Module 12

Fat embolism syndrome can occur as a complication of A. liver trauma. B. burns. C. orthopedic trauma. D. spleen trauma.

C

Which mechanism caused by circulating myoglobin can lead to the development of kidney injury? A. Dark tea-color urine B. Administration of diuretics C. Renal tubular obstruction D. Rapid screening for serum creatine kinase

C

Which activity is performed first when a client is bitten by a brown recluse spider? A. Removing the necrotic tissue B. Elevating the affected extremity C. Allowing complete rest to the client D. Applying cold compresses over the site

D The basic first aid for a brown recluse spider bite is to apply cold compresses over the site intermittently until there is no further progression of the wound, Cold helps decrease the enzyme activity of the venom and may limit tissue swelling and necrosis. Necrotic tissue is removed after evaluating the wound. Elevating the. affected extremity is recommended, but it is not the first action. The client is allowed to rest after ensuring the client is safe.

Which interventions will be contraindicated for a client who has a fracture and compartment syndrome? Select all that apply. One, some, or all responses may be correct. A. Splitting the cast in half B. Applying cold compresses C. Reducing the traction weight D. Loosening the client's bandage E. Elevating the extremity above heart level

BE Compartment syndrome is a condition Cold compresses and elevating above the heart level are contraindicated for compartment syndrome. in which swelling and increased pressure within a limited space (a compartment) press on and compromise the function of blood vessels, nerves, and tendons that run through that compartment. compartment syndrome. Application of cold compresses could result in Elevating the extremity above heart level could lower vasoconstriction and exacerbate venous pressure and slow arterial perfusion. Splitting the cast in half decreases syndrome. Reducing traction weight is beneficial because it decreases pressure and is beneficial in treating compartment external circumferential pressure. Loosening the bandage is beneficial because it decreases pressure.

A client has closed fractures of the right femur and tibia with multiple soft-tissue contusions. Which action would the nurse plan to take? A. Perform a neurovascular assessment of the extremity. B. Reassure the client that these injuries are not that serious. C. Gather equipment needed for the application of skeletal traction. D. Prepare the client for a surgical reduction of the injured extremity.

A Identifying the status of the damage is the priority. Before a treatment protocol is determined, the presence of nerve or vascular damage and compartment syndrome must be identified. False reassurance is never appropriate. Skeletal traction is used rarely. Closed fractures in the absence of soft tissue damage generally are reduced by manipulation. Closed fractures with soft tissue damage may require an external fixation device to reduce the fracture, immobilize the bone, and allow for treatment of the soft tissue damage. Preparing the client for surgery is premature; more data are necessary before a treatment option is determined.

A client sustains a crushing injury to the lower left leg, and a below-the-knee amputation is performed, For which common clinical manifestations of a pulmonary embolus would the nurse assess this client? Select all that apply. One, some, or all responses may be correct. A. Sharp chest pain B. Acute onset of dyspnea C. Pain in the residual limb D. Absence of the popliteal pulse E. Blanching of the affected extremity

AB Emboli can occur with crushing injuries of the extremities. Lodging of a thrombus in the pulmonary system results in a lack of oxygen to pulmonary tissues, causing localized sharp chest pain. Lodging of a thrombus in the pulmonary system will result in decreased breath sounds and dyspnea. Pain in the residual limb is related not to a pulmonary embolus but to severed nerve endings in the residual limb. A pulmonary embolus will not interfere with arterial circulation to a distal portion of an extremity. Blanching of the affected extremity is associated with interference with arterial circulation to an extremity.

Which actions would the nurse expect to take for a client who has compartment syndrome? Select all that apply. One, some, or all responses may be correct. A. Assisting with splitting the cast B. Monitoring urine output C. Evaluating pain using a pain scale D. Applying splints to the injured part E. Placing cold compresses to the affected area

ABC Compartment syndrome is increased pressure in a limited space, which compromises the compartmental blood vessels, nerves, and tendons. The cast may be split to reduce the external circumferential pressures. The nurse would assess urine output because the myoglobin released from damaged muscle cells may precipitate and cause obstruction in renal tubules. The nurse would evaluate the pain on a scale from 0 to 10: this helps plan care. Application of external pressure by splints, casts, and dressing to the client's symptoms. Application of cold compresses may result in vasoconstriction and exacerbate the injured area may worsen the symptoms.

Which sign of compartment syndrome would the nurse assess for in the client who has sustained blunt trauma to the forearm? A. Warm skin at the site of injury B. Escalating pain in the fingers C. Rapid capillary refill in affected hand D. Bounding radial pulse in the injured arm

B Elevated tissue pressure restricts blood flow, causing increasing ischemia and increasing pain; it is the cardinal early symptom of compartment syndrome. The arm will feel cool, not warm, because of a decrease in circulation. Sluggish, not rapid, capillary refill is a sign of compartment syndrome. The pulse will be diminished, not bounding; increasing edema impairs circulation.

Which condition is characterized by increased pressure within a limited space that compromises circulation? A. Sepsis B. Hypermetabolism C. Compartment syndrome D. Venous thromboembolism

C Compartment syndrome is a condition in which increased pressure within a limited space compromises circulation, resulting in ischemia and necrosis of tissues within that space. Among patients at high risk for the development of compartment syndrome are patients with upper and lower extremity trauma, including fractures, vascular ruptures, massive tissue injuries, or venous obstruction. Sepsis is a life-threatening illness caused by the body's response to an infection. Hypermetabolism is the physiologic state of increased metabolic activity, typically occurring after significant damage to the body. Venous thromboembolism is a condition in which a blood clot forms most often in the deep veins of the leg, groin, or arm.

Signs and symptoms of compartment syndrome in the lower extremities include A. increase urinary output. B. reddened skin. C. palpable pulses. D. increased pain despite meds.

D