Which nursing action would have the highest priority for a client with a leg in traction quizlet?

Terms in this set (34)

A client has a fractured humerus. Which dietary choice indicates that the client understands the nutrition needed to assist in healing the fracture?
a. Skim milk, vitamin D supplements, and fish
b. Soy milk, vitamin B supplements, and bacon, lettuce, and tomato sandwich
c. Whole milk, vitamin A supplements, and vegetable lasagna
d. Low-fat milk, vitamin C supplements, and roast beef

Students also viewed

Laboratory findings include:

v Increased erythrocyte sedimentation rate (ESR)

v Decreased serum albumin and calcium levels

v Decreased red blood cell (RBC) and platelets counts
v Increased serum lipase level

v Arterial blood gases levels may be assessed

v A chest x-ray will show a diffuse snowstorm pattern.

Treatment
Prevention of Fat Embolism is best accomplished through early immobilization of long bone fractures.

Five measures are generally used to treat fat embolism. It is treated as a medical emergency.

1. Oxygen, usually 40% by mask. In minor cases, this is all that is necessary. In severe cases, mechanical ventilation may be necessary.

2. Fluid replacement may be necessary to restore adequate volume and to flush the toxic fatty substances through the system.

3. Corticosteroids may be used to stabilize cell membranes and decrease inflammation.

4. Diuretics may be used if indicated to restore fluid to the vascular space.

5. Other drugs may be used, such as heparin and low-molecular-weight dextran, and aspirin (in males only) though their effectiveness is unclear.

Nursing Diagnosis
Potential for alteration in mental status r/t hypoxia
Altered gas exchange r/t increased respiratory secretions

Impaired gas exchange r/t decrease oxygen caring ability of blood (decrease RBC)
Anxiety r/t hypoxia

Nursing Interventions
Includes prevention of Fat Embolism by early immobilization of fractures, decreased manipulation, and support of fractured region when moving the patient the injured extremity.

v Adequate ventilation may be enhanced by elevating the head of the bed, as tolerated and mobilization of lung secretions by teaching the client to turn, cough and deep breathe.

v Identify and report early signs and symptoms, especially changes in behavior and level of consciousness.

v Maintain oxygen delivery, monitor intake, and output, and obtain daily weights.

Recommended textbook solutions

Which nursing action would have the highest priority for a client with a leg in traction quizlet?

Clinical Reasoning Cases in Nursing

7th EditionJulie S Snyder, Mariann M Harding

2,512 solutions

Which nursing action would have the highest priority for a client with a leg in traction quizlet?

Pharmacology and the Nursing Process

7th EditionJulie S Snyder, Linda Lilley, Shelly Collins

388 solutions

Which nursing action would have the highest priority for a client with a leg in traction quizlet?

The Human Body in Health and Disease

7th EditionGary A. Thibodeau, Kevin T. Patton

1,505 solutions

Which nursing action would have the highest priority for a client with a leg in traction quizlet?

Exercise Physiology: Theory and Application to Fitness and Performance

11th EditionEdward Howley, John Quindry, Scott Powers

593 solutions

Closed reduction

Explanation:
In a closed reduction, the bone is restored to its normal position by external manipulation. A bandage, cast, or traction then immobilizes the area. In an open reduction, the bone is surgically exposed in the operating room and realigned. If internal fixation is needed to stabilize a reduced fracture, the surgeon secures the bone with metal screws, plates, rods, nails, or pins. In external fixation, the surgeon inserts metal pins into the bone or bones from outside the skin surface and then attaches a compression device to the pin.

Recommended textbook solutions

Which nursing action would have the highest priority for a client with a leg in traction quizlet?

The Human Body in Health and Disease

7th EditionGary A. Thibodeau, Kevin T. Patton

1,505 solutions

Which nursing action would have the highest priority for a client with a leg in traction quizlet?

Pharmacology and the Nursing Process

7th EditionJulie S Snyder, Linda Lilley, Shelly Collins

388 solutions

Which nursing action would have the highest priority for a client with a leg in traction quizlet?

Clinical Reasoning Cases in Nursing

7th EditionJulie S Snyder, Mariann M Harding

2,512 solutions

Which nursing action would have the highest priority for a client with a leg in traction quizlet?

Medical Terminology for Health Professions

8th EditionAnn Ehrlich, Carol L Schroeder, Katrina A Schroeder, Laura Ehrlich

1,792 solutions

Which nursing action would have the highest priority for a client with a leg traction?

Which nursing intervention has the highest priority? Although all measures are correct, assessing neurovascular integrity takes priority because a decrease in neurovascular integrity could compromise the limb. The pull of the traction must be continuous to keep the client from sliding.

Which action would the nurse perform for a patient in traction?

RNs shall not release a patient from traction for the purpose of transfer to and from bed, stretcher, or procedure tables. The nurse shall notify the physician, so the physician may come and remove traction for transfer and to replace traction. 5. RNs shall provide pin care per physician order.

Which nursing intervention is a priority for the patient in traction to ensure the therapy is effective?

The priority nursing intervention before the patient goes into skin traction is to ensure that the patient assessment is completed because the nurse relies on baseline data collected before the procedure to compare with postprocedure neurovascular and skin assessments.

How should the nurse position the weights for a client in skin traction?

The weights must be suspended and not in contact with the bed or resting on the floor. The patient's body should always be in alignment with the force of traction.