Question

The client is admitted to the orthopedic unit diagnosed with a fractured pelvis. Which assessment requires immediate attention? A. BP \(120 / 70\), heart rate 100 B. Pain in the suprapubic area, pelvic deformities C. Dysuria, anorexia D. Boardlike abdomen, temperature \(101.4^{\circ}\) Fahrenheit

Short answer

A. Blood pressure 120/70, heart rate 100 B. Pain in the suprapubic area, pelvic deformities C. Dysuria, anorexia D. Boardlike abdomen, temperature 101.4°F Answer: D. Boardlike abdomen, temperature 101.4°F

Step-by-step solution

Analyze Option A

We have blood pressure (BP) \(120/70\) and a heart rate of \(100\). While the heart rate is slightly elevated, these vitals are relatively normal and do not indicate an immediate concern.

Analyze Option B

Pain in the suprapubic area and pelvic deformities: The client is diagnosed with a fractured pelvis, so pain and deformities are expected symptoms. While they are concerning, they do not necessarily require immediate attention since it's an expected outcome.

Analyze Option C

Dysuria (difficulty or pain during urination) and anorexia (loss of appetite): These could be common symptoms in patients suffering from a pelvis issue, but they're not necessarily an immediate concern within an orthopedic context.

Analyze Option D

Boardlike abdomen and a temperature of \(101.4^{\circ}\) Fahrenheit: A rigid (boardlike) abdomen could indicate internal bleeding or inflammation, and a fever may be a sign of infection. Both these symptoms together point to a more critical situation, which might require immediate attention.

Select the most concerning assessment

After analyzing all the options, Option D is the most concerning assessment, as it indicates a potentially critical situation of internal bleeding or inflammation coupled with a fever possibly due to an infection. This should be addressed immediately to avoid complications. Therefore, the correct answer is D. Boardlike abdomen, temperature \(101.4^{\circ}\) Fahrenheit.

Key concepts

Nursing Assessment

Nursing assessments are crucial in providing quality care and identifying the immediate needs of patients. For individuals admitted with injuries such as a fractured pelvis, a comprehensive and systematic assessment is essential. A nurse's observation and judgment can be life-saving, especially when recognizing subtle signs that may indicate serious complications. During the assessment process, nurses look at vital signs, physical symptoms, and patient complaints to evaluate their condition.

For instance, a heart rate of 100 might be slightly elevated but isn't alarming in isolation. However, accompanying symptoms such as a boardlike abdomen can indicate acute issues like internal bleeding or peritonitis, making it critical to prioritize actions based on the assessment. It is essential for nursing professionals to assess not only the physical injury but also to monitor for signs of infection, as indicated by fever. The assessment's goal is to quickly identify the most critical signs and symptoms that could result in patient deterioration if not addressed promptly.

Fractured Pelvis Complications

A fractured pelvis can lead to various complications, which can be life-threatening if not promptly identified and managed. Some complications include hemorrhage, damage to internal organs, and the development of deep vein thrombosis (DVT) due to immobility. A nursing assessment that reveals a boardlike abdomen and fever, as found in the given scenario, suggests the possibility of severe internal complications, such as bleeding or infection. Nurses must always be vigilant for these signs to prevent the progression of these complications.

Furthermore, the pain in the suprapubic area and visible pelvic deformities are indicative of the injury but can also contribute to the patient's inability to ambulate, which increases the risk of DVT. It is crucial for nurses to implement measures that mitigate these risks, such as initiating anticoagulation therapy as prescribed and ensuring that the patient is properly immobilized until they are stable.

Acute Care Nursing

Acute care nursing focuses on patients with severe, often sudden health issues that require immediate and intensive care. Nurses in this field need to utilize their in-depth knowledge and rapid assessment skills to provide critical care and make swift decisions. In the context of a fractured pelvis, acute care nurses play a key role in monitoring symptoms, managing pain, preventing complications, and coordinating care with other healthcare professionals.

In assessing a patient with a fractured pelvis, conditions like dysuria and anorexia may seem less urgent but are important to monitor over time. Acute care nurses' ongoing assessment and quick reaction to changes in patient conditions, such as a spike in temperature or the development of a rigid abdomen, are instrumental in preventing further harm. Nurses' actions in such cases include administering prescribed medications, facilitating diagnostic tests to confirm the cause of acute symptoms, and collaborating closely with the interdisciplinary team to ensure a holistic and effective patient care plan.