Surgical Scenario 1: Marilyn Hughes vsim
Which of the following are appropriate initial nursing interventions to control
discomfort in a fractured extremity stabilized with a splint or cast? (Select all that
apply.)
Intermittent cold packs , Elevation of extremity , Analgesic medication
Rationale:Pain caused by edema can be reduced in the fractured extremity that
has normal neurovascular checks by using intermittent cold packs and elevating
the extremity. An analgesic medication is ordered to control pain. Warm
compresses and lowering of the extremity can increase edema and pain.
When monitoring Ms. Hughes for possible complications following the surgical
repair of a fracture, it is important for the nurse to be alert for development of
which of the following conditions? (Select all that apply.)
Deep vein thrombosis , Compartment syndrome , Pulmonary embolism
Rationale:An embolism in the vein has the potential to cause pulmonary
embolism or a clot in the extremity resulting in deep vein thrombosis, leading to
increased swelling. This swelling can cause decreased blood flow, resulting in
the development of compartment syndrome for the client. Iron deficiency and
medial epicondylitis are not related to this type of surgical repair.
The nurse understands that assessing neurovascular function in a client with a
brace, splint, or cast is vitally important. This assessment should include which of
the following components? (Select all that apply.)
Numbness of the extremity , Movement of the extremity , Skin color of the
extremity
Rationale:When monitoring client recovery, the nurse needs to assess the skin
color (assessed via capillary refill), movement of extremity distal to the brace,
, and numbness to distal extremity, because these would indicate loss of
circulation. The "5 Ps" indicative of symptoms of neurovascular compromise are
pain, pallor, pulselessness, paresthesia, and paralysis. History of fractures and
the type of brace are important assessments; however they do not relate to
neurovascular compromise.
When monitoring for potential complications in the client with a cast, splint, or
brace, the nurse recognizes that which of the following is an early hallmark sign
of compartment syndrome?
Acute pain with passive range of motion
Rationale:A hallmark sign of compartment syndrome is pain that occurs or
intensifies with passive range of motion due to accumulation of fluid within the
compartmental space. The other answer choices reflect pain being controlled
and managed with nursing interventions.
When monitoring for potential complications after surgery, what finding would
cause the nurse to suspect that Ms. Hughes is experiencing postoperative
bleeding?
Decrease in hemoglobin
Rationale:The decrease in hemoglobin would suggest bleeding. Hematocrit
would also decrease. An increase in WBC count indicates infection. Bleeding and
decrease in intravascular fluid volume would cause an increase in creatinine from
decreased blood volume to the kidneys.
The nurse understands that neurovascular assessments should be performed
how frequently during the first 24 hours following application of an immobilization
device to a fractured extremity?
Which of the following are appropriate initial nursing interventions to control
discomfort in a fractured extremity stabilized with a splint or cast? (Select all that
apply.)
Intermittent cold packs , Elevation of extremity , Analgesic medication
Rationale:Pain caused by edema can be reduced in the fractured extremity that
has normal neurovascular checks by using intermittent cold packs and elevating
the extremity. An analgesic medication is ordered to control pain. Warm
compresses and lowering of the extremity can increase edema and pain.
When monitoring Ms. Hughes for possible complications following the surgical
repair of a fracture, it is important for the nurse to be alert for development of
which of the following conditions? (Select all that apply.)
Deep vein thrombosis , Compartment syndrome , Pulmonary embolism
Rationale:An embolism in the vein has the potential to cause pulmonary
embolism or a clot in the extremity resulting in deep vein thrombosis, leading to
increased swelling. This swelling can cause decreased blood flow, resulting in
the development of compartment syndrome for the client. Iron deficiency and
medial epicondylitis are not related to this type of surgical repair.
The nurse understands that assessing neurovascular function in a client with a
brace, splint, or cast is vitally important. This assessment should include which of
the following components? (Select all that apply.)
Numbness of the extremity , Movement of the extremity , Skin color of the
extremity
Rationale:When monitoring client recovery, the nurse needs to assess the skin
color (assessed via capillary refill), movement of extremity distal to the brace,
, and numbness to distal extremity, because these would indicate loss of
circulation. The "5 Ps" indicative of symptoms of neurovascular compromise are
pain, pallor, pulselessness, paresthesia, and paralysis. History of fractures and
the type of brace are important assessments; however they do not relate to
neurovascular compromise.
When monitoring for potential complications in the client with a cast, splint, or
brace, the nurse recognizes that which of the following is an early hallmark sign
of compartment syndrome?
Acute pain with passive range of motion
Rationale:A hallmark sign of compartment syndrome is pain that occurs or
intensifies with passive range of motion due to accumulation of fluid within the
compartmental space. The other answer choices reflect pain being controlled
and managed with nursing interventions.
When monitoring for potential complications after surgery, what finding would
cause the nurse to suspect that Ms. Hughes is experiencing postoperative
bleeding?
Decrease in hemoglobin
Rationale:The decrease in hemoglobin would suggest bleeding. Hematocrit
would also decrease. An increase in WBC count indicates infection. Bleeding and
decrease in intravascular fluid volume would cause an increase in creatinine from
decreased blood volume to the kidneys.
The nurse understands that neurovascular assessments should be performed
how frequently during the first 24 hours following application of an immobilization
device to a fractured extremity?
