Question

A client arrives in the emergency room with a possible fractured femur. The nurse should anticipate an order for: A. Trendelenburg position B. Ice to the entire extremity C. Buck's traction D. An abduction pillow

Short answer

Answer: C. Buck's traction.

Step-by-step solution

Option A: Trendelenburg position

The Trendelenburg position involves placing the patient in a supine position (lying on their back) with the legs elevated higher than the head to increase blood circulation to the brain. This would not necessarily be the best option for a possible fractured femur, as it may not provide any specific benefits or support to the injured leg.

Option B: Ice to the entire extremity

Applying ice to the entire leg may help to reduce inflammation and numb the area to temporarily alleviate pain. However, ice alone may not be sufficient in managing a fractured femur, as these injuries often require immobilization, pain relief, and potentially surgery.

Option C: Buck's traction

Buck's traction is a common treatment method for fractured femurs, as it helps to immobilize the injured leg and decrease muscle spasms, thereby reducing the risk of further injury and aiding in pain relief. This method involves attaching a weight to the injured leg to apply gentle traction and realign the broken bone fragments. This option seems to be the most appropriate action to anticipate in this scenario.

Option D: An abduction pillow

An abduction pillow is a wedge-shaped cushion used to maintain proper alignment and positioning of the legs after certain surgeries to the hip or leg. It is not generally used to manage a fractured femur. Based on this analysis, the nurse should anticipate an order for: C. Buck's traction.

Key concepts

Buck's Traction

Buck's traction is an integral part of the clinical management for individuals who have sustained a femur fracture. It's a type of skin traction used primarily to reduce pain and muscle spasms associated with the fracture while preventing further damage.

During Buck's traction, the impacted limb is stretched under controlled circumstances. Weights are carefully attached to the affected leg by an adhesive material wrapped around the skin or to a boot that is secured to the leg. The weight applied depends on the individual's weight and the severity of the fracture but is typically light, ranging from 5 to 10 pounds.

Key Steps in Buck's Traction:

• Application of the traction device to the affected leg.
• Calibration of the weight necessary to provide the correct amount of tension.
• Continuous monitoring by healthcare professionals to ensure skin integrity and prevent complications.

Buck's traction serves as a temporary measure before definitive treatment, such as surgery. It's essential to remember that this intervention requires careful supervision by trained medical personnel to ensure its effectiveness and the patient's safety.

Emergency Nursing Care

Emergency nursing care for a patient with a suspected fractured femur encompasses immediate and proficient actions to manage the patient's condition and prevent complications.

The first steps in emergency care involve assessing the patient's vital signs and the affected extremity for any signs of further injury or complications. Emergency nursing care prioritizes:

Initial Assessment:

• Inspecting the area for open wounds, swelling, and deformity.
• Assessing circulation, sensation, and movement (CSM).
• Controlling any bleeding and preventing shock.

Immobilization:

• Supporting the injured limb to alleviate pain.
• Preparing for the application of traction or splints.

Coordination of Care:

• Communicating with the rest of the healthcare team to arrange for further diagnostic testing, like X-rays or MRI scans.
• Preparing the patient for possible surgical intervention if necessary.

In an emergency setting, rapid and compassionate care is paramount, and the role of the nurse is crucial in ensuring the stabilization of the patient's condition.

Pain Management

Managing pain effectively is a crucial aspect of treating a fractured femur. The aim is to provide the patient with relief while maintaining a level of consciousness that allows them to cooperate with medical staff and, eventually, participate in their rehabilitation activities.

Multiple strategies are employed, depending on the severity of the pain and the specific needs of the patient. These may include:

Pharmacological Interventions:

• Administering analgesics such as acetaminophen or NSAIDs for mild pain.
• Prescribing opioids for more severe pain, with careful monitoring to avoid side effects and dependencies.

Non-Pharmacological Interventions:

• Utilizing ice packs to reduce swelling and numb the pain.
• Applying heat in later stages to improve blood flow and reduce discomfort.
• Encouraging guided imagery or relaxation techniques to help the patient cope with the pain.

A patient-centered approach to pain management often involves a combination of methods tailored to the patient's individual needs and responses. Effective communication between the patient and healthcare providers is vital to ensure pain is managed efficiently and appropriately.