question about pathophysiology of fractures

Nursing Students Student Assist

Published

For the past several rotations all of my patient's admitting medical diagnoses have been fractures. So my #1 diagnosis on my POC has to be related to that. I'm having a terrible time finding information about specific fractures. My patient this week had rib 2-3 fractures, and Rt. patella fracture. I'm not sure what to put as my medical diagnosis. Her injuries are from a MVC. So I cannot use osteoporosis like I have in the past for some patients. Any suggestions? Can I even use patella fracture as a medical diagnosis? Or am I way off here? Like I said, I'm not finding any specifics on patho for certain types of fractures, at least not very detailed info.

Up Vote Up Vote ×

Altered breathing pattern r/t inability to inhale deeply/pain secondary to multiple rib fractures...you might could use impaired gas exchange if the patient is ever on oxygen. Oh but you r talking about Medical diagnosis...If it were me Id probably list MvC with rib and patellar fx's. Traumas especially from a MVC have many diagnosis going on..but you should use what the doctors wrote...h&p or admit diagnosis

Up Vote Up Vote ×

Ok, thank you! I didn't think about putting MVC in there with it. The specific adm diagnoses were open patella fracture and rib 2-3 fracture with flail. But there was nothing about type of fracture. That's why I'm having a hard time finding an actual patho for it. I guess I will look up rib fractures from MVC and see what I can find.

Up Vote Up Vote ×
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

Fracture from the BLUNT FORCE trauma......look up Flail Chest

A flail chest is a life-threatening medical condition that occurs when a segment of the rib cage breaks under extreme stress and becomes detached from the rest of the chest wall. It occurs when multiple adjacent ribs are broken in multiple places, separating a segment, so a part of the chest wall moves independently. The number of ribs that must be broken varies by differing definitions: some sources say at least two adjacent ribs are broken in at least two places,some require three or more ribs in two or more places. The flail segment moves in the opposite direction as the rest of the chest wall: because of the ambient pressure in comparison to the pressure inside the lungs, it goes in while the rest of the chest is moving out, and vice versa. This so-called "paradoxical motion" can increase the work and pain involved in breathing.
Trauma.org | Rib fractures & Flail Chest Flail Chest - Medscape Reference I LOVE medscape....it requires registration but it is FREE. It is a good/valid resource/source.

If you think about a trauma and the mechanism of injury...what in the car would most likely cause an open fracture of the knee?The dashboard? Again BLUNT FORCE TRAUMA. Patellar (Kneecap) Fractures-OrthoInfo - AAOS Patella Fractures again medscape.

What is an open fracture? What complications are possible with open fractures? Patellar (Kneecap) Fractures-OrthoInfo - AAOS

Look up trauma and blunt force trauma as well as high impact MVC trauma.

Up Vote Up Vote ×
Specializes in ER trauma, ICU - trauma, neuro surgical.

A medical diagnosis describes the injuries sustained and the mechanism of injury. MVC, rib fractures, patella fracture, flail chest, and blunt force trauma are all medical diagnoses. Those terms are fine for listing a medical diagnosis. Many of the fractures that have terms, like spiral fracture or hairline fracture, mainly describe the direction of fracture and the extent (while still being place or in anatomical alignment). Once they are dislocated, those terms go out the window...it's just a fracture dislocation. You may be able to find specifics on the type of fracture to the patella, but a flail chest...it doesn't matter because they are free-floating.

Up Vote Up Vote ×

Thanks guys! This is very helpful. I was wondering why there wasn't more information on either of these in the chart. Unfortunately, at about 11:45 last night I fell asleep. My POC is always due at midnight after clinical. So after two hours of being out of it I woke up and realized what I had done. I didn't have any more time to edit it. I did find some info on fractured ribs on the OrthoInfo site. But not as detailed as the above. Next week I will be looking the medical diagnosis up first, then meds. My instructors suggested looking up meds last, but I've found that I have to have that information before I get started on diagnoses. I'm really not sure why they would want us to do it that way, especially when we are going to need to know about the meds we will be giving. Anyways, thanks again for the help.

Up Vote Up Vote ×
Specializes in ER trauma, ICU - trauma, neuro surgical.

No problem! Yeah, I would agree to look up the meds last. They take a while to gather all the info. But, when you are a nurse, the meds can tell you all sorts of information. Many times, pts will tell you that the only history they have is hypertension, but then you'll see that they are on 10 different medications! It gives you a good idea of what is going on or what history they had. Good Luck!

Up Vote Up Vote ×
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

be cautious doing it that way for it can be easy to be tricked for there are many off label uses of meds......then you will be looking up the wrong disease/diagnosis.

Look at your patient...look up nothing...what do they need....what made them come top the hospital? For example.....this patient was brought to the hospital because they were badly hurt in a car crash......then you look up Trauma. This patient didn't have just fractured ribs....you even said the word....this patient had FLAIL CHEST.....a serious HIGH SPEED impact to this patient chest to cause many ribs to fracture causing damaged to the chest ribs and lungs.....you also have to consider damage to the heart and great vessels like the aorta.

What complications can be caused by damaged lungs, heart, chest?

They hit their knee hard enough to break it and leave the bone open and exposed....how many times have you fallen and never broke that bone. can you imagine the impact that it took???? What complications can occur with a bone exposed from a traumatic injury in a dirty car.

Do you see????

Look at your patient....it's all about the patient.

Up Vote Up Vote ×
+ Add a Comment