Question

Todd Lawrence is an 8-year-old boy who has been hospitalized for treatment with skeletal traction after sustaining a compound fracture of his left leg 8 days ago. During the night he developed a fever of 102.6°F (39.2°C). This morning his temperature is 101.8°F (38.8°C). The pin sites are red and inflamed and the upper leg area is tender to the touch. Todd is complaining of pain, rating it a 9 out of a possible 10 on a numerical pain rating scale. Laboratory tests reveal leukocytosis, an increased erythrocyte sedimentation rate (ESR) and positive blood cultures.

1. What data will you report to the provider? Provide rationales.
2. What is causing these symptoms in this patient?
3. What treatment would the nurse expect to be ordered?
4. Provide three interventions for the nurse to promote Todd’s growth and development while he is immobilized in traction and receiving prescribed treatment.

Answer 1

Skeletal traction is used for compound fractures which involves surgery that includes insertion of pins, wires and screws . Then weight is applied on bone through pulleys, weight for the purpose of bone alignment.

DATA TO BE REPORTED TO THE PROVIDER :

• Fever of 102.6 degree Farenheit at night and 101.8 degree F in the morning.
• The pin sites of the traction is red and the left leg is tender .
• Pain scale 9 out of 10.
• Elevated levels of WBC and ESR.
• Positive blood culture.

Rationale :

All the symptoms of fever, redness and tenderness are signs of infection .

Elevated levels of WBC , ESR and positive blood culture confirms the infection in this child. Therefore, these are important data that has to be reported to the provider.

CAUSE OF THE SYMPTOMS :

Infection with bacteria at the site of traction is the cause for the symptoms in this patient as evidence by redness, tenderness and fever. Laboratory reports confirming the positive culture indicates bacterial infection.

TREATMENT THAT THE NURSE EXPECT TO BE ORDERED :

Antibiotics is a treatment of choice for this patient. Since culture test is done, antibiotic is chosen according to the level of sensitivity.

NURSING INTERVENTIONS :

• Reposition the patient according to the instructions to prevent skin integrity loss.
• Provide proper nutrition.
• Manage pain with analgesics.
• Administer antibiotics at proper intervals.
• Assess for signs and symptoms of compartment syndrome .
• Perform neurological assessment atleast every 4 to 6 hourly based on the condition of the child.
• Provide story books or toys as per the interest of the child.

Thank you.