Compound Fracture (Preschooler)

The nurse recognizes that Madison is at risk for the onset of osteomyelitis. Which nursing intervention should be included in the plan of care to prevent this complication? Petal the edges of the boot cast with adhesive tape. Cleanse around the pin site with half-strength hydrogen peroxide. Place an eggcrate mattress on the bed under the bed sheet. Apply an elastic stocking to the unaffected leg.

Cleanse around the pin site with half-strength hydrogen peroxide. Persons with skeletal traction are at high risk for osteomyelitis because of the potential for direct entry of microorganisms at the pin site. Cleansing the pin site with half-strength hydrogen peroxide may be initiated to reduce this risk

The nurse notes that in addition to the pain Madison's foot is cool and pale with capillary refill of 5 seconds. What additional assessment should the nurse perform? Deep tendon reflexes. Toe movement. Skin turgor. Lack of hair growth.

Toe movement. Neurovascular assessment includes the "5 Ps." They are pain, pallor, pulse, paresthesia, and paralysis. Changes indicate increasing pressure on the blood vessels and nerves supplying the extremity distal to the cast or injury.

After 3 weeks the traction is discontinued, a long leg cast is applied, and Madison is scheduled for discharge from the hospital. For which problem should Madison's parents be instructed to contact the healthcare provider? The cast sounds hollow when tapped. Madison's capillary refill is less than 2 seconds. Madison reports itching inside the cast. Warm spots are felt on the cast.

Warm spots are felt on the cast. If the cast feels warm, has hot spots, drainage, bleeding, or an unusual odor, the healthcare provider should be notified so that further evaluation can be done to determine if an infection or skin breakdown has occurred.

Madison's mother tells the nurse that she doesn't know how to respond to Madison when the child expresses her anger. In teaching the mother, what response should the nurse suggest she use with Madison? "You shouldn't act out by throwing things at me." "I am sad that you are throwing things at me." "I will not stay here if you keep throwing things." "Throwing things is not the way good girls behave."

"I am sad that you are throwing things at me." Preschoolers need limit-setting guidelines and discipline. The parent's response should focus on the activity, rather than the child. Phrasing a response beginning with "I" rather than "you" is less judging to the child.

Several days later, Madison throws her toys at her mother. Her mother is in tears and asks the nurse, "Why does she only get angry with me? She never yells at the nurses or her father." What is the best response by the nurse? "You are the one providing all the discipline. It is natural for her to be angry at you." "Do you believe she would be happier being with her father rather than with you?" "You should not allow her to become that angry because it is harmful for both of you." "It is natural to be upset when your child expresses anger toward you."

"It is natural to be upset when your child expresses anger toward you." This open-ended statement offers the mother the opportunity to continue to express her feelings about the situation. The nurse can then offer reassurance that this expression of anger by Madison is normal and help the mother find ways to deal with the situation.

Madison goes to surgery, where reduction and fixation is performed. Following surgery, Madison is transferred to the orthopedic nursing unit where she will be in skeletal traction for several weeks. Which traction is a type of skeletal traction? Buck extension. 90-90 Femoral. Russell. Bryant.

90-90 Femoral In this type of traction, a pin or wire is placed in the distal fragment of the femur, and a cast is applied to the lower leg. Traction ropes are used to maintain a 90 degree flexion of both the hip and the knee.

The prescribed dose of morphine reads, "Administer morphine sulfate 0.2 mg/kg IV every 3 to 4 hours." Madison weighs 33 pounds. The tubex of morphine contains 5 mg/mL. How many mL of medication should the nurse administer? (Enter numeric value only. If rounding is necessary, round to the nearest tenth.)

0.6 mL First, convert pounds to kilograms: 33 lbs/2.2 kg = 15 kg Next, determine the dose per kilogram: 15 kg × 0.2 mg/kg = 3 mg Last, calculate the mL needed: 3 mg/5 mg × 1 mL = 0.6 mL

The nurse reminds Madison and her parents that the cast will take 1 to 2 days to dry completely. The parents demonstrate lifting the cast by holding it with the palms of their hands. What action should the nurse take in response to how they are handling the care of the cast? Ask the parents if they feel too overwhelmed to learn cast care at the present time. Demonstrate the correct technique for moving the cast using only the fingertips. Suggest that Madison might be more comfortable if a pillow is used when moving the cast. Acknowledge that the parents have correctly learned how to move the cast while it is wet.

Acknowledge that the parents have correctly learned how to move the cast while it is wet. The palms of the hands should be used to move a wet cast to avoid finger indentations that cause pressure points.

Lack of activity may indicate pain in the preschooler, an age at which a child is normally always on the go. Preschoolers may not be able to localize pain clearly. The child has clearly identified the degree of pain on the FACES scale and should be medicated accordingly What action should the nurse implement? Administer another dose of morphine immediately. Hold the dose until she is about to leave for surgery. Use distraction methods rather than analgesics until Madison goes to surgery. Document that pain assessment findings are inconsistent.

Administer dose of morphine immediately. Lack of activity may indicate pain in the preschooler, an age at which a child is normally always on the go. Preschoolers may not be able to localize pain clearly. The child has clearly identified the degree of pain on the FACES scale and should be medicated accordingly

Madison has been resting comfortably since surgery. She is receiving morphine 3 mg IV every 4 hours, and she has consistently indicated adequate pain control via the FACES pain scale and through remarks to her mother, who has been staying at her bedside. Twenty hours after surgery, the nurse administers the next scheduled dose of morphine. Two hours later, Madison is crying and agitated. She points to her foot and cries, "There, there, it hurts there." Which nursing action has the highest priority? Administer a breakthrough dose of morphine. Redirect Madison's attention to a new toy. Assess the appearance of Madison's foot. Monitor Madison's vital signs and oxygen saturation.

Assess the appearance of Madison's foot. Pain distal to the site may be the first sign of a serious complication needing immediate attention.

Madison arrives on the nursing unit with her traction intact. She has a boot cast on her lower leg. Which nursing interventions should be included in the plan of care while Madison is in traction? (Select all that apply.) Remove the traction for 10 minutes every hour. Keep weights securely positioned on the floor. Assess toes for capillary refill and edema. Attach the ropes to the footboard to prevent sliding. Ensure that the amount of weight remains consistent.

Assess toes for capillary refill and edema (Decreased perfusion to the foot or increased edema could lead to a potentially life-threatening complication.) Ensure that the amount of weight remains consistent (The nurse should assess the amount of the weight regularly to ensure that no changes have been made to the prescribed amount of traction. Well-meaning family and friends or older children may remove weights.)

This parent goes on to say that her son prefers sitting in the front seat. She states this is the safest place because her car is equipped with front and side airbags. When an older child is sitting on a booster seat, where is the best place to locate the seat? Front passenger seat of a car with airbags. Front passenger seat of a car without airbags. Back seat of a car with only a lap belt. Back seat of a car with lap and shoulder belts.

Back seat of a car with lap and shoulder belts. The Center for Disease Control recommends that children younger than 12 years of age be placed in the rear seat of cars to prevent injury to the head from hitting the dashboard and injury from airbags intended for the protection of adult-sized passengers. The shoulder belt reduces the risk that the child may double over the lap belt, which could cause injury to the abdomen and spinal cord. For the younger child, it is also important to ensure that the shoulder harness fits correctly to prevent injury to the child's neck and face.

What feature identifies Madison's fracture as an open fracture? Depressed area over the fracture site. Bone fragments protruding through the skin. A partially bent appearance on x-ray. Multiple bone fragments visible on x-ray.

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

The nurse talks to Madison's parents about preparing her for cast removal. Which technique is most beneficial when preparing a preschooler for a procedure that may be frightening? Call the child life therapy team to explain the procedure. Remind the child that removing the cast means she can return to normal activities. Reassure the child that there is nothing scary about the procedure. Describe what the child will experience shortly before the procedure takes place.

Describe what the child will experience shortly before the procedure takes place. Advance preparation increases the likelihood that the preschooler will fantasize about the procedure and develop undue fears. As a general guideline, the younger the child, the closer to the procedure the preparation should occur.

If a staff member is unable to reach Madison's parents, what guidelines will determine the staff's ability to provide needed care? A minor child can give permission and consent for care and is then considered emancipated. Emergency care may be provided after a reasonable attempt to reach the parents has been made. Since the sister has responsibility for the child, she can give informed consent for needed procedures. A minor child can assent to care, which is considered equivalent to an adult giving informed consent for care

Emergency care may be provided after a reasonable attempt to reach the parents has been made.

Madison usually snacks on animal crackers in the morning. She has a box at her bedside. She asks the nurse if she can have some while her mother is away from the bedside. What action should the nurse take? Tell Madison that she will need to wait for her mother to return before she can have a snack. Give Madison crackers to play with, but tell her not to eat any until her mother returns. Give Madison a few crackers and stay with her while she eats them. Give Madison a few crackers and leave her alone to enjoy her snack while watching TV.

Give Madison a few crackers and stay with her while she eats them. It is important to maintain Madison's routine; therefore she should be allowed to have her usual morning snack. It is also important to supervise Madison because preschoolers have great imaginations and Madison may choose to hide some of the animal crackers in her cast if left alone while having her snack.

The nurse also monitors Madison's lab values. Which change in serum lab values would most likely indicate the onset of osteomyelitis? Decreased hemoglobin (Hgb). Decreased white blood cells. Increased erythrocyte sedimentation rate (ESR). Increased creatine phosphokinase (CPK).

Increased erythrocyte sedimentation rate (ESR). The ESR will increase during an inflammatory process, which would be present in acute osteomyelitis, an infection of the bone.

The nurse identifies that a priority nursing diagnosis for Madison is "Injury risk for peripheral neurovascular compromise." Implementation of which nursing intervention will reduce this risk? Perform hourly assessment of Madison's level of consciousness. Initiate hourly assessment of Madison's foot distal to the fracture site. Assign an unlicensed assistive personnel (UAP) to measure Madison's vital signs hourly. Evaluate Madison for the presence of orthostatic hypotension.

Initiate hourly assessment of Madison's foot distal to the fracture site. The trauma to the leg can cause swelling and possible compromise of circulation and nerve function distal to the fracture site. Madison's foot should be assessed hourly for signs of diminished function.

Madison's parents invite the nurse to attend a parenting class at Madison's preschool to talk about car safety. A parent in the class states that her 5-year-old son is very mature for his age and feels more grown-up using an adult seatbelt. She states that he follows the rules much better when he gets to make decisions, therefore, he is more willing to keep the seatbelt buckled. She goes on to say that he is large for his age, weighing almost 50 pounds. How should the nurse respond? Reassure this parent that the child is large enough to safely use an adult seatbelt. Instruct this parent that the child's age and size still require the use of a safety seat. Support this parent's desire to increase the child's independent decision-making. Redirect the topic to types of injuries that occur when car seats are not used correctly.

Instruct this parent that the child's age and size still require the use of a safety seat. Children should remain in car safety seats until they weigh 40 pounds. It is highly recommended that children then use a booster car safety seat until they weigh at least 60 pounds, or until they are at least 8 years old. This raises the child to a height that is better able to accommodate the safe use of a car's seatbelt system, which is designed for adults.

How is the presence of crepitus related to this femur fracture determined? Observe the area around the fracture for swelling, pain, and tenderness. Observe the area distal to the fracture for spasms or rigidity. Gently palpate over or around the wound and listen for a crackling sound. Listen for a grating sound when the affected area is moved.

Listen for a gratin sound when the affected area is moved. Crepitus is a grating sound heard upon movement of bone fragments

Based on these assessment findings, the nurse recognizes that Madison has developed compartment syndrome. In addition to notifying the healthcare provider of this development, what action should the nurse implement? Apply a pressure dressing over the affected area. Obtain equipment needed for cast removal. Encourage Madison to keep trying to move her toes. Place an ice pack over the affected area.

Obtain equipment needed for cast removal. Compartment syndrome is the compression of structures, such as arteries and nerves, within a closed compartment in an extremity. This complication typically occurs within 24 hours of a fracture. It should be reported to the healthcare provider immediately because permanent damage can occur within 12 hours of identification of the syndrome. Cast removal is often necessary to relieve the pressure, and surgical fasciotomy is sometimes needed as well.

The nurse administers an additional dose of analgesic to Madison after conferring with the healthcare provider and Madison reports that her pain is tolerable. Other clients require assistance, so the nurse needs to utilize her team members to effectively care for all clients. A client with a pelvic fracture is being transferred from the ED and a postoperative client with crutches needs assistance ambulating to the bathroom. A licensed practical nurse (LPN) and an unlicensed assistive personnel (UAP) are available to work with the nurse. Given the available medical personnel, what staff assignment is best? Ongoing monitoring of Madison's foot by the LPN, while the nurse assists the postoperative client with crutches and the UAP determines if the new client has any immediate problems. Ongoing monitoring of Madison's foot by the nurse, while the UAP assists the postoperative client with crutches and the LPN determines if the new client has any immediate problems. Ongoing monitoring of Madison's foot by the UAP, while the nurse assists the postoperative client with crutches and the LPN determines if the new client has any immediate problems. Ongoing monitoring of Madison's foot by the LPN, while the UAP assists the postoperative client with crutches and the nurse determines if the new client has any immediate problems.

Ongoing monitoring of Madison's foot by the LPN, while the UAP assists the postoperative client with crutches and the nurse determines if the new client has any immediate problems. Ongoing monitoring of Madison's foot can be performed by the LPN since the nurse has already made an assessment and taken action. The UAP can assist the client with crutches, which allows the nurse to assess the problems of a new client. The nurse is the only member of the team who has the expertise to perform an admission assessment and determine client needs and problems.

The nurse understands that which signs and symptoms are indicative of the osteomyelitis complication? (Select all that apply.) Pain that increases with movement. Bradycardia. Hypothermia. Edema. Irritability.

Pain that increases with movement Edema Irritability

The UAP goes to the playroom to get Madison some toys. The UAP is planning to spend some time with Madison. Which activity is the best choice for Madison? Pretend beauty parlor. Monopoly board game. Fifty-piece puzzle. Looking at picture books.

Pretend beauty parlor. Preschoolers enjoy imitative and dramatic play, and they especially enjoy adult make believe. This activity will help Madison with fine motor skills, as well as communication skills, and should keep her engaged for a period of time. Preschoolers also enjoy things like village and farm sets, hand puppets, simple handicrafts, and letter flash cards.

Madison reports that her pain is still controlled and she is starting to get hungry. The nurse sends the UAP to provider her with a snack. Which snack selection is the best choice for Madison while she is immobilized? Pudding. Popsicle. Blueberry muffin. Graham crackers.

Pudding Pudding provides protein and calories, both of which are important for an immobile child who is at risk for negative nitrogen balance.

When Madison returns for cast removal, the nurse uses a doll that allows Madison to role-play the procedure of cast removal. The nurse tells Madison that the cast-cutter makes a noise, but if it touches her leg, it will probably feel like a "tickle." The nurse explains to Madison and her parents that which will occur during and after the cast is removed? She may feel heat or a vibration or a tickle during the removal. The machine to remove the cast is very noisy. Lotions should not be applied on the legs for 1 week after cast removal. Skin might be scaly or dry after the cast is removed. The client will be ready to walk on her foot without issue once the cast is removed.

She may feel heat or a vibration or a tickle during the removal. The machine to remove the cast is very noisy. Skin might be scaly or dry after the cast is removed The client should be spoken to with words she may understand, and the removal does get worse and vibrate. Skin is most likely going to be dry from cast placement.

After resolving the other client care needs, the nurse returns to Madison's room. Which task should be delegated to the LPN at this time? Revise the plan of care to reflect the recent complication. Teach Madison's parents about compartment syndrome. Evaluate the effectiveness of the dose of morphine administered. Spend time with Madison to distract her from the discomfort.

Spend time with Madison to distract her from the discomfort

As the nurse assumes care for the client, which actions are most important for the nurse take? (Select all that apply.) Stabilize the injury. Perform range of motion (ROM) exercises to the affected limb. Assess neurovascular status every hour. Place an ice pack over the injury. Elevate the affected extremity.

Stabilize the injury (this will prevent further damage to the leg) Assess neuromuscular status every hour (this helps the nurse to verify adequate profusion to the extremity) Place an ice pack over the injury (will decrease swelling of the injury) Elevate the affected extremity (will decrease swelling to the injury)

Madison insists that the play activity include Elsa, her invisible friend. While playing, Madison throws some toys on the floor and scolds Elsa for dropping them. Madison's mother tells Madison that the activity cannot continue if Madison is going to throw her toys. How should the nurse respond to this situation? Remind the mother that Madison's actions are normal and to be expected. Help the mother develop a plan to reduce Madison's need for an imaginary friend. Support the mother's decision to hold Madison accountable for her own misbehavior. Advise the mother that imaginary playmates at this age indicate regressive behavior.

Support the mother's decision to hold Madison accountable for her own misbehavior. Imaginary friends serve many useful purposes in the preschool years. The nurse should reassure Madison's mother that the inclusion of an imaginary friend is a healthy behavior but support the mother's recognition that Madison should not use her imaginary friend to escape responsibility for her own misbehavior.

Since Madison's parents are divorced, which parent should the nurse try to contact first? The parent from whose house the sister assumed care of Madison (physical custody). The parent in whose home Madison lives the majority of the time (physical custody). The parent who has been assigned legal custody of Madison by the court. Both parents must be contacted, even if they do not share joint legal custody of Madison.

The parent who has been assigned legal custody of Madison by the court.