Case Study Question 5 The nurse is caring for a 23-year-old client admitted to the medical-surgical unit following surgery for a compound fracture of the right tibia and fibula. Nurses’ Notes   0830: Admitted from Post Anesthesia Care Unit following surgery to repair an open fracture with internal fixation with application of a fiberglass cast. R lower extremity elevated. IV infusing as ordered. Client medicated for pain prior to transport. Vital Signs BP 110/72, HR 90, RR 29, Temp 99F (37.2C). Unable to assess pedal pulse on R lower extremity due to cast. Motion of toes limited by pain and cast. Will monitor for signs of acute complications. 0930: Client resting at this time. Will continue to monitor. 1100: Client reporting pain 10/10 in R lower extremity. Updated neurovascular checks. 1115: Vital Signs BP 82/44, HR 112, RR 22, Temp 99F (37.2C). Provider notified of client changes.   Neurovascular Flowsheet   Right Lower Extremity Pain Score  0-10/10 Motion F = full L = limited N = none Sensation F = full P = partial N = none Capillary Refill B = brisk < 3 seconds S = sluggish > 3 seconds Color N = normal P = pale D = dusky C = cyanotic Warmth H = hot W = warm T = tepid C = cold   Pulse 4+ bounding 3+ increased 2+ normal 1+ weak 0 absent UTA unable to assess     Time:  0830 3/10 L F B N W UTA 0930 3/10 L F B N W UTA 1030 4/10 L F B N W UTA 1100 10/10 N N S P T UTA 1115 10/10 N N S P T UTA 1130 10/10 N N S D T UTA 1145 10/10 L N S P T 1+ 1245 3/10 L N S N C 0 Orders   0830: Admission Orders: Bedrest with right leg elevated on 2 pillows May use bedside commode with assistance, no weight bearing to R lower extremity Advance to Regular diet as tolerated VS and neurovascular checks every hour for 4 hours then every 4 hours. 1130: STAT Orders: Strict bedrest, maintain R leg at level of the heart Assist client to use bedpan; Monitor intake and output Keep client nothing by mouth until cleared Document height and weight Order cast cutting tray and compartment pressure measuring device to bedside Check Neurovascular status and vital signs every 15 minutes for 2 hours  IV fluid bolus of 500 mL of normal saline over 30 minutes for blood pressure

A client goes to the physician’s office for an annual check-up and the nurse provides client teaching concerning osteoporosis screening. Which is the best teaching for a client regarding osteoporosis?

What are the priority nursing interventions in the care of a client who is a two day post op total hip replacement?  Select all that apply.

After receiving change of shift report which patient will the nurse assess first?

The nurse is teaching the client to administer enoxaparin following a total knee replacement. The nurse will instruct the client in which of the following? Select all that apply. 

An older adult client experienced a fall and required treatment for a fractured hip. Which of the following are contributory factors to the incidence of falls and fractured hips among the older adult population? Select all that apply.

Case Study Question 6 The nurse is caring for a 23-year-old client admitted to the medical-surgical unit following surgery for a compound fracture of the right tibia and fibula. Nurses’ Notes   0830: Admitted from Post Anesthesia Care Unit following surgery to repair an open fracture with internal fixation with application of a fiberglass cast. R lower extremity elevated. IV infusing as ordered. Client medicated for pain prior to transport. Vital Signs BP 110/72, HR 90, RR 29, Temp 99F (37.2C). Unable to assess pedal pulse on R lower extremity due to cast. Motion of toes limited by pain and cast. Will monitor for signs of acute complications. 0930: Client resting at this time. Will continue to monitor. 1100: Client reporting pain 10/10 in R lower extremity. Updated neurovascular checks. 1115: Vital Signs BP 82/44, HR 112, RR 22, Temp 99F (37.2C). Provider notified of client changes 1145: Cast removed at bedside, see updated flow sheet. 1245: Vital Signs BP 116/70, HR 88, RR 16, Temp 98.8 F(37.1C), pain 3/10.   Neurovascular Flowsheet   Right Lower Extremity Pain Score  0-10/10 Motion F = full L = limited N = none Sensation F = full P = partial N = none Capillary Refill B = brisk < 3 seconds S = sluggish > 3 seconds Color N = normal P = pale D = dusky C = cyanotic Warmth H = hot W = warm T = tepid C = cold   Pulse 4+ bounding 3+ increased 2+ normal 1+ weak 0 absent UTA unable to assess     Time:  0830 3/10 L F B N W UTA 0930 3/10 L F B N W UTA 1030 4/10 L F B N W UTA 1100 10/10 N N S P T UTA 1115 10/10 N N S P T UTA 1130 10/10 N N S D T UTA 1145 10/10 L N S P T 1+ 1245 3/10 L N S N C 0 Orders   0830: Admission Orders: Bedrest with right leg elevated on 2 pillows May use bedside commode with assistance, no weight bearing to R lower extremity Advance to Regular diet as tolerated VS and neurovascular checks every hour for 4 hours then every 4 hours. 1130: STAT Orders: Strict bedrest, maintain R leg at level of the heart Assist client to use bedpan; Monitor intake and output Keep client nothing by mouth until cleared Document height and weight Order cast cutting tray and compartment pressure measuring device to bedside Check Neurovascular status and vital signs every 15 minutes for 2 hours  IV fluid bolus of 500 mL of normal saline over 30 minutes for blood pressure

A client was admitted with a possible diagnosis of osteomyelitis. Based on the documentation below, which laboratory result is the priority for the nurse to report to the physician?  03/12/XX 0900 Client admitted with elevated temperature of 102o F, complaining of bone pain and muscle spasms. Laboratory called with the following results; rheumatoid factor negative, blood culture positive (+) for Staphylococcus aureus, alkaline phosphate 60 International Units/Liter, erythrocyte sedimentation rate 10mm/hr.                                         Susan Wright, RN  

The nurse is caring for a stable client in Buck’s traction. Which task is best to delegate the Unlicensed Assistive Personnel (UAP)? Select all that apply.

After teaching a group of clients with osteoarthritis about the benefits of regular exercise, which of the following statements indicate that teaching has been effective?