PCN-UNIT 14 MOBILITY

A client has sustained a closed fracture and just had a cast applied to the affected arm. The client is complaining of intense pain. The nurse has elevated the limb, applied an ice bag and administered an analgesic with very little relief. The nurse interprets this pain may be due to: A.Impaired tissue perfusion B. The newness of the fracture C. The anxiety of the client D.Infection under the cast

A. Impaired tissue perfusion

Which of the following statements applies to compartment syndrome? A. Increased pressure within the tissues results from excessive edema at the fracture site. B. Capillary pressures over 15 mm Hg can result in permanent muscle and nerve damage. C. The presence of a peripheral pulse will rule out compartment syndrome D. Pain associated with compartment syndrome will be relieved with use of analgesics.

A. Increased pressure within the tissues results from excessive edema at the fracture site.; • Muscles are contained within elastic fascial sheaths. When injured muscles swell, a hematoma forms, or external compression is applied, the pressure within the fascial compartment increases. If the pressure rises high enough, capillary pressure is exceeded and circulation is compromised. This results in ischemic injury to the muscles and nerves within the fascial compartment. • Normal tissue pressure ranges between zero and 10 mmHg. Capillary blood flow within the compartment may be compromised at pressures > 20 mmHg. Muscle and nerve fibers are at risk for ischemic necrosis at pressures >30 to 40mmHg.

A child is admitted with a fracture of the femur and placed in skeletal traction. What should the nurse assess first? A. The pull of traction on the pin B. The Ace bandage C. The pin sites for signs of infection D. The dressings for tightness

A. The pull of traction on the pin; Skeletal traction applies the pull directly to the skeletal structure by tongs, pin or wire. The nurse should assess the pull of the traction on the pin first. This is critical to the success of the traction. Once this is assessed, then the pin sites are assessed for signs of infection.

A 62 year old female is recovering from a fibula/tibia fracture and subsequent external fixation. Which of the following aspects of the patient's history and treatment is least important to bone healing? A.History of peripheral vascular disease B. Adequate anticoagulation on heparin C. History of smoking D.History of severe trauma and comminuted fracture

B. Adequate anticoagulation on heparin; adequate anticoagulation will prevent clots which prevent healing

A ten year old has 5 lb. Bucks extension traction on his left leg. What should the nurse assess or? Select all that apply: A. Dryness' of the skin, by removing the foam wraps and boot B. Alignment of the shoulder, hips and knees C. Frayed rope near pulleys D. Correct amount of traction weight on fractureE. Pressure on the coccyx

B. Alignment of the shoulder, hips and knees C. Frayed rope near pulleys D. Correct amount of traction weight on fracture E. Pressure on the coccyx Bucks traction provides skin traction to keep the extremity in straight alignment and can be observed by noting a straight line formed between the shoulder, hips and knees. The rope must be intact to maintain the ordered traction from the weights. The correct amount of traction must be maintained to keep the fractured femur in correct alignment . Because the client is in a recumbent positon, the nurse should also inspect the skin on the back and buttocks for integrity. The nurse should not remove the splints wraps and boot without a physician's order.

The nurse is assessing a client for neurologic impairment after a total hip replacement. Which of the following would indicate impairment in the affected extremity? A. Decreased distal pulse B. Inability to move C. Diminished capillary refill D.Coolness to the touch

B. Inability to move; Being unable to move the affected leg suggests neurologic impairment. A decrease in the distal pulse, diminished capillary refill and coolness to touch of the affected extremity suggest vascular compromise .

The nurse advises the client who has had a femoral head prosthesis placement on the type of chair to sit in during the first 6 to 8 weeks after surgery. Which would be the correct type to recommend? A. A desk-type swivel chair B. A low padded upholstered chair C. A high backed chair with armrests D.A very soft recliner with an attached footrest

C. A high backed chair with armrests;

The client with a casted fracture complains of tingling, cyanosis and severe pain. What is the nurse's priority action? A. Elevate the extremity. B. Offer ice. C. Cut the cast open. D.Have the client move his or her fingers.

C. Cut the cast open.; Cyanosis indicates lack of blood flow, and the limb is in jeopardy of losing circulation and tissue cell death.

A 79 year old woman with a recent hip fracture is demonstrating signs of confusion, respiratory distress and tachycardia. What complication might the nurse suspect? A. Infection B. Petechiae C. Fat emboli D. Deep vein thrombosis

C. Fat emboli (= signs and symptoms of fat emboli to pulmonary structures); Fat emboli usually presents 24 to 72 hours after initial injury but it may be 2 weeks/ long bone injury or pelvis or major trauma/ 5-15 % mortality. Common triad of symptoms: Respiratory changes; neurological abnormalities: (mild confusion, drowsiness to seizures) Petechial rash: due to embolization of small dermal capillaries

The nurse is giving discharge instructions on keeping " Fido", a hyper small beagle dog in the laundry room while recuperating from a total hip replacement. This is an example of which type of nursing intervention? A. Collaborative: promotion of comfort B. Collaborative: family instruction C. Independent: injury prevention D. Independent: preservative functioning

C. Independent: injury prevention

Situation: J.R. is a 33 year old lawyer who sustained a leg fracture secondary to a collision with a tree while skiing. His fracture has been diagnosed as "compound open, transverse fracture of the tibia and fibula." Leg was surgically aligned and casted. He has been admitted to the unit for observation, pain control and antibiotic therapy. The type of fracture J.R. sustained is best described as bones: A. Broken in two or more pieces. B. Cracked, but not completely separated. C. Broken along the long axis of the bone. D. Broken and protruding through the skin

D. Broken and protruding through the skin.

During the initial assessment of a child admitted to the pediatric unit with osteomyelitis of the left tibia. What should the nurse expect the area over the tibia to exhibit? A. Diffuse tenderness B. Decreased pain C. Increased warmth D. Localized edema

Findings associated with osteomyelitis commonly include pain over the area, increased warmth, localized tenderness, and diffuse swelling over the involved bone. The area over the affected bone is red.