Lewis Chap 62 Fractures
A patient experiences an unstable wrist fracture. Which type of cast will be most beneficial for the patient? Long arm cast External fixation Short arm cast, restricting motion at the wrist and elbow Short arm cast, providing wrist immobilization and unrestricted elbow motion
A. Rationale A patient who has an unstable wrist fracture needs restricted movement of the wrist and elbow that extends to the proximal humerus. This is provided by a long arm cast. Simple fractures and complex fractures with extensive soft tissue damage, nonunion or malunion, and limb lengthening can be done through external fixation, which is often used in an attempt to salvage extremities. By definition, a short arm cast facilitates unrestricted elbow motion, which is harmful for the patient with an unstable wrist fracture.
A nurse evaluates a patient who reports twisting an ankle while walking down steps. Besides edema, which symptoms would most likely be observed if a nondisplaced simple fracture were present? Numbness, coolness, and loss of pulse Loss of sensation, redness, and warmth Coolness, redness, and inability to bear weight Redness, warmth, and inability to use the affected part
D. Rationale Common signs of a fracture include edema, redness, warmth, inability to bear weight or use the affected joint, and pain at the site of injury. Coolness, tingling, numbness, and loss of pulses are signs of a vascular problem or may reflect a complication of a more complex fracture.
A patient with a long leg cast reports pain in the toes. The nurse discovers that the toes are pale and cool to the touch with intact pulses and minimal neuropathy. The findings indicate that the patient may be experiencing what? Osteomyelitis A fat embolism A pressure ulcer Compartment syndrome
D. Rationale Compartment syndrome is the progressive compromise of neurovascular function of tissue in a confined space such as a cast. It may also result from circumferential inflammation around an extremity. The earliest sign is paresthesias, followed by pain, pressure resulting from edema, pallor, paralysis, and absence of pulse. (Absence of the peripheral pulse is a late and ominous sign.) A pressure ulcer is caused by decreased circulation due to pressure, tissue hypoxia, and destruction. Osteomyelitis is an infectious process within the bone. A fat embolism is an acute event in which fat globules released into circulation obstruct pulmonary circulation. It is seen with fractures of long bones such as the femur.
A patient arrives in the emergency department after sustaining a fall. The initial assessment reveals that the left leg is shorter than the right and externally rotated. What condition should the nurse suspect? Fractured hip Fractured pelvis Fractured tibia/fibula Nondisplaced fractured femur
A. Rationale Older adults, especially women, are at high risk for fracture. One classic sign of a fractured hip is a leg that is shorter than the opposite one and abnormally rotated (internally or externally). A fractured hip is accompanied by pain and possibly neurovascular changes. A leg that is shorter than the other one and externally rotated is not a sign of a fractured pelvic, femur, or tibia/fibula.
Which body part of the patient is at risk for superior mesenteric artery syndrome when sustaining a fracture? Knee Vertebrae Lower extremity Upper extremity
B. Rationale In stable spine injuries, a thoracic or lumbar spine body jacket brace is used for immobilization and support. Superior mesenteric artery syndrome occurs if the brace is applied too tightly, compressing the superior mesenteric artery against the duodenum. Knee injuries, lower extremity injuries, and upper extremity injuries do not require a thoracic or lumbar spine body jacket brace and, therefore, are not associated with mesenteric artery syndrome.
The nurse teaches a student nurse about traction. Which statement made by the student nurse reflects effective learning? "Traction prevents active and passive exercise." "Traction provides immobilization to the fractured joint." "Traction decreases the joint space before a major joint reconstruction." "Traction provides expansion of joint space during arthroscopic procedures."
B. Rationale Traction is the application of a pulling force to an injured or diseased part of the body or an extremity. Traction is used to immobilize a joint or part of the body in order to promote joint stabilization and prevent soft tissue damage. Traction promotes active and passive exercise in order to prevent muscle spasms, which may further complicate the fracture. Traction helps to increase space in the joint before major joint reconstruction. Traction provides expansion of joint space during arthroscopic procedures.
The nurse is providing postoperative care to a patient who underwent surgical repair of a fractured hip two days ago. Which assessment finding indicates the need for immediate nursing action and intervention? C Pain at the surgical site Sudden shortness of breath Serosanguineous wound drainage Limited range of motion of the affected leg
B. The nurse is providing postoperative care to a patient who underwent surgical repair of a fractured hip two days ago. Which assessment finding indicates the need for immediate nursing action and intervention? <p>The nurse is providing postoperative care to a patient who underwent surgical repair of a fractured hip two days ago. Which assessment finding indicates the need for immediate nursing action and intervention?</p> Pain at the surgical site Sudden shortness of breath Serosanguineous wound drainage Limited range of motion of the affected leg
The nurse provides discharge instructions to a patient who has undergone total hip arthroplasty. Which statement by the patient indicates understanding of the instructions? "I'll walk at least two miles a day after I get home." "I may get back to work as soon as I feel that I'm able." "I have to do the physical therapy exercises several times a day." "I should take frequent bike rides to increase my activity and joint flexibility."
C. Rationale After hip arthroplasty (replacement), the patient must perform specially designed exercises to help regain muscle strength. Care must be taken to prevent dislocation of the prosthesis and to prevent fatigue during the recovery period. Walking two miles per day and taking bike rides would put too much physical stress on the patient. Slow but steady progress will indicate when the patient's activity tolerance level is such that he or she may return to work.
A patient experiences a nondisplaced fracture. What condition can potentially displace the fracture in the patient? Crepitation Ecchymosis Muscle spasm Edema and swelling
C. Rationale Muscle spasms may displace previously nondisplaced fractures. Crepitation may increase the chance of nonunion of the bones. Ecchymosis is discoloration of the skin that may appear immediately after the injury and distal to the injury. Edema and swelling indicate occluded circulation.
Which type of fracture is most common in adults greater than 65 years of age? Hip fracture Pelvic fracture Colles' fracture Fracture of the humerus
Rationale A. Hip fractures are most common in older adults, with 90 percent of these fractures occurring as a result of a fall. Colles' fracture is a fracture of the distal radius and is one of the most common fractures in adults of any age. Pelvic fractures range from benign to life threatening, depending on the mechanism of injury and associated vascular insult. Only a small percentage of all fractures are pelvic fractures. This type of injury is associated with a high mortality rate. Fractures of the humerus involve the shaft of the humerus and are common among young and middle-aged adults.
The nurse plans care for a patient who has a fractured femur. During the 48 to 72 hours after the fracture the nurse should monitor the patient for the development of what? Fat emboli Renal calculi Muscle atrophy Bone demineralization
Rationale A. Pressure on the bone marrow or an increase in catecholamines (related to stress) can mobilize fatty acids and the development of fat globules in the bloodstream. These fat globules travel to the lung and become lodged, causing the pulmonary symptoms. Renal calculi, muscle atrophy, and bone demineralization are potential complications of immobility; however, they would develop much later than 72 hours after the fracture.
A nurse is caring for a patient who has just sustained a hip fracture. Which nursing action should be performed first? Administering pain medication Preparing for immediate surgery Immobilizing the affected extremity Placing the injured extremity in traction
Rationale C. The priority of emergency management for a fractured hip is immobilizing the affected extremity, because movement could cause further damage and more extensive internal bleeding and worsen the patient's pain. Administering pain medication, preparing the patient for immediate surgery, and placing the injured extremity in traction are secondary nursing interventions that require further direction from the primary health care provider.
A patient with a fracture of the femur has the extremity in skeletal traction and is encouraged to use an overhead trapeze apparatus. The nurse explains that the primary purpose of the overhead trapeze is what? To assist with leg exercises To enhance breathing and lung expansion To promote circulation throughout the body To facilitate independent movement while the patient is in bed
Rationale D. An overhead trapeze will facilitate independent movement in bed. It also maintains range of motion of the upper extremities and strengthens the biceps. Assisting with stump exercises, enhancing breathing and lung expansion, and promoting circulation throughout the body are secondary benefits to using an overhead trapeze but are not the primary purpose.
A patient's x-ray exam reveals that there is no evidence of callus formation after the second week of treatment for a bone fracture. What does the nurse infer related to healing of the fracture? It is healing normally. It is failing to heal despite treatment. It is healing at a slower rate than expected. It is healing in an abnormal position in relation to midline of structure.
Rationale During the second week of treatment after a bone fracture, an x-ray is performed to check for the presence of callus formation. Callus formation indicates that the healing process of the bone has started. Absence of callus formation indicates failure of the healing process in spite of treatment. When the fracture healing progress is slower than expected over time, it indicates a delayed union of the fractured bone. The fracture is not healing normally. When the fracture heals in an abnormal position in relation to the midline of the structure, it indicates angulation.
The registered nurse teaches a student nurse about care of a patient with a fracture of the humerus, compartment syndrome, and a plaster cast in place. The student nurse provides discharge education to the patient. Which statement made by the student nurse needs correction? "Elevate the extremity above the heart level." "Use a hair dryer on a low setting to dry the cast thoroughly." "Avoid covering the cast with plastic for extended periods of time." "Control the itching sensation by using a hair dryer on a cool setting at the site of itching."
Rationale S. Elevation of the extremity above the heart level is contraindicated for patients with compartment syndrome, which is a painful condition that occurs when the pressure within the muscle increases to dangerous levels. If the cast gets wet by mistake, it should be dried thoroughly using a hair dryer on the low setting. Itching is a common sensation experienced by patients and can be controlled by using a hair dryer on the cool setting instead of using hard objects to scratch the area. The patient should not cover the cast with plastic for prolonged periods.
