467: Bone Trauma

A client who has extremity right wrist fracture complains of severe burning pain, frequent changes in the skin from hot and dry to cold, and feeling clammy skin that is shiny and growing more hair in the injured extremity. The nurse should anticipate providing care for what complication?

Complex regional pain syndrome

The nurse is assisting with the application of a cast. What will the nurse expect to be done first?

Cleaning the skin surface

A client has a plaster cast applied to the left leg. Which comment by the client following the procedure should the nurse address first?

My toes are stiff

A client with a right leg fracture is returning to the orthopedist to have the cast removed. During cast removal, it is important for the nurse to assure:

The client that he or she won't be cut

Which may occur if a client experiences compartment syndrome in an upper extremity?

Volmann's contracture

After surgery to treat a hip fracture, a client returns from the postanesthesia care unit to the medical-surgical unit. Postoperatively, how should the nurse position the client?

With the leg on the affected side abducted

The nurse is helping to set up Buck's traction on an orthopedic client. How often should the nurse assess circulation to the affected leg?

Within 30 minutes, then every 1 to 2 hours

A client with a fractured femur is placed in skeletal traction. Which intervention will increase client independence when moving in bed?

Apply a trapeze to bed frame

A group of students are reviewing information about cast composition in preparation for a discussion on the advantages and disadvantages of each. The students demonstrate understanding of the topic when they cite which of the following as an advantage of a plaster cast?

Better molding to the client

The nurse caring for a client, who has been treated for a hip fracture, instructs the client not to cross their legs and to have someone assist with tying their shoes. Which additional instruction should the nurse provide to client?

Don't flex hip more than 90 degrees

Which client(s) is most likely to have compartment syndrome after sustaining a fracture? Select all that apply.

Elevated pressure within the muscles Hemorrhage in the site of injury A plaster cast applied immediately after injury

A client is seen in the orthopedic clinic for complaints of severe pain in the left hip. After a series of diagnostic tests, the client is diagnosed with severe degenerative joint disease of the left hip and suggested to have the hip reconstructed. What procedure will the nurse schedule the client for?

Left hip arthroplasty

A fracture is considered pathologic when it

Occurs through an area of diseased bone

Which nursing diagnosis is a priority for a client with a traumatically amputated lower extremity?

Risk for injury related to amputation

A client who has sustained a fracture reports an increase in pain and decreased function of the affected extremity. What will the nurse suspect?

Avascular necrosis

An emergency department client is diagnosed with a hip dislocation. The client's family is relieved that the client has not suffered a hip fracture, but the nurse explains that this is still considered to be a medical emergency. What is the rationale for the nurse's statement?

Avascular necrosis may develop at the site if it is not promptly resolved

A patient has stepped in a hole in the yard, causing an ankle injury. The ankle is edematous and painful to palpation. How long should the nurse inform the patient that the acute inflammatory stage will last?

Between 24 and 48 hours

A patient has suffered a femoral shaft fracture in an industrial accident. What is an immediate nursing concern for this patient?

Hypovolemic shock

The client returns to the nursing unit following an open reduction with internal fixation of the right hip. Nursing assessment findings include temperature 100.8 degrees Fahrenheit, heart rate 112 beats per minute, respiratory rate 28 breaths per minute, and blood pressure 86/58. There is no urine in the Foley catheter collection bag. The nurse interprets these findings as indicating which complication?

Hypovolemic shock

Radiographic evaluation of a client's fracture reveals that a bone fragment has been driven into another bone fragment. The nurse identifies this as which type of fracture?

Impacted

Which factor inhibits fracture healing?

Local malignancy

Which nursing intervention is essential in caring for a client with compartment syndrome?

Removing all external sources of pressure, such as clothing and jewelry

The nurse is caring for a client with an external fixator that requires pin care twice a day. The nurse observes that there is a new purulent drainage around one of the pins. What intervention should the nurse anticipate doing?

Obtaining a culture

A client is being prepared for a total hip arthroplasty, and the nurse is providing relevant education. The client is concerned about being on bed rest for several days after the surgery. The nurse should explain what expectation for activity following hip replacement?

The PT will likely help you get up using a walker the day after your surgery

A client has had surgical repair of a hip injury after joint manipulation was unsuccessful. After surgery, the nurse implements measures to prevent complications. Which complications is the nurse seeking to prevent? Select all that apply.

Skin breakdown Wound infection Pneumonia