Question

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8. How can nurses utilize clinical judgment to provide emergency care for the patient with an extremity fracture?
9. How can nurses Interpret findings from a focused neurovascular assessment for patients experiencing fractures or amputations? Give 3 examples
10. Delineate 5 safe, evidence-based nursing care needed to maintain casts for patients with fractures.
11. What can be the nursing care needed to maintain traction and external fixation for patients with fractures?
12. Develop an evidence-based postoperative plan of care for a patient after hip fracture repair.
13. How can nurses outline emergency care for people who experience a traumatic amputation.
14. How can nurse's differentiate the patient-centered care needed to manage complex regional pain syndrome and phantom limb pain.

Answer 1

1. Prevent infection
   • Cover any breaks in the skin with clean or sterile dressing.
2. Provide care during client transfer.
   • Immobilize a fractured extremity with splint in the position of the deformity before moving the client; avoid strengthening the injured body part if a joint is involved.
   • Support the affected body part above and below fracture site when moving the client.
3. Provide client and family teaching.
   • Explain prescribed activity restrictions and necessary lifestyle modification because of impaired mobility.
   • Teach the proper use of assistive devices, as indicated.
4. Administer prescribed medications, which may include opioid or nonopioid analgesics and prophylactic antibiotics for an open fracture.
5. Prevent and manage potential complications.
   • Observe for symptoms of life-threatening fat embolus, which may include personality change, restlessness, dyspnea, crackles, white sputum, and petechaie over the chest and buccal membranes. Assist with respiratory support, which must be instituted early.
   • Observe for symptoms of compartment syndrome, which include deep, unrelenting pain; hard edematous muscle; and decreased tissue perfusion with impaired neurovascular assessment findings.
   • Monitor closely for signs and symptoms of other complications.
6. Patient education regarding different factors that affect fracture healing
7. Factors that enhance fracture healing
   • Immobilization of fracture fragments
   • Maximum bone fragment contact
   • Sufficient blood supply
   • Proper nutrition
   • Exercise: weight bearing for long bones
   • Hormones: growth hormone, thyroid, calcitonin, vitamin D, anabolic steroids
8. Factors that inhibit fracture healing
   • Extensive local trauma
   • Bone loss
   • Inadequate immobilization
   • Space or tissue between bone fragments
   • Infection
   • Local malignancy
   • Metabolic bone disease (Paget’s disease)
   • Irradiated bone (radiation necrosis)
   • Avascular necrosis
   • Intra-articular fracture (synovial fluid contains fibrolysins, which lyse the initial clot and retard clot formation)
   • Age (elderly persons heal more slowly)
   • Corticosteroids (inhibit the repair rate)

Encourage him to perform prescribes exercises.	To prevent stump trauma.
Provide stump care on a routine basis: inspect the area, cleanse and dry thoroughly, and rewrap stump with an elastic bandage or air splint, or apply a stump shrinker (heavy stockinette sock), for “delayed” prosthesis.	Provides an opportunity to evaluate healing and note complications (unless covered by immediate prosthesis). Wrapping stump controls edema and helps form stump into a conical shape to facilitate the fitting of the prosthesis.
Measure circumference periodically	Measurement is done to estimate shrinkage to ensure proper fit of sock and prosthesis.
Rewrap stump immediately with an elastic bandage, elevate if “immediate or early” cast is accidentally dislodged. Prepare for reapplication of the cast.	Edema will occur rapidly, and rehabilitation can be delayed
Assist with specified ROM exercises for both the affected and unaffected limbs beginning early in the postoperative stage.	Prevents contracture deformities, which can develop rapidly and could delay prosthesis usage.
Encourage active and isometric exercises for the upper torso and unaffected limbs.	Increases muscle strength to facilitate transfers and ambulation and promote mobility and more normal lifestyle.
Maintain knee extension.	To prevent hamstring muscle contractures.
Provide trochanter rolls as indicated.	Prevents external rotation of lower-limb stump
Instruct patient to lie in the prone position as tolerated at least twice a day with a pillow under the abdomen and lower-extremity stump.	Strengthens extensor muscles and prevents flexion contracture of the hip, which can begin to develop within 24 hr of sustained malpositioning.
Caution against keeping the pillow under a lower-extremity stump or allowing BKA limb to hang dependently over the side of bed or chair.	Use of pillows can cause permanent flexion contracture of the hip; a dependent position of stump impairs venous return and may increase edema formation.
Demonstrate and assist with transfer techniques and use of mobility aids like trapeze, crutches, or walker.	Facilitates self-care and patient’s independence. Proper transfer techniques prevent shearing abrasions and dermal injury related to “scooting.”
Assist with ambulation.	Reduces the potential for injury. Ambulation after lower-limb amputation depends on the timing of prosthesis placement.
Instruct patient in stump-conditioning exercises.	Hardens the stump by toughening the skin and altering feedback of resected nerves to facilitate the use of the prosthesis.
Refer to the rehabilitation team.	Provides for the creation of exercise and activity program to meet individual needs and strengths, and identifies mobility functional aids to promote independence. Early use of a temporary prosthesis promotes activity and enhances general well-being and positive outlook. Note: Vocational counseling and retraining also may be indicated.
Provide foam or flotation mattress.	Reduces pressure on skin and tissues that can impair circulation, potentiating the risk of tissue ischemia and breakdown.