Lewis chap 62 Fractures
The nurse suspects that a patient is experiencing a fat embolism after sustaining a femur fracture. What clinical manifestations does the nurse expect? Tachypnea, tachycardia, shortness of breath, and paresthesia Paresthesia, bradycardia, bradypnea, petechial rash on the chest and neck Tachypnea, tachycardia, shortness of breath, petechial rash on the chest and neck Bradypnea, bradycardia, shortness of breath, petechial rash on the chest and neck
Rationale A fat embolism may occur in a patient who has had a fracture of a large bone such as a femur or hip. The classic symptoms of a fat embolism include tachypnea, tachycardia, shortness of breath, and petechial rash on the chest and neck. Tachypnea, tachycardia, shortness of breath, and paresthesias; paresthesias, bradycardia, bradypnea, and petechial rash; and bradypnea, bradycardia, shortness of breath, and petechial rash are not directly characteristic of a pulmonary embolism. p. 1480
A patient is hospitalized with severe bleeding in the leg. An x-ray exam of the leg reveals that the periosteum is intact across the fracture and that the bone is still in alignment. What type of fracture does the patient have? Oblique fracture Pathologic fracture Greenstick fracture Comminuted fracture
Rationale A nondisplacement fracture in which the periosteum is intact across the fracture and the bone is still in alignment is classified as a greenstick fracture. In an oblique fracture, the line of the fracture extends in an oblique direction. A pathologic fracture is a spontaneous fracture at the site of a bone disease. Displaced fractures are usually comminuted fractures in which there are more than two bone fragments with the smaller fragments floating or oblique.
A nurse is examining a patient who is in a body jacket brace. The patient states that the brace is applied too tightly. What findings in the patient may indicate that the brace is too tightly applied? Select all that apply. ? Abdominal pain Burning sensation Guarding and rigidity Nausea and vomiting Increased abdominal pressure
Rationale After application of the body jacket brace, it is important to assess the patient for the development of superior mesenteric artery syndrome (cast syndrome). This condition occurs if the brace is applied too tightly, compressing the superior mesenteric artery against the duodenum. The patient generally complains of abdominal pain, abdominal pressure, nausea, and vomiting. Burning sensations, guarding, and rigidity may not be found in cast syndrome; these symptoms are more prominent if an intraabdominal disorder is present.
The nurse is providing discharge education to a patient with a fiberglass cast. What should the nurse be sure to include with the education? It must not get wet. The fiberglass is heavier than a plaster cast. It has to be replaced every one to two weeks. Skin irritation is more common than with a plaster cast.
Rationale Although there are many advantages of fiberglass casts, such as its capacity to withstand wetness and its lightness compared to plaster, the one major disadvantage is that the particles of fiberglass may be irritating to the skin. A fiberglass cast is water-repellent and does not require replacement if it becomes wet. A fiberglass cast may remain on the patient for the duration of the treatment and does not require replacement every one to two weeks. A fiberglass cast is lighter than plaster.
What action should a nurse implement to prevent foot drop in a patient who has a full-leg cast? Encourage bed rest Support the foot with 90 degrees of flexion Maintain the foot in a boot with 45 degrees of flexion Place an antiembolic garment on the affected leg and foot.
Rationale As a means of preventing foot drop in a leg with a cast, the foot should be supported with 90 degrees of flexion. Encouraging bed rest for his patient is not required. Supporting the foot with 45 degrees of flexion will not prevent foot drop. Antiembolic garments will protect against thromboembolic events but not foot drop.
The nurse is assessing a patient who has a traumatic leg injury. What intervention is the most important in the initial assessment? Assess the patient's pain level Realign the extremity in the appropriate position Check for full or partial loss of feeling and sensation Determine the extremity's color and temperature in the area of the injury
Rationale Baseline assessments are very important. It is most important to assess the extremity's color and temperature in the area of the injury to determine any venous or arterial insufficiency. If arterial or venous blood flow in the area is blocked, the area could become ischemic and die. Assessment of temperature is crucial to determine circulation and perfusion to the extremity and any change in temperature in the extremity should be reported promptly to the health care provider. Assessing the patient's pain is important but not as crucial as determining any arterial insufficiency. Realigning the injured extremity can lead to further damage or cause vascular insufficiency. Loss of sensation may be a late sign of neurovascular damage.
A patient with a leg fracture is scheduled for a fasciotomy. What complication is identified to have caused the need for this type of surgery? Infection Fat embolism syndrome Compartment syndrome Venous thromboembolism
Rationale Compartment syndrome is characterized by swelling and increased pressure within a limited space, which presses and compromises the function of the blood vessels, nerves, and/or tendons that run through that compartment. Surgical decompression of soft tissue is done through fasciotomy. The occurrence of infection is greatly reduced with antibiotics in conjunction with aggressive surgical management. Fat embolism syndrome treatment includes fluid resuscitation to prevent hypovolemic shock, correction of acidosis, and replacement of blood loss. Venous thromboembolism can be managed with drug management therapy such as anticoagulants
A nurse is completing the discharge sheet for a patient with hip fracture, who has been treated by insertion of a prosthesis using a posterior approach. What instructions should be given to this patient before discharge? Select all that apply. Use low toilet seats and chairs without arms. An adaptive device is not necessary for putting on shoes. Place a chair inside the tub and remain seated while washing. Inform the dentist about the prosthesis before any dental work. Keep the hip in a neutral, straight position when sitting or lying.
Rationale For a patient who had a hip fracture and has been treated by insertion of a prosthesis using a posterior approach, it is important to teach him or her and the caregiver about the measures to prevent dislocation. Certain measures, such as placing a chair in the tub and remaining seated while washing and keeping the hip in a neutral and straight position when sitting, lying, or walking prevents dislocation. The patient should be advised to inform his or her dentist about the prosthesis before any dental work, so that prophylactic antibiotics can be given if indicated. Many positions and daily activities predispose the patient to the dislocation of the prosthesis. Some of these activities include putting on one's own shoes and socks without using adaptive devices; crossing the legs or feet while seated; assuming the side-lying position incorrectly; standing up or sitting down while the body is flexed more than 90 degrees relative to the chair; and sitting on low seats, especially low toilet seats. It is also important to sit in chairs with arms, because these help the patient to rise to a standing position.
This morning a patient had a long leg cast applied and wants to get up and try to practice crutch walking. What is the best rationale that the nurse should give the patient for not allowing the patient to perform this task? The cast is not dry yet and it may be damaged while using crutches. The nurse does not have anyone available to accompany the patient. Rest, ice, compression, and elevation (RICE) are in process to decrease pain. Excess edema and other problems are prevented when the leg is elevated for 24 hours.
Rationale For the first 24 hours after a lower extremity cast is applied, the leg will be elevated on pillows above the heart level to avoid excessive edema and compartment syndrome. The cast also will be drying during this 24-hour period, although it will not be damaged by use of crutches. The lack of having someone to accompany the patient is important for safety, but is not the most important reason. RICE is used for soft tissue injuries, not with long leg casts.
After a motor vehicle crash, a patient has a dislocated right hip joint, and the bone is exposed in the right thigh. What type of fracture should the nurse document? Select all that apply. Open Closed Displaced Greenstick Comminuted
Rationale In this case, the bone is exposed, and therefore it is an open fracture. Comminuted fractures have two or more fragments of bones. Fractures can be classified as displaced or nondisplaced. In a displaced fracture, the two ends of the broken bone are separated from one another and are out of their normal positions. This fracture is not a closed one, because the fractured bone is exposed through soft tissue injury. Greenstick fracture is a type of fracture in which the periosteum is intact across the fracture and the bone is still in alignment.
During the discharge of an older adult patient who has had a history of repeated falls at home, what instructions should a nurse give to the patient to prevent falls? Select all that apply. Use a walker or cane. Exercise fingers and toes. Never use ramps in buildings. Avoid weight-bearing exercises. Avoid walking on uneven surfaces.
Rationale It is very important to teach older patients about the correct measures to prevent falls. Some of these include using a walker or cane while walking and avoiding walking on uneven surfaces. It is also important to develop hobbies, such as needlework or jigsaw puzzles that help to exercise the fingers, and to exercise the toes, thus preventing stiffness. Using ramps in buildings and on street corners, instead of steps, can decrease the risk of falling. Weight-bearing exercises should be performed, because they are important to maintain the strength of the bones and joints.
A newborn baby has sustained an uncomplicated midshaft fracture of the femur. In how many weeks will the fracture heal? Record your answer as a whole number. 3 weeks 7 weeks 10 weeks 20 weeks
Rationale Many factors influence fracture healing, including displacement, the site of the fracture, the blood supply to the area, and any immobilization and internal fixation devices (e.g., screws, pins). Healing time for fractures increases with age. An uncomplicated midshaft fracture of the femur heals in 3 weeks in a newborn and in 20 weeks in an adult.
A patient with a cast for a fractured radius reports, "My fingers feel numb." Which action is the highest priority for the nurse? Elevating the arm on two pillows Notifying the primary health care provider Performing a thorough neurovascular assessment Reassuring the patient that this is a normal response
Rationale Numbness distal to a casted extremity is an indication of decreased circulation, nerve compression, and possibly compartment syndrome. The nurse should perform a full neurovascular assessment to determine the extent of the problem. After the nurse has performed the assessment, the arm may be elevated on two pillows while the primary health care provider is notified. Numbness in the fingers of the casted arm is not a normal response.
A nurse is attending a patient who has sustained a fracture of the femur. What interventions should the nurse perform to ensure a healthy diet for optimal healing of the injured tissues? Select all that apply. Include 1g/kg of protein daily. Include foods rich in vitamins C and D. Increase calcium-rich foods in the diet. Decrease the intake of foods rich in B vitamins. Decrease magnesium- and phosphorus-rich foods.
Rationale Proper nutrition is an essential component of the healing process in injured tissue. An adequate energy source is needed to promote muscle strength and tone, build endurance, and provide energy for ambulation and maintaining a proper gait. The patient's dietary requirements must include adequate protein, usually 1 g/kg of body weight. The calcium intake should be increased, because immobility and bone healing increase calcium needs. Intake of vitamins C and D should be increased, because these are necessary for optimal soft tissue and bone healing. Magnesium and phosphorus are also necessary for the healing process, and their intake should be increased. B vitamins also aid in the healing of soft tissues and bones.
What instructions should be given to a patient with a cast to prevent edema and skin breakdown? Select all that apply. Exercise joints above and below the cast. Cover the cast with plastic for prolonged periods. Remove the padding of the cast after going home. Apply ice on the fracture site during the first 24 hours. Elevate the affected limb above heart level during the first 48 hours.
Rationale Regardless of the type of cast material, a cast can interfere with circulation and nerve function if edema occurs after the application of the cast. Therefore it is important to teach the patient and caregivers about measures to prevent edema. Elevating the limb above heart level and applying ice in the initial phase (24 to 48 hours) help in preventing edema. The patient should also be encouraged to exercise the joints above and below the cast. Pulling out the cast padding, inserting foreign objects into the cast to scratch an itch, and covering the cast with plastic may predispose patients to skin breakdown and infections. Therefore they should be advised to abstain from doing such things.
A patient with a hip fracture has been treated with insertion of a prosthesis. What findings indicate dislocation of this prosthesis? Select all that apply. Limb shortening Edema of the limb A lump in the buttock Weak pulse in the limb External rotation of the limb
Rationale Symptoms such as sudden severe pain, a lump in the buttock, limb shortening, and external rotation indicate prosthesis dislocation. This requires a closed reduction with conscious sedation or open reduction to realign the femoral head in the acetabulum. Edema of the limb and a weak pulse can be due to other causes, such as compartment
Which type of cast is best for a patient with an unstable wrist fracture? Posterior splint Short arm cast Long arm cast Sugar-tong splint
Rationale The long arm cast is commonly used for stable forearm or elbow fractures and unstable wrist fractures. It is similar to the short arm cast but extends to the proximal humerus, restricting motion at the wrist and the elbow. The sugar-tong posterior splint accommodates post injury swelling in the fractured extremity. A short arm cast is used for stable wrist fractures. The sugar-tong splint is typically used for acute wrist injuries or injuries that may result in significant swelling.
The nurse is completing a neurovascular assessment on the patient with a tibial fracture and a cast. The feet are pulseless, pale, and cool. The patient says they are numb. What should the nurse suspect is occurring? Paresthesia Pitting edema Poor venous return Compartment syndrome
Rationale The nurse should suspect compartment syndrome with one or more of the following six Ps: paresthesia, pallor, pulselessness, pain distal to the injury and unrelieved with opioids, pressure increases in the compartment, and paralysis. Although paresthesia and poor venous return are evident, these are just some of the manifestations of compartment syndrome. Pitting edema is not evident.
The nurse is caring for the patient with skeletal traction for an extremity fracture. What action(s) by the nurse are most appropriate? Select all that apply. Keep the weights off of the floor. Elevate the end of the bed as needed. Ensure that the weights are secured to the pulleys. Confirm that the forces are pulling in the same direction. Make sure that the traction ranges from 5 to 45 pounds (2.3 to 20.4 kg). Apply the traction intermittently as prescribed by the health care provider (HCP).
Rationale The weights must be kept off of the floor. The end of the bed may need to be elevated so that the weights are off the floor for traction to be applied. Traction weight ranges from 5 to 45 pounds (2.3 to 20.4 kg). Weight forces have to be in the opposite direction (counter traction). Traction must be applied continuously to be effective and the weights have to move freely through the pulleys.
The nurse is caring for a patient with a fractured femur. Which nursing action(s) by the nurse is the priority? Select all that apply. Resting the extremity. Elevating the extremity. Providing analgesia as necessary. Compressing the involved extremity. Applying ice compresses to the injured area. Stopping the activity and limiting movement.
Rationale There are five interventions performed for an acute injury. Stopping the activity and limiting movement, applying ice compresses to the injured area, compressing the involved extremity, elevating the extremity, and providing analgesia as necessary. Resting the extremity is not included in the immediate care.
The patient is brought to the emergency department after a car accident and has a femur fracture. What nursing intervention should the nurse implement to prevent a fat embolus in this patient? Administer enoxaparin Provide range of motion exercises Apply sequential compression boots Immobilize the fracture preoperatively
Rationale To prevent fat emboli, the nurse immobilizes the long bone to reduce movement of the fractured bone ends and decrease the risk of a fat embolus from the bone 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.
The nurse is caring for a patient with a fracture who has a Buck's traction boot in place. Which complication is prevented by the use of the boot? Muscle spasms Posttraumatic arthritis Intraarticular adhesions Extraarticular adhesions
Rationale Traction devices apply a pulling force on a fractured extremity in order to realign the bone. A Buck's traction boot is a type of skin traction used to immobilize a fracture, prevent hip flexion contractures, and reduce muscle spasms. Continuous passive motions (CPM) decrease the incidence of posttraumatic arthritis. CPM is used for various joints, such as the knee and shoulder, to prevent intraarticular and extraarticular adhesions.
A patient with a fracture of the femur is to be placed in Buck's traction. How should the nurse explain the functions of Buck's traction to the patient? Select all that apply. It immobilizes the fracture. It reduces muscle spasms. It reduces injury-related edema. It prevents hip flexion contractures. It helps in union of the fractured bone.
Rationale Traction is the application of a pulling force to an injured or diseased part of the body, often an extremity. A Buck's traction boot is a type of skin traction used to immobilize the fracture, prevent hip flexion contractures, and reduce muscle spasms. The traction does not reduce edema or directly help in union of the fractured bone. However, it indirectly helps the process of union of the fractured bone by keeping the limb aligned and reducing spasms and contractures.
A patient is being treated for a vertebral injury. After the application of a body brace jacket, the patient reports abdominal pain and pressure, nausea, and vomiting. What is the nurse's priority assessment? Assess for temperature elevation and other signs of infection. Assess for excessive pain with passive stretch of the extremities. Assess vital signs and compare the quality of the pulses bilaterally. Assess the abdomen for decreased bowel sounds through a window in the brace.
The patient is being treated for a vertebral injury with a body brace jacket. Monitoring the abdomen is necessary to observe decreased bowel sounds through a window present in the brace. This symptom occurs if the brace is applied too tightly, compressing the superior mesenteric artery against the duodenum. Monitoring vital signs and comparing pulses help to identify differences in rate or quality but are not the priority. Monitoring for temperature elevation and other signs of infection are important but are not the priority. Monitoring for excessive pain with passive stretching of the affected extremity's muscles, pallor, paresthesia, and late signs of paralysis and pulselessness is done to check for compartment syndrome.
The nurse is caring for a patient with a spinal bone fracture and osteoporosis. The patient asks the nurse for information on osteoporosis. What is the most appropriate response by the nurse? Tendons and ligaments become more flexible. Almost 50% of a person's muscle mass is decreased by age 70. An increase in motor neurons can lead to more problems with skeletal muscle movement. For many people, diseases such as osteoarthritis and osteoporosis are not a normal part of growing older.
These two bone diseases are not a normal part of aging for many people. In the aging adult, tendons and ligaments become less flexible, leading to more rigid movement. By age 70, a person's muscle mass is reduced by almost 30 percent. The number of motor neurons decrease, which leads to more physical problems.