NU272 HESI Case Study: Compound Fracture (Preschooler)
Q&A
Meet the Client - -A four-year-old is EMS documentation indicates the presence of
brought to the emergency department (ED) by crepitus.
ambulance following an automobile accident that
occurred while the child was headed to the park
with her sister, who is also her babysitter. The How is the presence of crepitus related to this
child sustained a compound fracture of the femur fracture determined? - -Listen for a
femur, which requires surgical reduction, grating sound when the affected area is moved.
followed by skeletal traction. - Listen for a grating sound when the affected
area is moved.
Ethical-Legal Issues: Consent for Care - -
The child's teenage sister accompanies her to The child has an open fracture. What is a priority
the hospital. She reports that their parents are nursing intervention? - -Cover the wound
both at work. loosely with a sterile dressing.
- The area is covered with a sterile dressing to
prevent contamination of organisms from the
If a staff member is unable to reach the child's skin.
parents, what guidelines will determine the staff's
ability to provide needed care? - -
Emergency care may be provided after a As the nurse assumes care for the client, which
reasonable attempt to reach the parents has actions are most important for the nurse take?
been made. (Select all that apply. One, some, or all options
- Rationale: Exceptions to requiring parental may be correct.) - -Immobilize the injury.
consent before treating children can occur in Assess neurovascular status every hour.
emergency situations. Most healthcare facilities Elevate the affected extremity.
will provide emergency, life-saving medical care
to a minor if unable to reach parents after a
reasonable attempt has been made. The nurse identifies that a priority nursing
diagnosis is injury risk for peripheral
neurovascular compromise. Which lab value
Since the child's parents are divorced, which would be of most concern for the nurse? - -
parent should the nurse try to contact first? - Hemoglobin of 9.5 g/dl (95 g/L).
-The parent who has been assigned legal - This is a low value. A low hemoglobin will not
custody by the court. provide sufficient oxygen for tissue repair.
- The parent who has been assigned legal
custody has the right to give consent.
The nurse assesses for pain. The child points to
the FACES pain scale rating indicating a high
Clinical Manifestations - -The child's level of pain, but she is lying still and seems
parents are reached and they are both on their vague about the location of the pain when asked
way to the hospital. They both give telephone by the nurse. A prescription for IV morphine
consent for her emergency care. The nurse every 4 hours is available. The child is due a
performs an assessment of the affected leg and dose of morphine, and the transport team is en
notes leg deformity, swelling, and ecchymosis. route to escort her to surgery. - --
1/6
, NU272 HESI Case Study: Compound Fracture (Preschooler)
Q&A
pins. This is critical to the success of the traction
and the first priority when the client arrives to the
Based on this assessment, what is the best unit.
nursing intervention? - -Administer another
dose of morphine immediately.
- Lack of activity may indicate pain in the Skeletal traction applies the pull directly on the
preschooler, an age at which a child is normallyskeletal structures. The nurse should immediately
always on the go. Preschoolers may not be able assess the pull of the traction on the pins. This is
to localize pain clearly. The child has clearly critical to the success of the traction and the first
identified the degree of pain on the FACES scalepriority when the client arrives to the unit. -
and should be medicated accordingly. -Assess toes for capillary refill and edema.
- Decreased perfusion to the foot or increased
edema could lead to a potentially life-threatening
The prescribed dose of morphine reads, complication.
"Administer morphine sulfate 0.2 mg/kg IV every Ensure that the amount of weight remains
3 to 4 hours." The client weighs 33 pounds. The consistent.
tubex of morphine contains 5 mg/mL. How many - The nurse should assess the amount of the
mL of medication should the nurse administer? weight regularly to ensure that no changes have
(Enter numeric value only. If rounding is been made to the prescribed amount of traction.
necessary, round to the nearest tenth.) - - Well-meaning family and friends or older children
0.6 mL may remove weights.
First, convert pounds to kilograms: 33 lbs/2.2 kg
= 15 kg The nurse recognizes that the client is at risk for
Next, determine the dose per kilogram: 15 kg × the onset of osteomyelitis. Which nursing
0.2 mg/kg = 3 mg intervention should be included in the plan of
care to prevent this complication? - -
Last, calculate the mL needed: 3 mg/5 mg × 1 Cleanse the pin site with half-strength hydrogen
mL = 0.6 mL peroxide.
- Persons with skeletal traction are at high risk for
osteomyelitis because of the potential for direct
Traction - -The client goes to surgery, entry of microorganisms at the pin site. Cleansing
where reduction and fixation is performed. the pin site with half-strength hydrogen peroxide
Following surgery, the client is transferred to the may be initiated to reduce this risk.
orthopedic nursing unit where she will be in
skeletal traction for several weeks.
The nurse monitors the client's lab values. Which
change in serum lab values would most likely
Upon arrival to the unit, which nursing indicate the onset of osteomyelitis? - -
assessment has the greatest priority? - - Increased erythrocyte sedimentation rate (ESR).
The pull of the traction on the pins. - The ESR will increase during an inflammatory
- Skeletal traction applies the pull directly on the process, which would be present in acute
skeletal structures. The nurse should osteomyelitis, an infection of the bone.
immediately assess the pull of the traction on the
2/6
Q&A
Meet the Client - -A four-year-old is EMS documentation indicates the presence of
brought to the emergency department (ED) by crepitus.
ambulance following an automobile accident that
occurred while the child was headed to the park
with her sister, who is also her babysitter. The How is the presence of crepitus related to this
child sustained a compound fracture of the femur fracture determined? - -Listen for a
femur, which requires surgical reduction, grating sound when the affected area is moved.
followed by skeletal traction. - Listen for a grating sound when the affected
area is moved.
Ethical-Legal Issues: Consent for Care - -
The child's teenage sister accompanies her to The child has an open fracture. What is a priority
the hospital. She reports that their parents are nursing intervention? - -Cover the wound
both at work. loosely with a sterile dressing.
- The area is covered with a sterile dressing to
prevent contamination of organisms from the
If a staff member is unable to reach the child's skin.
parents, what guidelines will determine the staff's
ability to provide needed care? - -
Emergency care may be provided after a As the nurse assumes care for the client, which
reasonable attempt to reach the parents has actions are most important for the nurse take?
been made. (Select all that apply. One, some, or all options
- Rationale: Exceptions to requiring parental may be correct.) - -Immobilize the injury.
consent before treating children can occur in Assess neurovascular status every hour.
emergency situations. Most healthcare facilities Elevate the affected extremity.
will provide emergency, life-saving medical care
to a minor if unable to reach parents after a
reasonable attempt has been made. The nurse identifies that a priority nursing
diagnosis is injury risk for peripheral
neurovascular compromise. Which lab value
Since the child's parents are divorced, which would be of most concern for the nurse? - -
parent should the nurse try to contact first? - Hemoglobin of 9.5 g/dl (95 g/L).
-The parent who has been assigned legal - This is a low value. A low hemoglobin will not
custody by the court. provide sufficient oxygen for tissue repair.
- The parent who has been assigned legal
custody has the right to give consent.
The nurse assesses for pain. The child points to
the FACES pain scale rating indicating a high
Clinical Manifestations - -The child's level of pain, but she is lying still and seems
parents are reached and they are both on their vague about the location of the pain when asked
way to the hospital. They both give telephone by the nurse. A prescription for IV morphine
consent for her emergency care. The nurse every 4 hours is available. The child is due a
performs an assessment of the affected leg and dose of morphine, and the transport team is en
notes leg deformity, swelling, and ecchymosis. route to escort her to surgery. - --
1/6
, NU272 HESI Case Study: Compound Fracture (Preschooler)
Q&A
pins. This is critical to the success of the traction
and the first priority when the client arrives to the
Based on this assessment, what is the best unit.
nursing intervention? - -Administer another
dose of morphine immediately.
- Lack of activity may indicate pain in the Skeletal traction applies the pull directly on the
preschooler, an age at which a child is normallyskeletal structures. The nurse should immediately
always on the go. Preschoolers may not be able assess the pull of the traction on the pins. This is
to localize pain clearly. The child has clearly critical to the success of the traction and the first
identified the degree of pain on the FACES scalepriority when the client arrives to the unit. -
and should be medicated accordingly. -Assess toes for capillary refill and edema.
- Decreased perfusion to the foot or increased
edema could lead to a potentially life-threatening
The prescribed dose of morphine reads, complication.
"Administer morphine sulfate 0.2 mg/kg IV every Ensure that the amount of weight remains
3 to 4 hours." The client weighs 33 pounds. The consistent.
tubex of morphine contains 5 mg/mL. How many - The nurse should assess the amount of the
mL of medication should the nurse administer? weight regularly to ensure that no changes have
(Enter numeric value only. If rounding is been made to the prescribed amount of traction.
necessary, round to the nearest tenth.) - - Well-meaning family and friends or older children
0.6 mL may remove weights.
First, convert pounds to kilograms: 33 lbs/2.2 kg
= 15 kg The nurse recognizes that the client is at risk for
Next, determine the dose per kilogram: 15 kg × the onset of osteomyelitis. Which nursing
0.2 mg/kg = 3 mg intervention should be included in the plan of
care to prevent this complication? - -
Last, calculate the mL needed: 3 mg/5 mg × 1 Cleanse the pin site with half-strength hydrogen
mL = 0.6 mL peroxide.
- Persons with skeletal traction are at high risk for
osteomyelitis because of the potential for direct
Traction - -The client goes to surgery, entry of microorganisms at the pin site. Cleansing
where reduction and fixation is performed. the pin site with half-strength hydrogen peroxide
Following surgery, the client is transferred to the may be initiated to reduce this risk.
orthopedic nursing unit where she will be in
skeletal traction for several weeks.
The nurse monitors the client's lab values. Which
change in serum lab values would most likely
Upon arrival to the unit, which nursing indicate the onset of osteomyelitis? - -
assessment has the greatest priority? - - Increased erythrocyte sedimentation rate (ESR).
The pull of the traction on the pins. - The ESR will increase during an inflammatory
- Skeletal traction applies the pull directly on the process, which would be present in acute
skeletal structures. The nurse should osteomyelitis, an infection of the bone.
immediately assess the pull of the traction on the
2/6
