (NCP) for Diabetes Insipidus

Nursing Care Plan (NCP) for Diabetic Ketoacidosis (DKA)

Nursing Care Plan (NCP) for Disseminated Intravascular Coagulation (DIC)

Nursing Care Plan (NCP) for Diverticulosis / Diverticulitis

Nursing Care Plan (NCP) for Emphysema

Nursing Care Plan (NCP) for Encephalopathy

Nursing Care Plan (NCP) for Endocarditis

Nursing Care Plan (NCP) for Gastroesophageal Reflux Disease (GERD)

Nursing Care Plan (NCP) for GI (Gastrointestinal) Bleed

Nursing Care Plan (NCP) for Guillain-Barre

Nursing Care Plan (NCP) for Heart Valve Disorders

Nursing Care Plan (NCP) for Hydrocephalus

Nursing Care Plan (NCP) for Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS)

Nursing Care Plan (NCP) for Hyperthermia (Thermoregulation)

Nursing Care Plan (NCP) for Hyperthyroidism

Nursing Care Plan (NCP) for Hypovolemic Shock

Nursing Care Plan (NCP) for Lung Cancer

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Nursing Care Plan (NCP) for Mumps

Nursing Care Plan (NCP) for Myasthenia Gravis (MG)

Nursing Care Plan (NCP) for Myocardial Infarction (MI)

Nursing Care Plan (NCP) for Nephrotic Syndrome

Nursing Care Plan (NCP) for Osteoporosis

Nursing Care Plan (NCP) for Pancreatitis

Nursing Care Plan (NCP) for Pericarditis

Nursing Care Plan (NCP) for Restrictive Lung Diseases

Nursing Care Plan (NCP) for Rubeola – Measles

Nursing Care Plan (NCP) for Spinal Cord Injury

Nursing Care Plan (NCP) for Syncope (Fainting)

Nursing Care Plan (NCP) for Syndrome of Inappropriate Antidiuretic Hormone (SIADH)

Nursing Care Plan (NCP) for Thoracentesis (Procedure)

Nursing Care Plan (NCP) for Thrombophlebitis / Deep Vein Thrombosis (DVT)

Nursing Care Plan (NCP) for Tuberculosis

Nursing Care Plan for Cirrhosis (Liver)

Nursing Care Plan for Distributive Shock

Nursing Care Plan for Nasal Disorders

Nursing Care Plan for Pulmonary Edema

Nursing Care Plan for Restrictive Lung Diseases (Pulmonary Fibrosis, Neuromuscular Disorders)

Nursing Care Plan for Scleroderma

Nursing Case Study for Breast Cancer

Nursing Case Study for Cardiogenic Shock

Nursing Case Study for Hepatitis

Nursing Case Study for Pneumonia

Nursing Case Study for Type 1 Diabetes

Obstruction for Certified Emergency Nursing (CEN)

Obstructive Sleep Apnea for Progressive Care Certified Nurse (PCCN)

Ondansetron (Zofran) Nursing Considerations

Pancreatitis For PCCN for Progressive Care Certified Nurse (PCCN)

Patient Positioning

Pentobarbital (Nembutal) Nursing Considerations

Peritonitis for Certified Emergency Nursing (CEN)

Pleural Space Complications (Pneumothorax, Hemothorax, Pleural Effusion, Empyema, Chylothorax) for Progressive Care Certified Nurse (PCCN)

Positioning (Pressure Injury Prevention and Tourniquet Safety) for Certified Perioperative Nurse (CNOR)

Post-Anesthesia Recovery

PPE Precautions (Personal Protective Equipment) for Certified Perioperative Nurse (CNOR)

Propofol (Diprivan) Nursing Considerations

Respiratory A&P Module Intro

Respiratory Alkalosis

Respiratory Course Introduction

Respiratory Depression (Medication-Induced, Decreased-LOC-Induced) for Progressive Care Certified Nurse (PCCN)

Respiratory Distress Syndrome for Certified Emergency Nursing (CEN)

Respiratory Failure (Acute, Chronic, Failure to Wean) for Progressive Care Certified Nurse (PCCN)

Respiratory Infections (Pneumonia) for Progressive Care Certified Nurse (PCCN)

Respiratory Infections Module Intro

Respiratory Procedures Module Intro

Respiratory Trauma for Certified Emergency Nursing (CEN)

Respiratory Trauma Module Intro

Rheumatoid Arthritis Assessment Nursing Mnemonic (RHEUMATOID)

Shock States (Anaphylactic, Hypovolemic) For PCCN for Progressive Care Certified Nurse (PCCN)

Spinal Cord Injury Case Study (60 min)

Stroke Assessment (CVA)

Surgical Wound Classification Documentation for Certified Perioperative Nurse (CNOR)

Systemic Lupus Erythematosus (SLE)

The Medical Team

Trach Suctioning

Tuberculosis for Certified Emergency Nursing (CEN)

Vaccine-Preventable Diseases (Measles, Mumps, Pertussis, Chicken Pox, Diphtheria) for Certified Emergency Nursing (CEN)

Ventilator Settings

Wound Dressing Maintenance for Certified Perioperative Nurse (CNOR)