A 28-year-old male patient has a fractured left humerus. He has a cast on his arm. The nurse observes pallor, coolness, and a decrease in capillary refill time to his left hand and fingers. These observations are likely to indicate
a. compartment syndrome.
b. early infection.
c. hemorrhage.
d. shock.
A
Collection of objective data involves assessment of the patient's ability to flex the fingers or toes, coolness of the extremity, and absence of pulse in the affected extremity all of which indicate the impaired circulation symptomatic of compartment syndrome. Assessment of skin color for signs of pallor or cyanosis is made.
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The nurse uses each of the following assessments during the course of every client's care, including:(Select all that apply) Standard Text: Select all that apply
1. Complete assessment 2. Focused assessment by body system 3. Focused assessment of a body part 4. Fontanel assessment 5. Pain threshold
The nurse is measuring the blood pressure of a 12-year-old boy with an oscillometric device. The boy's reading is greater than the 90th percentile for gender and height. What is the appropriate nursing action?
A) Repeat the reading with the oscillometric device. B) Repeat the blood pressure reading using auscultation. C) Measure the blood pressure in all four extremities. D) Measure the blood pressure with a Doppler.
Of the following nursing diagnoses, which best reflects the effects of fluid and electrolyte imbalance on human functioning?
1. Disturbed thought processes related to cerebral edema 2. Pain related to active transport 3. Constipation related to immobility 4. Distended neck veins related to fluid volume deficit
Convert 506 mcg to milligrams: ________ (use appropriate unit notation)
Fill in the blank(s) with the appropriate word(s).