NSG 312- Mobility

Pediatrics bones; what are three characteristics?

1. Porous 2. Pliable 3. less dense

A nurse is caring for a client who has a fracture of the forearm. The parent tells the nurse that the provider said it was a green stick fracture and asks what that means. Which of the following statements should the nurse make? A. "The bone is broken on one side and bent on the other side" B. "Fragments of bones have splintered into the surrounding area" C. "The bone ends have been forced toward each other" D. The sharp edge of the bone has broken through the skin"

A. The bone is broken on one side and bent on the other side

Skeletal traction

Adults Upper Tibia Up to 20 kg Long period of time Pin care continuous pulling force applied directly to the skeletal structure and/or specific bone Used when more pulling force is needed than skin traction can withstand A pin or rod is inserted through or into the bone Force is applied through the use of weights attached by rope Weights are never removed by the nurse

A nurse is caring for a child who sustained a fracture. Which of the following actions should the nurse take? (Select all that apply) A. Place heat pack on the site of injury B. Elevate the affected limb C. Asses neurovascular status frequently D. Encourage ROM of the affected limb E. Stabilize the injury

B. C. E.

Counter-traction

must be used for effectiveness (body weight)

Immobility can be _______ , such as knee surgery or ___________ such as paraplegia

temporary , permanent

A nurse is caring for a client who is post operative following an open reduction internal fixation (ORIF) of a femur fracture. Which of the following parameter should the nurse include in the evaluation of the neurovascular status of the client's affect extremity? (Select all that Apply) A. Color B. Temperature C. Ecchymosis D. Skin integrity E. Sensation

?? A. Color B. Temperature D. Skin Integrity

What are the 5 P's of compartment syndrome?

Pain Paresthesia Pallor Paralysis Pulselessness

What are four important rules when caring for brace?

1. limit movement 2. keep snug but do not impair circulation 3. no direct contact with skin 4. assess neurovascular and skin status

Assess the care of site

1. skin under straps and pin sites 2. Neurovascular tissue 3. place sheepskin pas under child's extremities

A nurse is assessing a client who is 24 hour post operative following an open reduction and internal fixation to repair a fracture of the femur. Which of the following assessment findings is an early manifestation of acute compartment syndrome (ACS) A. Dyspnea B. red-brown petechia C. Headache D. Agitation

A. Dyspnea - early manifestation of ACS that due to hypoxemia

A nurse is assessing a client who has a fracture of the femur. The nurse obtains vital signs on admission and again in 2 hours. Which of the following changes in assessment should indicate to the nurse that the client could be developing a serious complication? A. increased respiratory rate of 18 to 44/min B. increased oral temperature of 36.6 C to 37.7 C C. increased blood pressure from 112/68 to 120/72 D. Increased heart rate from 68 to 72

A. Increased respiratory rate of 18 to 44

A nurse is teaching a group of parents about fractures. Which of the following information should the nurse include in the teaching? A. "Children need a longer time to heal from a fracture than an adult" B. "Epiphyseal plate injuries can result in altered bone growth" C. "A greenstick fracture is a complete break in the bone" D. "Bones are unable to bend, so they break"

B. "Epiphyseal plate injuries can result in altered bone growth"

A nurse is caring for a child who is in skeletal traction. Which of the following actions should the nurse take? (select all that apply) A. Remove the weights to reposition the client B. Asses the client's position frequently C. Asses pin sites every 4 hours D. Ensure the weights are hanging freely E. Ensure the rope's knot is in contact with the pulley

B. C. D.

A nurse is completing pro-operative teaching with an adolescent client who is scheduled to receive spinal instrumentation for scoliosis. Which of the following information should the nurse include in the teaching? A. "You will go home the same day as your surgery" B. "You will have minimal pain" C. "You will need to receive blood" D. "You will not be able to eat until the day after surgery"

C.

A nurse is caring for a toddler who is diagnosed with hip dysplasia and has been placed in a hip spica cast. The child mother asks why a Pavlik harness is not being used. Which of the following responses should the nurse make? A. "The Palvik harness is used for children with scoliosis" B. "The Palvik harness is used for school-age children" C. "The Palvik harness cannot be used for your child because her condition is too severe" D. "The Palvis harness is used for infants less than 6 months old"

D.

expected findings of fractures: Assessment

Pain Crepitus Deformity Edema Ecchymosis Warmth or redness Decreased use of affected area

Muscles: ______ same but increased in ________ and __________

number , size, circumference

Risk factors for fractures

obesity poor nutrition developmental characteristics, ordinary play activities, and recreation that place children at risk for injury

Traction

pulling force to a body part reduce a fracture maintains alignment provides muscle rest

Plastic deformation (bend) fracture

the bone is bent no more than 45 degrees

Comminuted fracture

the fracture includes small fragments of bone that lie in the surrounding tissue

Open or compound fracture

the fracture occurs with an open wound and bone protruding

Closed or simple fracture

the fracture occurs without a break in the skin

A nurse is caring for a child who has a fracture. Which of the following are manifestation of a fracture? (select all that apply) A. Crepitus B. Edema C. Pain D. Fever E. Ecchymosis

A. B. C. E.

A nurse is assessing a client who is experiencing complications due to immobility. Which of the following findings should the nurse expect? Select all that Apply A. Contractors of the extremities B. Polyuria C. Diarrhea D. Crackles in the lungs E. Pressure ulcers

A. D. E.

A nurse is reviewing the laboratory findings for a client who developed fat embolism syndrome (FES) following a fracture. Which of the following lab findings should the nurse expect? A. decreased serum calcium levels B. decreased level of serum lipids C. decreased ESR D. Increased platelet count

A. decreased serum calcium levels

What should you avoid when positioning?

Avoid: - crossing legs - sitting for along period of time - wearing restrictive clothing on lower extremities - putting pillows behind the knees - massaging the legs

A nurse is caring for a client who has fractures the the symphysis pubis and pelvis. The nurse should monitor the client for which of the following findings of a common complications of a pelvic fracture? A. Diarrhea B. Hematuria C. Increased thirst D. Impaired taste

B. Hematuria

A nurse is planning care for a newly admitted client who has skeletal traction for a fractured femur. Which of the following interventions should the nurse include in the plan? A. Instruct the client to flex and extend the ankle twice daily B. Monitor the client's pedal pulses every hour C. Remove the weights every four hours D. Evaluate pressure points daily

B. Monitor the client's pedal pulses every hour

A nurse is caring for a client whose right leg is in Buck's traction. Which of the following interventions should the nurse implement to promote the client's mobility? A. Log rolling every 2 hours B. Isometric exercises of both legs C. Active range-of-motion exercises of the left leg D. Passive range of motion to the right leg

C. Active range-of-motion exercises of the left leg

A nurse is caring for a client who has a fractured tibia as a result of a fall. The client x-ray shows that the bone is splinted into several pieces around the shaft. The nurse should identify that the client has which of the following types of fractures? A. Impacted B. Transverse C. Comminuted D. Oblique

C. Comminuted

A nurse is caring for client who has impaired mobility. Which of the following support devices should the nurse plan to use to prevent the client from developing plantar flexion contractors? A. Trochanter roll B. Sheepskin heel pad C. Abduction pillow D. Footboard

C. Footboard- prevents foot drop

A nurse is providing discharge teaching to a client who has a fracture of the right tibia and a fiberglass cast. Which of the following instructions should the nurse include in the teaching? A. Use a blow dryer on a moderate heat setting to dry the cast after showering B. Use a cotton swab to relieve itching under the cast C. Report any worsening or unrelieved pain D. Avoid moving the affected leg

C. Report any worsening or unrelieved pain

A nurse is developing a plan of care for a client who has a spinal fracture and complete spinal cord transection at the level of C5. Which of the following rehabilitation goals should the nurse add to the client's plan of care? A. ability to achieve independent transfer from bed to wheelchair B. Independent control of bowel and bladder function C. Use of a wheelchair with a chin or mouth stick D. Ability to self-feed with the use of adaptive equipment

D. Ability to self-feed with the use of adaptive equipment

A nurse is caring for a child who is in a plaster spica cast. Which of the following actions should the nurse take? A. Use a heat lamp to facilitate drying B. Avoid turning the child until the cast is dry C. Assist the client with crutch walking after the cast is dry D. Apply moleskin to the edges of the cast.

D. Apply moleskin to the edges of the cast

Care of family members includes

Emotional support Care coordination Education Care Early signs of complications- contracture, osteomyelitis

Should you use a hair dryer to dry plaster cast?

NO!

Compete fracture

bone fragments are separated

Incomplete fracture

bone fragments are still attached

Buckle (torus) fracture

compression of the bone resulting in a bulge or raised area at the fracture site

Green stick fracture

incomplete fracture of the bone

Stress fracture

small fractures/cracks in the bone due to repeated muscle contractions

Care of traction system: Suspended without interference

1. never remove weights from skeletal traction 2. Skin traction: apply manual pressure before removing weights for skin care 3. weights must hang free. never on the floor 4. Keep ropes clear- nothing on them 5. reposition PRN to maintain traction 6. Assess skin frequently 7. Asess pins frequently 8. Assess neurovascular status frequently 9. If NV changes found, take immediate action 10. interventions to decrease complications of immobility

Care of client with casts: Two ways to immobilize joint and/or bone

1. perform frequent neurovacscular assessment (capillary refill, color, warmth, movement, sensation) 2. elevate limb to prevent compartment syndrome

What are two things that increase the risk of complications in immobility?

1. the degree of immobility 2. the duration of immobility

A nurse is assessing a client who sustained a basal skull fracture and notes a thin stream of clear drainage coming from the client's right nostril. Which of the following actions should the nurse do first? A. Test the drainage for glucose B. Suction the nostril C. Notify the physician D. Ask the client to blow his nose

A. Test the drainage for glucose - CSF will test positive for glucose

A nurse is assessing a child who has LCP disease. Which of the following findings should the nurse expect? (Select all that apply) A. Longer affected leg B. Hip stiffness C. Intense pain D. limited ROM E. Limp with walking

B. D. E.

A nurse witnesses a motor vehicle crash and finds a client who is not breathing. The nurse suspects the client has a cervical vertebrae fracture. Which of the following nursing actions should you take first? A. Place the client in a rigid cervical collar B. Open the client's airway using a jaw-thrust maneuver C. Evaluate the client for other injuries D. Complete a neurological check of the client.

B. Open the client's airway using a jaw-thrust maneuver - to protect the clients cervical spine

A nurse is assessing a preschool-age child for developmental dysplasia of the hip. Which of the following assessments should the nurse include? A. Barlow test B. Trendelenburg Sign C. Manipulation of foot and ankle D. Ortolani test

B. Trendelenburg sign

A nurse is caring for a client who has an unrepaired femur fracture to the mid shaft. Which of the following techniques should the nurse use when performing an assessment of the client's neurovascular status? A. Measure the circumference of the thigh B. Palpate the femoral pulse C. Monitor the client's calf for edema D. Instruct the client to wiggle his toes

D. Instruct the client to wiggle his toes

A nurse is caring for a toddler who has a fractured right femur and is in Bryant traction. When determining that the traction is appropriately assembled, the nurse should observe which of the following? A. Skin straps maintain the leg in an extended position B. Weights are attached to a pin that is inserted in the femur C. A padded sling is under the knee of the affected leg D. The buttocks is elevated slightly off the bed

D. The buttocks is elevated slightly off the bed

F.R.A.C.T.U.R.E. stands for what?

Firm mattress/foot drop ROM for unaffected extremities Alignment Complications Trapeze Urinary infection Respiratory complications Evaluate circulatory impairments

What is mobility?

Freedom for independent purposeful movement

What two systems need to be functional in order to have mobility?

nervous and muscoskeletal systems

When would you use a brace?

For longer periods of time than splints

Transverse fracture

break is straight across the bone

What should you encourage when positioning ?

- Do ankle pumps ! Point the toes toward the head and then away from the head - foot circles. rotate the feet in circles at the ankles - knee flexion = flex and extend the legs

Assessment of fracture includes

- mobility - ROM - exercise status - activity intolerance - body alignment with sitting, standing, walking

A nurse is caring for a client who has a new short-leg cast on his lower leg to treat an ankle fracture. Which of the following findings requires immediate notification to the provider? A. Moderate level of pain B. Dependent edema distal to the cast C. Inability to flex toes of the casted foot D. Ecchymosis of the distal foot

C. Inability to flex toes of the casted foot

Complicated fracture

the fracture results in injury to other organs and tissues

Skin traction

children, short-period below the knee, 2.3 kg, assess the skin pulling force is applied by weights using tape and straps applied to the skin along with boots and/or cuffs weights are attached by a rope to the extremity Buck, Russell, Bryant

Treatment of Fractures (3 ways)

traction casts braces

Purpose of traction

1. regain normal length and alignment 2. reduce and immobilize a fractured bone 3. eliminate muscle spasms/pressure on nerves 4. Prevent deformity/contractures

A nurse is caring for a client who has returned from the surgical site following surgery for a fractured mandible. The client had inter-maxillary fixation to repair and stabilize the fracture. Which of the following actions is the priority for the nurse to take? A. Prevent aspiration B. Ensure adequate nutrition C. Promote oral hygiene D. Relieve the client's pain

A. Prevent aspiration

A Nurse is caring for an older adult client who had a femoral head fracture 24 hr ago and is in skin traction. The client reports shortness of breath and dyspnea. The nurse should suspect that the client has developed which of the following complications? A. Pneumonia B. Fat Embolism C. Pneumothorax D. Airway obstruction

B. Fat Embolism- occurs 12-48 hours after a fracture, causes dyspnea, respiratory distress, alterations in mental status, tachycardia. Older adults with hip fracture are at greater risk.

Oblique fracture

Break is diagonal across the bone

Spiral fracture

Break spirals around the bone

A Client who has a femur fracture states, "I can't stay in bed any longer. I need to get home so I can take care of my family." The nurse responds, "You have talked to your family several times. Can you tell me more about your specific concerns?" Which type of therapeutic communication response is the nurse using? A. Summarizing B. Empathizing C. Focusing D. Clarifying

C. Focusing

A nurse is caring for a client who is post operative following a reduction and internal fixation of a fractured femur. Which of the following actions is most important for the nurse to complete in the post operative period? A. Medicate the client for pain B. Instruct the client to use crutches C. Perform neurovascular check of the extremities D. Direct the client to perform exercises of the ankles and toes

C. Perform neurovascular check of the extremities

How should you handle a wet cast?

In the palm of your hand- NOT with your fingers Keep edges clean, dry, smooth Manage itching Teach cast care

What is immobility?

Inability to move freely

T.R.A.C.T.I.O.N. stands for?

Temperature Ropes freely Alignment Circulation of 5 P's Type, location fracture Increase fluid intake Overhead trapeze No weights on bed, floor

How long does it take for a plaster cast to dry?

up to 2 days

Halo traction (Cervical traction)

halo-type bar that encircles the head screws are inserted into the outer skull attached to either bed traction or rods secured to a vest worn by client

A nurse is caring for a child who is suspected of having Legg-Calve-Perthes disease. The nurse should prepare the child for which of the following diagnostic procedures? A. Bone biopsy B. Genetic testing C. MRI D. Radiograph

D

What are 6 complications of immobility?

1. compartment syndrome 2. infection 3. DVT 4. pulmonary embolism 5. skin breakdown 6. Psychosocial (Socialization, sleep pattern)

A nurse is developing a plan of care for a client who has a fracture to achieve the outcome of functional healing. To assist in meeting this goal, which of the following nursing interventions is the highest priority? A. Maintain immobilization and alignment B. Provide optimal nutrition and hydration C. Promote independence in activities of daily living D. Provide relief from pain and discomfort

A. Maintain immobilization and alignment

A nurse is caring for an adolescent client who has a newly applied fiberglass cast for a fractured tibia. Which of the following is the priority action for the nurse to take? A. Perform a neuromuscular assessment B. Explain the discharge instructions to the clients and parents C. Provide reassurance to the clients and patients D. Apply an ice pack to the casted leg

A. Perform a neuromuscular assessment

A nurse is caring for a client who has emphysema and has difficulty with mobility. The client receives home health care and spends most of the day in a reclining chair. Which of the following physiological responses to prolonged immobility should the nurse suspect? A. increased insulin production B. decreased RBC production C. decreased sodium excretion D. Increased calcium excretion

D. Increased calcium excretion

Physeal (growth plate) fracture

Injury to the end of the long bone on the growth plate