The patient is complaining of increasing pain several hours after a cast was applied for a severe lower leg injury. What actions should the nurse implement after giving additional pain medica-tion with no relief?
a. Call the physician and order a cast saw to the bedside.
b. Elevate the leg as high as possible and put ice on the cast.
c. Administer half of a dose of additional pain medication and check vital signs.
d. Try to distract the patient and have nurs-ing assistive personnel (NAP) stay with him or her.
A
The patient is experiencing symptoms of compartment syndrome, which is a medical emergency. The physician must be notified, and the cast saw made available because the cast will need to be split (bivalved) so the leg can be assessed. Ice is contraindicated, as is placing the leg high. There is already decreased circulation of the extremity, and nothing should be done to further impair it. The nurse cannot alter the prescribed dose of medication that may be given to the patient without consulting the healthcare provider. Distracting the patient is not a useful response to this situation. The nurse should remain at the patient's bedside until the emergency situation is addressed.
You might also like to view...
The nurse is caring for a patient whose ABG results reveal the following: pH 7.56, PaCO2 32 mm Hg, HCO3 42 mEq/L, PaO2 90 mm Hg. Which condition will the nurse expect to see in the patient's chart as the underlying cause of these results?
a. Gastroenteritis with severe nausea, vomiting, and diarrhea b. Widespread tissue ischemia caused by cardiogenic shock c. Respiratory failure caused by pneumonia with pleural effusions d. Hyperventilation after a panic attack
A nurse is teaching a sex education course in a local high school. What statement, made by the nurse, would be accurate regarding the human sexual response?
A) Humans require endocrine stimuli during a time period called estrus for a sexual response to occur. B) Stimulation occurs with massive increases in sensitivity. C) Sexual climax occurs from massive sympathetic stimulation. D) The period of recovery is initiated with parasympathetic stimulation.
The nurse is providing education to a client about anxiety disorders. Which statement by the client requires further follow up by the nurse?
A) "I can expect to experience anxiety throughout my life." B) "Sometimes anxiety can get out of hand." C) "Usually anxiety lasts for weeks after a stressor is gone." D) "Anxiety disorders sometimes lead people to feel panicked in social settings."
The father of a 7-year-old boy reports to the nurse that two
or three times over the past weeks he has observed his son seemingly staring into space and rubbing his hands. The behavior lasts for a minute or so, followed by an inability of the child to understand what's being said to him. When the nurse asks the child about his experience, he says he doesn't know what his father is talking about. What do these symptoms suggest to the nurse? A) Simple partial sensory seizures B) Simple partial motor seizures C) Complex partial seizures D) Absence seizures