43 trauma to bones and muscles
Which nursing intervention is appropriate for minimizing muscle spasms in the client with a hip fracture? Apply a soft compression dressing. Assist the client with use of a trapeze. Maintain the internal fixator. Maintain Buck's traction.
Maintain Buck's traction. Explanation: Buck's traction decreases pain, muscle spasm, and external rotation by immobilizing the hip fracture.
When providing discharge teaching to a client with a fractured toe, the nurse should include which instruction? Apply heat to the fracture site. Apply ice to the fracture site. Perform ankle dorsiflexion three times per day. Use crutches for 1 week.
Apply ice to the fracture site. Explanation: Applying ice to the injury site soon after an injury causes vasoconstriction, helping to relieve or prevent swelling and bleeding. Applying heat to the fracture site may increase swelling and bleeding. Ankle dorsiflexion has no therapeutic use after a toe fracture. It's unlikely the client would need crutches after a toe fracture.
There are a variety of problems that can become complications after a fracture. Which of the following is described as a condition that occurs from interruption of the blood supply to the fracture fragments after which the bone tissue dies, most commonly in the femoral head? Avascular necrosis Fat embolism Pulmonary embolism Shock
Avascular necrosis Explanation: Avascular necrosis is described as a condition that occurs from interruption of the blood supply to the fracture fragments after which the bone tissue dies, most commonly in the femoral head.
When evaluating for hypovolemic shock, the nurse should be aware of which of the following clinical manifestations? Hypotension Hypertension Bounding pulse Bradycardia
Hypotension Explanation: The nurse should be alert to a weak pulse (thread), decreased blood pressure, decreased urine output, rapid, shallow respirations, and elevated heart rate.
A 75-year-old patient had surgery for a left hip fracture yesterday. When completing the plan of care, the nurse should include assessment for which of the following complications? Select all that apply. Pneumonia Necrosis of the humerus Skin breakdown Sepsis Delirium
Pneumonia Skin breakdown Sepsis Delirium Explanation: Complications in patients with hip fractures are often related to the age of the patient. During the first 24 to 48 hours following surgery for hip fracture, atelectasis or pneumonia from the anesthesia can develop. Thromboemboli are possible, as is sepsis. Elderly patients are also at risk for delirium in hospital settings because of the stress of the trauma, unfamiliar surroundings, sleep deprivation, and medications. An elderly patient with decreased mobility is at risk for skin breakdown. Necrosis is a potential complication of the surgery, but the complication would be with the femur, not the humerus.
A 14-year-old patient is treated in the emergency room for an acute knee sprain sustained during a soccer game. The nurse reviews discharge instructions with the patient's mother. The instructions cover pain management and swelling reduction for the acute inflammatory stage which lasts: 24 to 48 hours. 3 to 4 days. 4 to 5 days. At least 7 days.
24 to 48 hours. Explanation: Rest and ice applications during the first 24 to 48 hours produce vasoconstriction while decreasing bleeding and edema. After this time, the acute inflammatory stage decreases. Refer to Box 42-1 in the text.
Which nursing intervention is appropriate for a patient with a closed reduction extremity fracture? Encouraging participation in ADLs Promoting intake of omega-3 fatty acids Using frequent dependent positioning to prevent edema Administering prescribed enema to prevent constipation
Encouraging participation in ADLs Explanation: General nursing measures for a patient with a fracture reduction include administering analgesics, providing comfort measures, encouraging participation with ADLs, promoting physical mobility, preventing infection, maintaining skin integrity, and preparing the patient for self-care. Omega-3 fatty acids have no implications on the diet of a patient with a fracture reduction. Dependent positioning may increase edema since the extremity is below the level of the heart. While some pain medications may contribute to constipation, this intervention would be reserved for a patient experiencing constipation and not as a preventative measure.
A client undergoes hip-pinning surgery to treat an intertrochanteric fracture of the right hip. The nurse should include which intervention in the postoperative care plan? -(Performing passive range-of-motion (ROM) exercises on the client's legs once each shift) -Keeping a pillow between the client's legs at all times -Turning the client from side to side every 2 hours -Maintaining the client in semi-Fowler's position
Keeping a pillow between the client's legs at all times Explanation: After hip pinning, the client must keep the affected leg abducted at all times; placing a pillow between the legs reminds the client not to cross the legs and to keep the leg abducted. Passive or active ROM exercises shouldn't be performed on the affected leg during the postoperative period because this could damage the operative site and cause hip dislocation. Most clients should be turned to the unaffected side, not from side to side. After hip pinning, the client must avoid acute flexion of the affected hip to prevent possible hip dislocation; therefore, semi-Fowler's position should be avoided.
Which patient(s) is most likely to have compartment syndrome after sustaining a fracture? Select all that apply. The patient with elevated pressure level within the muscles The patient with hemorrhage in the site of injury The patient with a plaster cast applied immediately after injury The patient who sustained a clavicle fracture The patient using ice for pain control in the extremity
The patient with elevated pressure level within the muscles The patient with hemorrhage in the site of injury The patient with a plaster cast applied immediately after injury Explanation: Compartment syndrome occurs when the normal pressure of a compartment is altered in cases of fracture by the force of the injury itself, by development of edema, or by hemorrhaging at the site of the injury, which increases the contents of the compartment, or from outside pressure caused by constriction from a dressing or cast. A patient with elevated muscle pressure is at risk for compartment syndrome. The application of a plaster cast immediately after the injury places the patient at risk for compartment syndrome because the cast will not allow for edema and therefore will compress the tissue. Clavicle fractures are not a risk factor for compartment syndrome due to the location of the fracture. Ice will assist in decreasing the edema and may help prevent compartment syndrome.
A client is treated in the emergency department for acute muscle strain in the left leg caused by trying a new exercise. During discharge preparation, the nurse should provide which instruction? "Apply ice packs for the first 12 to 18 hours." "Apply heat packs for the first 24 to 48 hours." "Apply ice packs for the first 24 to 48 hours, then apply heat packs." "Apply heat packs for the first 24 hours, then apply ice packs for the next 48 hours."
"Apply ice packs for the first 24 to 48 hours, then apply heat packs." Explanation: The nurse should instruct the client to apply ice packs to the injured area for the first 24 to 48 hours to reduce swelling and then apply heat to increase comfort, promote reabsorption of blood and fluid, and speed healing. Applying ice for only 12 to 18 hours may not keep swelling from recurring. Applying heat for the first 24 to 48 hours would worsen, not ease, swelling. Applying ice 48 hours after the injury would be less effective because swelling already has occurred by that time.
A client undergoes a total hip replacement. Which statement made by the client indicates to the nurse that the client requires further teaching? "I'll need to keep several pillows between my legs at night." "I need to remember not to cross my legs. It's such a habit." "The occupational therapist is showing me how to use a sock puller to help me get dressed." "I don't know if I'll be able to get off that low toilet seat at home by myself."
"I don't know if I'll be able to get off that low toilet seat at home by myself." Explanation: The client requires additional teaching if he is concerned about using a low toilet seat. To prevent hip dislocation after a total hip replacement, the client must avoid bending the hips beyond 90 degrees. The nurse should instruct the client to use assistive devices, such as a raised toilet seat, to prevent severe hip flexion. Using an abduction pillow or placing several pillows between the legs reduces the risk of hip dislocation by preventing adduction and internal rotation of the legs. Teaching the client to avoid crossing the legs also reduces the risk of hip dislocation. A sock puller helps a client get dressed without flexing the hips beyond 90 degrees.
