Question

A client has a fractured tibia from a football injury. A cast was applied to the leg. Assessment reveals complaints of pain unrelieved by pain medication, restricted toe movements, edema, and slow capillary refill. What is the nurse's best action? A. Elevate the extremity on a pillow B. Administer pain medication C. Notify the physician of the assessment findings D. Perform a neurovascular reassessment

Short answer

Answer: C. Notify the physician of the assessment findings.

Step-by-step solution

Review the symptoms and actions

The client is experiencing pain unrelieved by pain medication, restricted toe movements, edema, and slow capillary refill. We must determine which action (elevating the extremity, administering pain medication, notifying the physician, or performing a neurovascular reassessment) would be most likely to address these symptoms.

Evaluate the actions with regard to the symptoms

(A) Elevating the extremity on a pillow may help reduce edema and improve blood flow, but it doesn't address the other symptoms or potential underlying problems. (B) Administering pain medication has already been done, and it hasn't alleviated the client's pain. (D) Performing a neurovascular reassessment might help gather more information about the client's condition and may be necessary in the future, but it doesn't address the client's current symptoms or the potential need for a change in intervention.

Choose the best action

(C) Notifying the physician of the assessment findings is the best course of action because it allows the nurse to relay important information about the client's condition to the physician, who can then adjust the treatment plan accordingly. The other actions do not address all of the client's symptoms and may not lead to a change in the intervention necessary to address those symptoms. The correct answer is C. Notify the physician of the assessment findings.

Key concepts

Neurovascular Assessment

A neurovascular assessment is a critical evaluation process for patients, especially those with fractures or potential circulatory issues. It helps assess circulation, motor, and sensory function. This is particularly important for detecting signs of complications such as compartment syndrome, which is a painful condition that occurs when pressure within the muscles builds to dangerous levels. When performing a neurovascular assessment, nurses or practitioners focus on the "five P's":

• Pain: Is the pain disproportionate to the injury?
• Pallor: Assess the color or pallor of the limb. Pale color could indicate poor blood flow.
• Paresthesia: This refers to numbness or tingling sensations that might signal nerve damage.
• Paralysis: Can the patient move the limb without restriction?
• Pulse: Check the capillary refill and pulse to ensure adequate blood flow.

Anybody with a fracture should be monitored closely using this simple yet thorough assessment. This helps in early intervention, which may include relieving pressure from the affected area or adjusting the treatment plan.

Nursing Interventions

Nursing interventions are actions that nurses take to improve a patient's outcomes. For a case like a fractured tibia, these interventions focus on pain management, observing for potential complications, and providing essential patient education.
Effective communication and timely intervention greatly impact the patient's recovery.
Some common nursing interventions for fracture management include:

• Pain management through medication, positioning, and sometimes alternative methods like cold therapy.
• Monitoring for signs of complications, such as excessive swelling, unusual pain, or changes in neurovascular status.
• Educating the patient about movement restrictions and the importance of notifying staff if they notice changes.

By actively engaging in these interventions, nurses play a vital role in the healing process and prevention of complications.

Patient Assessment

Patient assessment is a cornerstone of effective nursing care and involves collecting all the significant information about the patient's current health status. This process is continuous and requires nurses to use critical thinking to gather, analyze, and interpret data. In the context of a fracture, several key areas are evaluated:

• Pain level: Consistently checking pain levels helps determine the effectiveness of pain management strategies.
• Mobility: Assessing the patient's ability to move the affected area helps in understanding the extent of the injury.
• Circulation: Monitoring capillary refill and extremity temperature ensures that blood flow is sufficient.

Regular clinical assessments are essential to provide tailored and effective care. Any irregularities found during a patient's assessment should be promptly communicated to the healthcare team for further evaluation.

Fracture Management

Fracture management involves a range of strategies aimed at ensuring proper healing and function of the affected limb. This includes both non-surgical and surgical methods, depending on the type and severity of the fracture. The primary goals are to immobilize the fracture, control pain, and prevent further injury or complications.
In the case of tibial fractures, common management steps include:

• Immobilization: Applying a cast or splint to keep the bone in place during healing.
• Pain control: Using medications to manage pain, allowing the patient to rest and recover.
• Monitoring: Regular follow-ups to ensure that the fracture is healing properly and there are no signs of complications such as infection or impaired blood circulation.

Proper fracture management also involves teaching the patient about cast care and what symptoms to watch out for, ensuring they play an active role in their recovery process.