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Nursing Interventions
Fractures 101
Complications
Pediatric Considerations
Education
100

K.B. is settled into her room and begins to complain of pain (7 out of 10) in her leg and arm. She weighs 65 kg. You note that the ordered dose of morphine was given 4 hours ago. Your drug reference states that the appropriate dose is 0.05 – 0.1 mg/kg every 4 – 6 hours. The provider prescribed 5mg IV every 4 – 6 hours. The morphine injection comes in a concentration 2mg/mL.

  • Is this does safe ?
  • How much will you draw up into the syringe?
  • Yes because it is appropriate for her weight as well as the allotted time frame
  • 2 ½ mL
100

What are the 6 P's related to cast care?

Pain

Pulses

Pallor

Paresthesia

Paralysis

Pressure

100
  • What are possible reasons for changes in K.B.'s  neurological status?


  • Concussion
  • Contusion
  • Increase in intracranial pressure
100

A nurse is going over discharge teaching for a client with a sprained ankle. Which Mnemonic is appropriate at this time?

A. CAGE

B. RICE

C. FAST

D. AMPLE

Rest Ice Compression and Elevation is necessary to aid in healing and pain relief of patients with skeletal injuries.

100

What are some appropriate interventions to teach you client being discharged with a cast about possible itching that may occur? 

A. Ice packs 

B. Hair dryer

C. Lotion

D. Reposition 

E. Avoid water

Ice packs 

Hair dryer 

Lotion can be applied on skin around the outside of the cast but not inside of the cast. 

These methods are non invasive and are safe to use to provide relief

200

NCLEX

The nurse prepares a client for a bone scan. What priority assessment should the nurse perform for this client?

A. History of claustrophobia

B. Presence of metallic implants such as a pacemaker or aneurysm clips

C. Current vital signs

D. Presence of intravenous (IV) access

Presence of intravenous (IV) access

A bone scan involves administering a radioisotope to visualize the bone for diagnostic purposes. It is critical that the nurse ensure that the client has IV access for injection of the radioisotope prior to the procedure

200

A nurse is answering a call light for a client who reports that their broken arm suddenly hurts. Upon assessment the nurse notices a major increase in swelling. Capillary refill is 5 seconds. The nurse notices the patient is experiencing compartment syndrome and should prepare for which of the following. 

A. application of a splint 

B. fasciotomy 

C. no treatment  

D. reduction of the bones

Fasciotomy 

this procedure is necessary to relieve pressure and restore perfusion.

200

A complication of Buck’s extension traction would be noted by a nurse if:

A. Dorsiflexion developed in the affected foot.

B. Toes of affected leg became dusky in color.

C. Redness and purulent drainage appeared at the pin site.

D. Skin over the fracture site was flushed.

Toes of affected leg became dusky in color.

Buck’s is skin traction to the lower leg. Circulatory disturbances and skin abrasions are the most important nursing concerns.

Buck’s is skin traction, not skeletal traction, which uses pins.

Buck’s is skin traction using an elastic bandage. The fracture site would not be visible.

Buck’s uses a foam boot to support the foot of the affected extremity in a dorsiflexed position. This position is, therefore, not a complication.

200

Which assessment finding found while assessing a patient with a fracture who has traction requires immediate intervention?

  • A. The weights are freely hanging on the floor.
  • B. Pin sites are free from drainage.
  • C. Patient uses the overhead trapeze bar to move around in the bed. 
  • D. Patient’s extremities have a capillary refill of less than 2 seconds.


The weights are freely hanging on the floor. 

Weights used for traction should freely hang but NOT on the floor. All the other options are expected findings.

200

Your patient is 2 hours post-op from a cast placement on the right leg. The patient has family in the room. Which action by the significant other requires you to re-educate the patient and family about cast care?

  • A. Gently moving the cast with the fingertips of the hands every 2 hours to help with drying.
  • B. Elevating the cast above heart level with pillows.
  • C. Checking the color and temperature of the right foot. 
  • D. Using a hair dryer on the cool setting to help with drying.


Gently moving the cast with the fingertips of the hands every 2 hours to help with drying.

 The cast should always be moved with the palms of the hands (NOT finger tips) during the drying period to prevent dent formation because this can cause the development of ulcers under the skin where the dents develop.

300

Post OP: K.B. is awake and taking ice chips. When reviewing her chart, you notice the following physician orders

  • Vital signs per routine
  • Neurologic checks every 4 hours
  • Turn, cough, deep breathe, and incentive spirometer every 2 hours while awake
  • Heat pack and elevate right lower extremity and right upper extremity
  • Neurovascular checks every hour
  • NPO
  • IV fluid D5 ½ NS at 100 mL/ hour
  • Morphine sulfate 5 mg IV every 4 – 6 hours

Which of the following orders are inappropriate? SATA

  • Neurologic checks should be done every 2 hours
  • It is not advised to use heat on effected extremity; Ice is more appropriate
  • D5 ½ NS is a hypertonic solution because the patient is NPO and this solution will cause more depletion of fluids
300

Figure 2 represents what type of fracture? 

a. transverse

b. compound

c. oblique 

d. closed

Comminuted Fracture 

A comminuted fracture is characterized by a bone broken into 3 or more pieces.

300

The nurse assesses which of the following clinical manifestations in a client with osteomyelitis?
Select all that apply:
A. Night sweats
B. Cool extremities
C. Petechiae
D. Fever
E. Nausea
F. Restlessness

A. Night sweats

D. Fever

E. Nausea

F. Restlessness

300

K.B. continues to improve. Physical and occupational therapists work with her on transfers and performing activities of daily living. She has many questions about how she will be able to go to school and resume her normal routine.

Recognizing K.B.’s developmental and cognitive stage, which of the following statements best supports you approach to discharge teaching?

  • Adolescents are capable of thinking in concrete terms only
  • Adolescents are preoccupied with the immediate situation rather than future events. 
  • Adolescents can anticipate future implications of current decisions.
  • Family acceptance is more important than peer acceptance

Adolescents are preoccupied with the immediate situation rather than future events.

300

For a patient who has experienced an open fracture that is now stabilized with a cast, it is important to educate them on the signs and symptoms of infection. List 3 symptoms patient's should report to the physician.

Fever 

Hot spots on cast/ radiating heat 

smell 

drainage 

increased pain 

pallor 

All of these symptoms indicate infection. Early intervention is key to preventing further complications

400

After K.B. has been on the unit for 6 hours, you identify the following changes in her assessment data:

  • K.B. is difficult to arouse, but when awake she is able to identify who and where she is
  • PERRLA 1+ with slower reaction time than earlier
  • Color pale, pink
  • Skin cool and clammy
  • Heart rate 126 RR/min, 28 breaths/min, temperature 99 degrees, Spo2 90%
  • The findings of the neurovascular checks of the affected extremities are unchanged


    • What will your immediate nursing interventions be?
  • Apply oxygen
  • Call the doctor
  • Glasgow Coma Scale
400

A patient sustained a fracture to the femur. The patient has suddenly become confused, restless, and has a respiratory rate of 30 breaths per minute. Based on the location of fracture and the presenting symptoms, this patient may be experiencing what type of complication?

  • A. Compartment Syndrome
  • B. Osteomyelitis 
  • C. Fat embolism
  • D. Respiratory depression

Fat embolism

 Patients who experience a fracture of the long bones (such as the femur) are at risk for a fat embolism. The patient will become confused and restless along with an abnormal respiratory status.

400

K.B. is transferred to the pediatric intensive care unit and treated for changes in her neurologic status. The next day the primary care provider determines that her condition is stable and has her transferred back to your unit. It is now 36 hours after surgery. K.B. suddenly begins to complain of extreme pain in her lower right leg. She had pain medication 2 hours ago and rates her pain as a 10 out of 10.

Which of these findings are early signs of compartment syndrome? SATA

  • Diminished pedal pulse
  • Macular rash 
  • Edema 
  • Paresthesia 
  • Capillary refill less than two seconds 
  • Increased pain
  • Diminished pedal pulse (correct)
  • Macular rash (incorrect)
  • Edema (correct)
  • Paresthesia (correct)
  • Capillary refill less than two seconds (incorrect)
  • Increased pain (correct)
400

A patient is seen at the urgent care center after falling on the right arm and shoulder. It will be most important for the nurse to determine
a. whether there is bruising at the shoulder area.
b. whether the right arm is shorter than the left.
c. the amount of pain the patient is experiencing.
d. how much range of motion (ROM) is present.

Whether the right arm is shorter than the left.

A shorter limb after a fall indicates a possible dislocation, which is an orthopedic emergency. The nurse will expect bruising and pain at the area, even without an injury that requires surgery. The shoulder should be immobilized until it is evaluated by the health care provider.

400

The nurse is educating a client on the proper use of crutches. The nurse asks the client to walk a few steps with the crutches. The client puts the crutches under his arms and rests the pads on his axilla. The clients arms are at a 30 degree angle and his hands are lightly resting at the grips by his side. Before the client takes a step, the nurse stops him to re-educate the client on his placement under his axilla. The client asks why he can't rest his body weight on the pads under his armpits. What is the best explanation for the nurse to give?

A. "If you put constant pressure on the nerve in your underarm you can cause paralysis in the arm."

B. "If you put your weight all in your underarm, you can bruise your underarms."

C. "If you put all your weight there it can cause a muscle strain and then you won't be able to use your crutches to walk anywhere."

D. "Because that is how you are supposed to do it. It is the best position for your body."

"If you put all your weight there it can cause a muscle strain and then you won't be able to use your crutches to walk anywhere."

500

Upon recognition of symptoms of compartment syndrome you page the orthopedic surgeon. Use SBAR to address patient status

Situation

  • Your name
  • Patient name
  • Unit
  • Problem
    Background
  • Admission diagnosis
  • Pertinent history
  • Current treatments

    • Assessment
  • Current vital signs
  • Physical assessment
  • Test results

    • Request
  • Needs evaluation
  • Cast removal
  • Possible fasciotomy
500

You're caring for a patient who has experienced a fracture to the right arm that is represented in Figure 3. What nursing intervention will you take with this type of fracture?

  • A. Cover the fracture with a sterile dressing.
  • B. Place the arm below the heart level.
  • C. Attempt bone reduction by manually readjusting the bone.
  • D. Place a tight compression bandage over the fracture.

A. cover the fracture with a sterile dressing.

 Figure 3 represents a compound fracture (also called an open fracture). Due to the nature of this fracture, the patient is at major risk for infection because the skin is no longer intact. Therefore, the nurse should cover the fracture site with a sterile dressing. NEVER attempt a  bone reduction. In addition, avoid a tight compression bandage due to the development of ischemia. Instead, you would want to immobilize the extremities and splint it.

500

A client is admitted following a motor vehicle accident where his left thigh was crushed beneath the vehicle.The nurse must assess for which of the following complications?

  • Acute renal failure
  • Hypotension
  • Hypokalemia
  • Fat emboli syndrome

Acute renal failure

A client with a crush injury is at risk for muscle breakdown and release of myoglobin into the circulation. This can result in acute tubular necrosis and renal failure.