NU 272 HESI Case Study: Compound Fracture (Preschooler) - Q & A

NU 272 HESI Case Study: Compound Fracture (Preschooler) - Q & A Meet the Client A four-year-old is brought to the emergency department (ED) by ambulance following an automobile accident that occurred while the child w ...

NU 272 HESI Case Study: Compound Fracture (Preschooler) - Q & A Meet the Client A four-year-old is brought to the emergency department (ED) by ambulance following an automobile accident that occurred while the child was headed to the park with her sister, who is also her babysitter. The child sustained a compound fracture of the femur, which requires surgical reduction, followed by skeletal traction. Ethical-Legal Issues: Consent for Care The child's teenage sister accompanies her to the hospital. She reports that their parents are both at work. If a staff member is unable to reach the child's parents, what guidelines will determine the staff's ability to provide needed care? Emergency care may be provided after a reasonable attempt to reach the parents has been made. - Rationale: Exceptions to requiring parental consent before treating children can occur in emergency situations. 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. Since the child's parents are divorced, which parent should the nurse try to contact first? The parent who has been assigned legal custody by the court. - The parent who has been assigned legal custody has the right to give consent. Clinical Manifestations The child's parents are reached and they are both on their way to the hospital. They both give telephone consent for her emergency care. The nurse performs an assessment of the affected leg and notes leg deformity, swelling, and ecchymosis. EMS documentation indicates the presence of crepitus. How is the presence of crepitus related to this femur fracture determined? Listen for a grating sound when the affected area is moved. - Listen for a grating sound when the affected area is moved. The child has an open fracture. What is a priority nursing intervention? Cover the wound loosely with a sterile dressing. - The area is covered with a sterile dressing to prevent contamination of organisms from the skin. As the nurse assumes care for the client, which actions are most important for the nurse take? (Select all that apply. One, some, or all options may be correct.) Immobilize the injury. Assess neurovascular status every hour. Elevate the affected extremity. The nurse identifies that a priority nursing diagnosis is injury risk for peripheral neurovascular compromise. Which lab value would be of most concern for the nurse? Hemoglobin of 9.5 g/dl (95 g/L). - This is a low value. A low hemoglobin will not provide sufficient oxygen for tissue repair. The nurse assesses for pain. The child points to the FACES pain scale rating indicating a high level of pain, but she is lying still and seems vague about the location of the pain when asked by the nurse. A prescription for IV morphine every 4 hours is available. The child is due a dose of morphine, and the transport team is en route to escort her to surgery. - Based on this assessment, what is the best nursing intervention? Administer another 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. The prescribed dose of morphine reads, "Administer morphine sulfate 0.2 mg/kg IV every 3 to 4 hours." The client 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 Traction The client goes to surgery, where reduction and fixation is performed. Following surgery, the client is transferred to the orthopedic nursing unit where she will be in skeletal traction for several weeks. Upon arrival to the unit, which nursing assessment has the greatest priority? The pull of the traction on the pins. - Skeletal traction applies the pull directly on the skeletal structures. The nurse should immediately assess the pull of the traction on the pins. This is critical to the success of the traction and the first priority when the client arrives to the unit. Skeletal traction applies the pull directly on the skeletal structures. The nurse should immediately assess the pull of the traction on the pins. This is critical to the success of the traction and the first priority when the client arrives to the unit. 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. The nurse recognizes that the client is at risk for the onset of osteomyelitis. Which nursing intervention should be included in the plan of care to prevent this complication? Cleanse 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 monitors the client's lab values. Which change in serum lab values would most likely indicate the onset of osteomyelitis? 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 understands that which signs and symptoms are indicative of osteomyelitis? (Select all that apply. One, some, or all options may be correct.) Resistance to movement. - The client's pain will be constant but will increase with movement. Edema. - The client will have noticeable edema. Irritability. - The client will be uncomfortable and irritable. A Complication Occurs The child 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, the child is crying and agitated. She points to her foot and cries, "There, there, it hurts there." Which nursing action has the highest priority? Assess the appearance of the client's foot. - Pain distal to the site may be the first sign of a serious complication needing immediate attention.