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An older adult patient has fallen in her home and is brought to the emergency department by ambulance with a suspected fractured hip. X-rays confirm a fracture of the left femoral neck. When planning assessments during the patients presurgical care, the nurse should be aware of the patients heightened risk of what complication?
- A. Osteomyelitis
- B. Avascular necrosis
- C. Phantom pain
- D. Septicemia
Correct Answer: B
Rationale: Fractures of the neck of the femur may damage the vascular system that supplies blood to the head and the neck of the femur, and the bone may become ischemic. For this reason, AVN is common in patients with femoral neck fractures. Infections are not immediate complications and phantom pain applies to patients with amputations, not hip fractures.
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A patient has sustained a long bone fracture and the nurse is preparing the patients care plan. Which of the following should the nurse include in the care plan?
- A. Administer vitamin D and calcium supplements as ordered.
- B. Monitor temperature and pulses of the affected extremity.
- C. Perform passive range of motion exercises as tolerated.
- D. Administer corticosteroids as ordered.
Correct Answer: B
Rationale: The nurse should include monitoring for sufficient blood supply by assessing the color, temperature, and pulses of the affected extremity. Weight-bearing exercises are encouraged, but passive ROM exercises have the potential to cause pain and inhibit healing. Corticosteroids, vitamin D, and calcium are not normally administered.
A patient is admitted to the orthopedic unit with a fractured femur after a motorcycle accident. The patient has been placed in traction until his femur can be rodded in surgery. For what early complications should the nurse monitor this patient? Select all that apply.
- A. Systemic infection
- B. Complex regional pain syndrome
- C. Deep vein thrombosis
- D. Compartment syndrome
- E. Fat embolism
Correct Answer: C,D,E
Rationale: Early complications include shock, fat embolism, compartment syndrome, and venous thromboemboli (deep vein thrombosis [DVT], pulmonary embolism [PE]). Infection and CRPS are later complications of fractures.
Elevate the arm above the shoulder 3 to 4 times daily.
- A. Avoid moving the elbow, wrist, and fingers until bone remodeling is complete.
- B. Engage in active range of motion using the affected arm.
- C. Use the arm for light activities within the range of motion.
Correct Answer: D
Rationale: A patient with a clavicle fracture may use a sling to support the arm and relieve the pain. The patient may be permitted to use the arm for light activities within the range of comfort. The patient should not elevate the arm above the shoulder level until the ends of the bones have united, but the nurse should encourage the patient to exercise the elbow, wrist, and fingers.
A patient has presented to the emergency department with an injury to the wrist. The patient is diagnosed with a third-degree strain. Why would the physician order an x-ray of the wrist?
- A. Nerve damage is associated with third-degree strains.
- B. Compartment syndrome is associated with third-degree strains.
- C. Avulsion fractures are associated with third-degree strains.
- D. Greenstick fractures are associated with third-degree strains.
Correct Answer: C
Rationale: An x-ray should be obtained to rule out bone injury, because an avulsion fracture (in which a bone fragment is pulled away from the bone by a tendon) may be associated with a third-degree strain. Nerve damage, compartment syndrome, and greenstick fractures are not associated with third-degree strains.
A nurse is planning the care of a patient with osteomyelitis that resulted from a diabetic foot ulcer. The patient requires a transmetatarsal amputation. When planning the patients postoperative care, which of the following nursing diagnoses should the nurse most likely include in the plan of care?
- A. Ineffective Thermoregulation
- B. Risk-Prone Health Behavior
- C. Disturbed Body Image
- D. Deficient Diversion Activity
Correct Answer: C
Rationale: Amputations present a serious threat to any patients body image. None of the other listed diagnoses is specifically associated with amputation.