Case study compound fracture (preschooler)
In teaching the mother, what response should the nurse suggest she use with Cora?
I am sad you are throwing things at me.
The prescribed dose of morphine reads, " administer morphine sulfate 0.1 mg/kg IV every 3-4 hours." Cora weighs 33 pounds. The tubex. Of morphine contains 5 mg/ml. What volume of medication should the nurse administer?
0.3 ml
What traction is a type of skeletal traction?
90-90 Femoral.
What action should the nurse take?
Acknowledge that the parents have correctly learned how to move the cast while it is wet.
What action should the nurse implement?
Administer another dose of morphine immediately.
What nursing action has the highest priority?
Assess the appearance of Cora's foot.
Which nursing intervention(s) should be included in the plan of care while Cora is in traction (select all that apply)
Assess toes for capillary refill and edema. Ensure that the amount of weight remains consistent.
When an older child is sitting in a booster seat, where is the best place to locate the seat?
Back seat of a car with lap and shoulder belts.
What feature identifies Cora's fracture as an open fracture?
Bone fragments protruding through the skin. A compound, or open, fracture involves a disruption in the skin over the fracture. Since bone fragments are protruding through the skin, skin integrity has been lost. A compound fracture increases the risk for infection and bleeding.
Which nursing intervention should be included in the plan of care to prevent osteomyelitis?
Cleanse around the pin site with half-strength hydrogen peroxide.
Which technique is most beneficial when preparing a preschooler for a procedure that may be frightening?
Describe what the child will experience shortly before the procedure takes place.
If a staff member is unable to reach Cora's parents, what guidelines will determine the staffs ability to provide needed care?
Emergency care may be provided after a reasonable attempt to reach the parents has been made. Most healthcare facilities will provide emergency, life-saving medical care to a minor if unable to reach parents after a reasonable attempt has been made.
What action should the nurse take?
Give Cora a few crackers and stay with her while she eats them.
Which changes in serum lab values would most likely indicate the onset of osteomyelitis?
Increased erythrocyte sedimentation rate (ESR).
Implementation of which nursing intervention will reduce this risk?
Initiate hourly assessments of Cora's foot distal to the fracture site.
How should the nurse respond?
Instruct this parent that the child's age and size still require the use of a safety seat.
What is the best response by the nurse?
It is natural to be upset when your child expresses anger towards you.
How is the presence of crepitus related to this femur fracture determined?
Listen for a grating sound when the affected area is moved. Crepitus is a grating sound heard upon movement of bone fragments.
In addition to notifying the healthcare provider of this development, what action should the nurse implement?
Obtain equipment needed for cast removal.
Given the available nursing personnel, what staff assignment is best?
Ongoing monitoring of Cora's foot by the LPN, while the UAP assists the postoperative client with crutches and the RN determines if the new client has any immediate problems.
Which activity is the best choice for Cora?
Pretend beauty parlor.
Which snack selection is the best choice for Cora while she is immobilized?
Pudding
Which task should be delegated to the LPN at this time?
Spend time with Cora to distract her from the discomfort.
How should the nurse respond to this situation?
Support the mothers decision to hold Cora accountable for her own misbehavior.
Since Cora's parents are divorced, which parent should the nurse try to contact first?
The parent who has been assigned legal custody of Cora by the court. The parent who has been assigned legal custody of the child is primarily responsible to give consent for medical care if at all possible. In many situations, however, the parent with physical custody may also be allowed by the court to give consent. If both parents share custody, they are both able to give consent for medical care.
What additional assessment should the nurse perform?
Toe movement.
For which problems should Cora's parents be instructed to contact the healthcare provider?
Warm spots felt on the cast.
