Fractures
What is a comminuated fracture?
A fracture that has broken into multiple pieces.
The home health nurse is caring for a patient experiencing constipation. The patient asks the nurse how to prevent constipation. Which recommendations should the nurse include in their answer to the patient? Provide 2 examples.
Drink at least 1500 mL of water per day.
Increase activity or exercise.
Increase fiber in the diet.
Defecate when the urge is felt.
The patient talks with the nurse about bladder health. What is one of the most important recommendations the nurse can make for this patient?
1.Eat foods high in fiber such as fresh fruits and vegetables.
2.Drink six to eight glasses of water or noncaffeinated fluids daily.
3.Exercise twice a day, in the morning and evening.
2.Drink six to eight glasses of water or noncaffeinated fluids daily.
A physician had ordered D 5 0.9% NaCl for a burn patient. You understand this is what type of fluid? (isotonic, hypotonic, hypertonic)
What is hypertonic
A patient with a history of cardiac problems talks with the nurse about bowel elimination. The nurse stresses to the patient not to strain during bowel movements. Straining can put pressure on the vagus nerve and cause bradycardia. Which physiological function is the nurse explaining?
Valsalva maneuver
Inadequate intake of what 3 nutrients can contribute to fractures?
Vitamin D, calcium, phosphorus.
Also known as paralytic ileus, this type of obstruction occurs when peristalsis stops even though no physical blockage is present.
“What is a functional obstruction?”
Rationale:
Postoperative ileus and certain medications can impair peristalsis.
The nurse is talking with a patient who was just diagnosed with a urinary tract infection. The patient asks the nurse how to prevent such infections in the future. The nurse should make which appropriate recommendations for the patient? Provide at least 2 examples.
Drink six to eight glasses of noncaffeinated fluids daily.
Void when the urge is felt.
Interpret the following ABG:
pH 7.30, PCO2 = 44, HCO3 = 20
What is metabolic acidosis
The nurse is caring for a patient with a colostomy of the ascending colon. What characteristic of stool would the nurse expect in the colostomy device?
Loose or watery stool.
Compartment syndrome is due to increased pressure depleting muscles from getting blood flow. If compartment syndrome isn't fixed, what are some potential complications? Name at least 2.
Amputation due to ischemia of the muscle/tissues
Surgical decompression (fasciotomy)
Necrosis
If left untreated, bowel obstruction can lead to this severe complication due to impaired blood flow and rising intraluminal pressure.
“What is bowel necrosis or perforation?”
Rationale:
Compromised tissue can die or rupture.
The nurse is caring for a patient who is confused and wearing a vest restraint in bed. The nurse speaks with an unlicensed assistant about toileting the patient. The nurse knows the unlicensed assistant understands the toileting procedure when making which statement.
1.The patient must remain in the restraint all day.
2.The patient needs to be toileted regularly to maintain a normal voiding schedule.
3.The patient needs to be provided with adult briefs for incontinence.
2.The patient needs to be toileted regularly to maintain a normal voiding schedule.
Order: Infuse D5W 500 mL with 20,000 units heparin at 25 mL/hr. Determine units/hr.
1,000 units/hr
When a patient has a cast in place, what are some nursing tasks to ensure safety/health of the fractured area? Name at least 4.
-Frequent neurovascular assessments (ex. asking the patient to move their toes)
-Palpate for "hot spots" around and under the cast (to ensure there is no developing infection)
-Report any drainage (any color/consistency)
-Assess for compartment syndrome (can lead to amputation)
What are the 4 classes of medications that are used in the treatment of fractures?
-Opioids (moderate-severe pain)
-NSAIDS (mild-moderate pain)
-Anticoagulants (to prevent DVT)
-Antibiotics (to prevent infection)
Abdominal distention, pain, vomiting, constipation, and absence of flatus are classic signs of this potentially life-threatening GI issue.
“What is bowel obstruction?”
Rationale:
Gas and fluids accumulate above the blockage, impairing intestinal function.
This type of urine specimen is required when urine is to be cultured and examined for bacterial infection?
What is a clean-catch midstream urine.
Doctor orders a Lidocaine infusion to be started at 30 mcg/kg/min. The patient weighs 298 lbs. You are supplied with a bag of Lidocaine that reads 4 mg/mL. How many mL/hr will you administer? (whole number)
what is 244 ml/hr
What are the 9 components of a urine chemistry test?
Urea, creatine, uric acid, chloride, sodium, potassium, phosphate, ammonium, calcium
What are some complications of surgery for any kind of fracture?
Infection
Neurovascular/vascular injury
Leg length discrepancy
Absent bowel sounds could indicate this abnormality.
What is paralytic ileus
These cells can be found in urine of female patients and are usually a vaginal contamination caused by the yeast known as what?
What is Candida albicans.
You are working as a triage nurse in the ED when the following four client arrive. Which client requires the most rapid action to protect other clients in the ED from infection?
1. 3-year-old who has paroxysmal coughing and whose sibling has pertussis
2. 5-year-old who has a new pruritic rash and a possible chickenpox infection
3. 62-year-old who has a history of a MRSA abdominal wound infection
4. 51-year-old who needs tuberculosis (TB) testing after being exposed to TB during a recent international airplane flight
What is patient #4?
Varicella (chickenpox) is spread by airborne means and could be rapidly transmitted to other clients in the ED. The child with the rash should be quickly isolated from the other ED clients through placement in a negative-pressure room. Droplet and/or contact precautions should be instituted for the clients with possible pertussis and MRSA infection, but this can be done after isolating the child with possible chickenpox. The client who has been exposed to TB does not place other clients at risk for infection because there are no symptoms of active TB.
Which client is at greatest risk for respiratory depression while receiving opioids for analgesia?
1. Elderly client with chronic pain who has a hip fracture.
2. Client with a heroin addiction and back pain
3. Young female client with advanced multiple myeloma
4. Child with an arm fracture and cystic fibrosis
What is patient #4?
At greatest risk are elderly clients, opiate-naive clients, and those with pulmonary disease. The child has two of the three risk factors.