NUR 353 Exam 2 (dev)

List 3 urinary complications associated with immobility.

1. Urinary stasis from lack of gravity pulling the urine from the renal pelvis into the ureters to the bladder. 2. UTIs from urinary stasis 3. Renal calculi from hypercalcemia

List some common diagnostic tests used for immobility.

1. X-ray (For pathological fractures) 2. MRI 3. CT scans 4. Bone scan (For osteoporosis) 5. Bone mineral density (For osteoporosis) 6. Myelogram (Injection of dye into the spine and imaging the spine using x-ray, CT scans or MRI.) 7. Arthrography (Evaluates condition of the joints) 8. Arthroscopy (A surgical procedure doctors use to look at, diagnose, and treat problems inside a joint) 9. Electromyography (Evaluates and records the electrical activity produced by skeletal muscles.)

How long does it take for plaster casts to dry?

10 to 72 hours

A term that encompasses similar concepts and includes nursing diagnoses related to inactivity. Risks for this include impaired skin integrity, constipation, altered respiratory function, altered peripheral tissue perfusion, activity intolerance, impaired physical mobility, injury, altered sensory perception, powerlessness, and body image disturbance.

Disuse syndrome

List two respiratory changes that occur with immobility.

1. Atelectasis (Collapse of alveoli) 2. Hypostatic pneumonia (Inflammation of the lung from stasis or pooling of secretions)

How can you prevent venous thromboembolisms in a patient that is immobile, has a fracture, or is postoperative for orthopedic surgery? (3)

1. Administer prophylactic anticoagulant drugs such as Warfarin or Heparin (Lovenox) 2. Apply anti embolism stockings and SCDs 3. Promote ROM exercises in unaffected leg and have patient dorsiflex and plantar flex the ankle of the affected lower extremity against resistance

List some objective data seen in someone with a fracture.

1. Apprehension 2. Guarding 3. Skin lacerations and color changes 4. Hematomas and edema 5. Decreased or absent pulse, decreased skin temperature 6. Delayed capillary refill 7. Restricted or lost function 8. Muscle weakness

What are three muscle relaxant a patient may be prescribed to decrease muscle spasm pain with a fracture?

1. Carisoprodol (Soma) 2. Cyclobenzaprine (Flexeril) 3. Methocarbamol (Robaxin)

List some gastrointestinal impairments caused by decreased mobility.

1. Constipation 2. Fluid intake decreases, risk for dehydration 3. Anorexia

Describe the metabolic changes that occur with immobility.

1. Decreases metabolic rate, altering the metabolism of carbs, fats, and proteins 2. Fluid, electrolyte and calcium imbalances 3. Decreased appetite 4. Slowed peristalsis 5. Endocrine system is altered 6. Hypercalcemia, calcium is released from the bones in immobile patients, which can cause pathologic fractures because there is not enough calcium in the bones!

List some general care guidelines for a patient who is immobilized.

1. Frequent turning and changing positions every 2 hours in bed or 30 minutes in a chair. 2. Frequent skin assessment and skin care. 3. Range of motion exercises 4. Deep breathing exercises 5. Weight bearing exercises if possible 5. Measures to optimize elimination, such as high fluids, high fiber, and laxatives or stool softeners. 6. Ambulation, stretches, balance

Fat embolisms are most common with what four bones?

1. Long bones, such as femur 2. Ribs 3. Tibia 4. Pelvis

List some musculoskeletal changes associated with immobility. (6)

1. Loss of endurance, strength and muscle mass and decreased stability and balance 2. Decreased muscle mass 3. Joint abnormalities (contractures--From muscle disuse, atrophy and shortening of the muscle fibers) 4. Disuse osteoporosis (Osteoporosis from immobility) 5. Pathological fractures from disuse osteoporosis 6. Impaired calcium metabolism

Nursing interventions for someone with a fat embolism. (5)

1. Main treatment is prevention 2. Coughing and deep breathing 3. Fluid resuscitation 4. Correction of acidosis from low oxygen levels 5. Replacement of blood loss

List three cardiovascular changes that occur with immobility.

1. Orthostatic hypotension 2. Thrombus formation 3. Decreased cardiac output, resulting in increased workload

List two screening tools to detect mobility/immobility.

1. Osteoporosis 2. Fall risk assessment

List some common symptoms associated with altered mobility.

1. Pain 2. Reduced joint movement 3. Reduced sensation or loss of sensation 4. Falls 5. Fatigue 6. Altered gait or imbalance 7. Reduced functional ability

What are the 6 P's of compartment syndrome?

1. Pain not managed by pain medication 2. Pressure 3. Paresthesia (Tingling from nerve damage) 4. Pallor, coolness, loss of normal color of extremity 5. Paralysis 6. Pulselessness: Diminished or absent

Describe the diet someone with a fracture should eat. (5)

1. Protein 1g/kg of body weight 2. Vitamins B, C, and D 3. Calcium, phosphorus and magnesium to ensure optimal soft tissue and bone healing 4. Fluid intake of 2-3 L/day 5. High fiber to prevent constipation

List some psychosocial effects seen with immobility.

1. Social isolation 2. Helplessness 3. Loneliness 4. Depression

What 3 things should a pt. report if they have a cast?

1. Swelling associated with pain and discoloration OR movement 2. Burning or tingling under cast 3. Sores or foul odor

List 3 individual risk factors for impaired mobility.

1. Traumatic injury, such as brain, spinal cord, and bones, joints and muscles. 2. Neurological conditions 3. Chronic conditions (and/or treatment interventions)

How long does it take for a neonates bones to heal?

2-3 weeks

A patient has been on bed rest for over 4 days. On assessment, the nurse identifies the following as a sign associated with immobility: a. Decreased peristalsis b. Decreased heart rate c. Increased blood pressure d. Increased urinary output

A (Immobility disrupts normal metabolic functioning: decreasing the metabolic rate; altering the metabolism of carbohydrates, fats, and proteins; causing fluid, electrolyte, and calcium imbalances; and causing gastrointestinal disturbances such as decreased appetite and slowing of peristalsis.)

You are caring for a patient who is immobile. Which of the following electrolyte imbalances would you expect in a patient who has been immobile? a. Hypercalcemia b. Hypokalemia c. Hyponatremia d. Hypermagnesemia

A (In immobile people, calcium is released from their bones into their blood stream. Normally, your kidneys will excrete this calcium but if they are unable to respond appropriately, hypercalcemia results.)

How long does it take for a younger child's bones to heal?

4 weeks

You should not bear weight on a cast for how long after a fracture?

48 hours

How long does it take for synthetic casts to dry?

5 to 20 minutes

How many meals per day should a person with a body jacket or hip spica cast eat?

6 small meals a day to prevent abdominal pressure and cramping

How long does it take for an older child's bones to heal?

6 weeks

How long does it take for an adolescent's bones to heal?

8-10 weeks

What is the first thing you should do if you suspect your patient has a fracture? a. Immobilize the affected limb or bone b. Ice the fractured bone to reduce pain c. Administer pain analgesics d. Attempt to move the bone back into place

A (Always immobilize the suspected fracture!)

A 28-yr-old woman with a fracture of the proximal left tibia in a long leg cast and complains of severe pain and a prickling sensation in the left foot. The toes on the left foot are pale and cool. Which nursing action is a priority? a. Notify the health care provider immediately. b. Elevate the left leg above the level of the heart. c. Administer prescribed morphine sulfate intravenously. d. Apply ice packs to the left proximal tibia over the cast.

A (Notify the health care provider immediately of this change in patient's condition, which suggest development of compartment syndrome. Pain unrelieved by drugs and out of proportion to the level of injury is one of the first indications of impending compartment syndrome. Changes in sensation (tingling) also suggest compartment syndrome. Because elevation of the extremity may lower venous pressure and slow arterial perfusion, the extremity should not be elevated above heart level. Similarly, the application of cold compresses may result in vasoconstriction and exacerbate compartment syndrome. Administration of morphine may be warranted, but it is not the first priority.)

The nurse is caring for a patient whose calcium intake must increase because of high risk factors for osteoporosis. Which of the following menus should the nurse recommend? a. Cream of broccoli soup with whole wheat crackers, cheese, and tapioca for dessert b. Hot dog on whole wheat bun with a side salad and an apple for dessert c. Low-fat turkey chili with sour cream with a side salad and fresh pears for dessert d. Turkey salad on toast with tomato and lettuce and honey bun for dessert

A (Teach patient and/or caregiver the current recommended dietary allowances for calcium and review foods high in calcium (e.g., milk fortified with vitamin D, leafy green vegetables, yogurt, and cheese).)

A 19-yr-old male patient has a plaster cast applied to the right arm for a Colles' fracture after a skateboarding accident. Which nursing action is most appropriate? a. Elevate the right arm on two pillows for 24 hours. b. Apply heating pad to reduce muscle spasms and pain. c. Limit movement of the thumb and fingers on the right hand. d. Place arm in a sling to prevent movement of the right shoulder.

A (The casted extremity should be elevated at or above heart level for 24 hours to reduce swelling or inflammation. The cast should be supported on pillows during the drying period to prevent denting and flattening of the cast. Ice (not heat) should be applied for the first 24 to 36 hours to reduce swelling or inflammation. Active movement of the thumb and fingers should be encouraged to reduce edema and increase venous return. A sling may be used to support and protect the extremity after the cast is completely dry, but the patient should perform active movements of the shoulder to prevent stiffness or contracture.)

A nurse is caring for an older adult who has had a fractured hip repaired. In the first few postoperative days, which of the following nursing measures will best facilitate the resumption of activities of daily living for this patient? a. Encouraging use of an overhead trapeze for positioning and transfer. b. Frequent family visits c. Assisting the patient to a wheelchair once per day d. Ensuring that there is an order for physical therapy

A (The trapeze bar allows the patient to pull with the upper extremities to raise the trunk off the bed, aid in transfer from bed to wheelchair, or perform upper-arm exercises. It increases independence and maintains upper body strength to help in performing activities of daily living.)

A nurse is teaching a community group about ways to minimize the risk of developing osteoporosis. Which of the following statements reflect understanding of what was taught? Select all that apply. a. "I usually go swimming with my family at the YMCA 3 times a week." b. "I need to ask my doctor if I should have a bone mineral density check this year." c. "If I don't drink milk at dinner, I'll eat broccoli or cabbage to get the calcium that I need in my diet." d. "I'll check the label of my multivitamin. If it has calcium, I can save money by not taking another pill." e. "My lactose intolerance should not be a concern when considering my calcium intake."

A B C (Patients at risk for or diagnosed with osteoporosis have special health promotion needs. Encourage patients at risk to be screened for osteoporosis and assess their diets for calcium and vitamin D intake. Multivitamins do not always have the needed amount of calcium for every individual. A patient needs to know his or her requirement and make a decision based on that.)

The effects of immobility on the cardiac system include which of the following? Select all that apply. a. Thrombus formation b. Increased cardiac workload c. Weak peripheral pulses d. Irregular heartbeat e. Orthostatic hypotension

A B E (The three major changes are orthostatic hypotension, increased cardiac workload, and thrombus formation.)

Patients who are experiencing immobility often have which of the following emotions? Select all that apply. a. Helplessness b. Hunger c. Anger d. Anxiety e. Increased communication f. Improved self-worth

A C D

Which of the following may be indicative of a fat embolism? Select all that apply. a. Pt. expresses a feeling of impending disaster b. RR 16 c. Increased platelet count d. Cyanotic skin color e. PaO2 of 50 mmHg

A D E (With fat embolisms, the patient will exhibit a feeling of impending doom. In a short time, their skin color will change from pallor to cyanosis. The patient will become comatose. There may be fat cells in the blood, urine, or sputum. The PaO2 will be below 60 mmHg. There is a decreased platelet count and hematocrit. There will be an elevated ESR.)

What is one thing a patient can use if the cast is itchy?

A hair dryer on cool setting

What should you give to a patient before moving around to decrease pain when moving their joints?

Anti-inflammatory and pain medications

A patient has a severely sprained ankle from a sports injury. What should the nurse teach the patient prior to discharge from the urgent care center? a. Alternate cold and heat for 30 minutes each until symptoms are relieved b. Apply cold for 20 to 30 minutes with breaks of 10 to 15 minutes during the first 2 days c. Use continuous cold for the first 24 hours and then continuous heat until the symptoms are relieved d. Apply continuous heat to the ankle for the first 24 hours and then continuous cold until the symptoms are relieved

B

The nurse is reviewing skin care of an immobilized patient with an unlicensed assistive employee. The nurse knows the employee understands the importance of skin care when making which statement? a. "Proper care of the skin is important because the immobilized patient does not want to smell bad." b. "Proper care of the skin is important because the immobilized patient is at high risk for breakdown." c. "Proper care of the skin is important because the immobilized patient will have many visitors." d. "Proper care of the skin is important because the immobilized patient will be incontinent."

B

What diagnostic test would be used for a patient who is experiencing muscular atrophy due to prolonged bedrest? a. MRI b. Electromyography c. Arthroscopy d. Bone scan

B (An electromyography is a diagnostic procedure to assess the health of muscles and the nerve cells that control them (motor neurons). Motor neurons transmit electrical signals that cause muscles to contract. An EMG translates these signals into graphs, sounds or numerical values that a specialist interprets.)

To prevent complications of immobility, what would be the most effective activity on the first postoperative day for a patient who has had abdominal surgery? a. Turn, cough, and deep breathe every 30 minutes while awake b. Ambulate patient to chair in the hall c. Passive range of motion 4 times a day d. Immobility is not a concern the first postoperative day

B (Prevention of complications of immobility begins when the patient becomes immobilized. Every 30 minutes is not necessary and disruptive to the healing process. Active patient participation in exercises is more beneficial to preventing venous stasis.)

An older adult has limited mobility as a result of a total knee replacement. During assessment you note that the patient has difficulty breathing while lying flat. Which of the following assessment data support a possible pulmonary problem related to impaired mobility? Select all that apply. a. B/P = 128/84 b. Respirations 26/min on room air c. HR 114 d. Crackles over lower lobes heard on auscultation e. Pain reported as 3 on scale of 0 to 10 after medication

B C D (Patients who are immobile are at high risk for developing pulmonary complications. The most common respiratory complications are atelectasis (collapse of alveoli) and hypostatic pneumonia (inflammation of the lung from stasis or pooling of secretions). Ultimately the distribution of mucus in the bronchi increases, particularly when the patient is in the supine, prone, or lateral position.)

What should a nurse frequently check with a patient with a cast?

BILATERAL neurovascular assessments

A child must experience mobility so he or she can explore and learn about the world. Lack of mobility in a child may interfere with which developmental milestone? a. Physiological bonding and growth b. Speech and hearing development c. Intellectual and psychomotor function d. Childhood play interaction

C

Your immobile patient is showing signs of complications of immobility when they state that their joints feel tense. What diagnostic test do you anticipate the physician will order to evaluate the condition of the patients' joints? a. Bone mineral density b. Electromyography c. Arthrography d. Myelogram

C (An arthrography evaluates the condition of joints.)

Which of the following observations of a cast would alert the nurse that an infection may be occurring? a. The nurse hears a hollow sound when they tap their finger on the cast b. There is an absence of odor c. Hot spots are felt on the cast surface d. The patient states they feel tingling with their affected limb

C (Hot spots and a foul-smelling odor indicate infection of a cast. A nurse will hear a hollow sound when the cast is dry. Tingling is one of the 6 P's for compartment syndrome (paresthesia).)

A patient on prolonged bed rest is at an increased risk to develop this common complication of immobility if preventive measures are not taken: a. Myoclonus b. Pathological fractures c. Pressure ulcers d. Pruritus

C (Immobility is a major risk factor for pressure ulcers. Any break in the integrity of the skin is difficult to heal. Preventing a pressure ulcer is much less expensive than treating one; therefore preventive nursing interventions are imperative.)

Which of the following are physiological outcomes of immobility? a. Increased metabolism b. Reduced cardiac workload c. Decreased lung expansion d. Decreased oxygen demand

C (Physiologic outcomes of immobility include decreased metabolism, increased cardiac workload, decreased lung expansion, and increased oxygen demand.)

What is the correct order in which elastic stockings should be applied? 1. Identify patient using two identifiers. 2. Smooth any creases or wrinkles. 3. Slide the remainder of the stocking over the patient's heel and up the leg 4. Turn the stocking inside out until heel is reached. 5. Assess the condition of the patient's skin and circulation of the legs. 6. Place toes into foot of the stocking. 7. Use tape measure to measure patient's legs to determine proper stocking size. a. 1, 5, 7, 4, 6, 2, 3 b. 1, 7, 5, 4, 6, 2, 3 c. 1, 5, 7, 4, 6, 3, 2 d. 1, 5, 4, 7, 6, 3, 2

C (This is the correct order in which elastic stockings should be applied.)

You are assessing your patients arm that recently had a fracture and had a cast applied to it. You notice swelling and the patient reporting pain that is not relieved with medication. What is the priority nursing diagnosis at this time? a. Impaired physical mobility b. Acute pain related to edema c. Risk for peripheral neuromuscular dysfunction d. Readiness for enhanced self-health management

C (This is the priority nursing diagnosis because this situation may be indicative of compartment syndrome.)

You are providing patient education about cast care to a parent who's child just had a hip spica cast applied. When stated by the parent, which of the following statements requires further education? a. "I can use a dryer or fan on the cool setting to help dry a wet cast." b. "I will not use the cross bar to lift my child." c. "I can use baby powder to prevent skin irritation under the cast when they complain of itchiness." d. "I should frequently check for signs of infection and compartment syndrome with this cast."

C (You should not use baby powder with any cast. It is a good medium for bacterial growth."

When entering the grocery store, a patient trips on the curb and sprains the right ankle. Which initial care is appropriate (select all that apply.)? a. Apply ice directly to the skin. b. Apply heat to the ankle every 2 hours. c. Administer antiinflammatory medication. d. Compress ankle using an elastic bandage. e. Rest and elevate the ankle above the heart. f. Perform passive and active range of motion.

C D E (Appropriate care for a sprain is represented with the acronym RICE (rest, ice, compression, and elevation). Antiinflammatory medication should be used to decrease swelling if not contraindicated for the patient. After the injury, the ankle should be immobilized and rested. Prolonged immobilization is not required unless there is significant injury. Ice is indicated, but will cause tissue damage if applied directly to the skin. Apply ice to sprains as soon as possible and leave in place for 20 to 30 minutes at a time. Moist heat may be applied 24 to 48 hours after the injury.)

What is a common bone-penetrating antibiotic that is used prophylactically before surgery of internal or external fixation?

Cephalosporin (Cefazolin)

What antibacterial agent should you use to clean pins from external fixation?

Chlorhexidine Do NOT use hydrogen peroxide because it may be cytotoxic to osteoblasts and may not be bactericidal.

Nonsurgical, manual realignment of bone fragments to their previous anatomic position. Traction and countertraction are manually applied to the bone fragments to restore position, length, and alignment. Usually performed while the patient is under local or general anesthesia. Immobilization afterwards

Closed reduction

What is more common in children: Open or closed reduction?

Closed reduction due to how quickly children's bones heal

Swelling and increased pressure within a confined space

Compartment syndrome

What is the chief concern during the first few hours after a cast is applied? How do you prevent this?

Compartment syndrome. Elevate the extremity/body part and frequently check neuromuscular integrity and any signs of compromise.

The break goes completely through the bone

Complete fracture

A plaster splint is applied with an elastic bandage to the leg of a patient with a fractured tibia in preparation for open reduction and internal fixation. The patient complains of increasing pain in the affected leg and foot that is not relieved by loosening of the elastic bandage. The most appropriate action by the nurse is to a. elevate the leg on two pillows b. apply ice over the fracture site c. notify the health care provider d. perform neurovascular assessment of the foot

D

This morning a 21-yr-old male patient had a long leg cast applied, and he asks to crutch walk before dinner. Which statement explains why the nurse will decline the patient's request? a. "No one is available to assist and accompany the patient." b. "The cast is not dry yet, and it may be damaged while using crutches." c. "Rest, ice, compression, and elevation are in process to decrease pain." d. "Excess edema and complications are prevented when the leg is elevated for 24 hours."

D (For the first 24 hours after a lower extremity cast is applied, the leg should be elevated on pillows above heart level to avoid excessive edema and compartment syndrome. A plaster cast will also be drying during this 24-hour period. RICE is used for soft tissue injuries, not with long leg casts.)

Which of the following nursing interventions should be implemented to maintain a patent airway in a patient on bed rest? a. Isometric exercises b. Administration of low-dose heparin c. Suctioning every 4 hours d. Use of incentive spirometer every 2 hours while awake

D (Incentive spirometry opens the airway, preventing atelectasis.)

An older-adult patient has been bedridden for 2 weeks. Which of the following complaints by the patient indicates to the nurse that he or she is developing a complication of immobility? a. Loss of appetite b. Gum soreness c. Difficulty swallowing d. Left-ankle joint stiffness

D (Patients whose mobility is restricted require range-of-motion (ROM) exercises daily to reduce the hazards of immobility. Temporary immobilization results in some muscle atrophy, loss of muscle tone, and joint stiffness. Two weeks of joint immobilization without ROM can quickly result in contractures.)

The patient is brought to the emergency department after a car accident and is diagnosed with a femur fracture. What nursing intervention should the nurse implement at this time to decrease risk of a fat embolus? a. Administer enoxaparin (Lovenox). b. Provide range-of-motion exercises. c. Apply sequential compression boots. d. Immobilize the fracture preoperatively.

D (The nurse immobilizes the long bone to reduce movement of the fractured bone ends and decrease the risk of a fat embolus development before surgical reduction. Enoxaparin is used to prevent blood clots not fat emboli. Range of motion and compression boots will not prevent a fat embolus in this patient.)

What type of gait with crutches would be used for someone who is learning to walk again? a. 1-point gait b. 2-point gait c. 3-point gait d. 4-point gait

D (This gait is used to train someone to walk again.)

A general downslide of overall physical strength and endurance. Although most patients might have a tweak of this after a big surgery or major illness, this term is usually applied when a formerly independent, or mostly independent, person is now not able to perform routine activities, like their ADLs, and IADLs, and their progress continues to decline.

Deconditioned

A spectrum of disorders related to abnormal development of the hip that may occur at any time during fetal life, infancy, or childhood

Developmental dysplasia of the hip (DDH)

The two ends of the broken bone are separated from one another and out of their normal positions

Displaced fracture Usually comminuted (more than two fragments) or oblique

With lower extremities, how should you place the fracture?

Elevate above the heart! Don't place in a dependent position to prevent compartment syndrome.

What should you NOT do if you have compartment syndrome?

Elevate the extremity/affected limb/fractured bone

True or false: Bone pain is more intense in adults.

False! It is more intense in children.

A disruption or break in the continuity of bone

Fracture

What type of sound indicates a plaster-of-Paris cast is dry when you tap it with your finger?

Hollow sound

What should your apply for the first 24 hours with a cast? Why?

Ice, reduces swelling

The state of not moving; motionless, not being able to move

Immobility

Occurs partly across a bone shaft but the bone is still intact

Incomplete fracture

How should you dry a hip spica cast?

Keep it uncovered and turn the child at least every 2 hours to help dry the cast evenly and prevent complications related to immobility. A regular fan or cool-air hair dyer may be used when the humidity is high. The complete evaporation of the water from a hip spica cast can take 24 to 48 hours. DO NOT used heated fans or dryers!

In children, until puberty what two things are stronger than bones?

Ligaments and tendons

When should fall assessment screening tools be used?

Look in Giddens

What part of a child's bone helps aid in rapid healing?

Periosteum

The state or quality of being mobile or movable

Mobility

The periosteum is intact across the fracture and the bone fragments are still in alignment

Nondisplaced fracture

The correction of bone alignment through a surgical incision. It usually includes internal fixation of the fracture with wires, screws, pins, plates, intramedullary rods, or nails. The type and location of the fracture, patient age, and concurrent disease may influence the decision to use this. Facilitates early ambulation

Open reduction

List one integumentary complication associated with immobility.

Pressure ulcers

Anatomic realignment of a fracture

Reduction

What vaccination might a patient get if they have an open fracture?

Tetanus and diphtheria toxoid or tetanus immunoglobulin

True or false: You should NEVER ice or elevate a limb with compartment syndrome.

TRUE

Why should you not cover a fresh plaster cast?

The air cannot circulate which causes heat build up and may cause a burn. Drying is delayed as well.

What should you explain to a child during cast removal? (3)

The cast cutter will not cut your skin. You may feel a tickle sensation. You may feel some heat too while they are cutting off the cast.

A patients fracture should be elevated above the heart for how long?

The first 48 hours

What is a common place of injury in children? What happens if it's not treated?

The growth plate or epiphysis plate. Can lead to improper growth if not treated correctly

What do you do if you have a child in a hip spica or long leg cast that needs to be transported in a car safely?

There are specifically designed car seats for children with these type of casts to meet safety requirements. Alterations to standard car seats to accommodate the cast are not recommended because it may fail to properly restrain the child.

The application of a pulling force to an injured or diseased body part or extremity

Traction

What part of your hand should you use when handling a plaster cast that is still wet?

Use palms of hand, avoid fingertips to prevent creating pressure points.

How do you know if a patient is experiencing a venous thromboembolism or a fat embolism?

You get petechiae on the chest and face with a fat embolism (25-50% of cases)