A child is 3 hours postoperative, having had an open reduction and internal fixation (ORIF) of a type IV tibial fracture, which is now also casted. Which action by the nurse takes priority?
A.
Assess neurovascular status every hour.
B.
Change IV pain medication to oral pills.
C.
Provide an ice bag for 30 minutes every hour.
D.
Teach parents about activity restrictions.
ANS: A
After surgery and/or casting, it is vital to assess neurovascular status, which is usually done with postoperative vital signs. Excessive swelling can disrupt circulation to the extremity, so the nurse assesses the child's neurovascular status frequently. Applying ice is also a good intervention, but not for more than 15 minutes at a time. When the child is tolerating oral foods and fluids, the nurse can switch to pain pills from IV narcotics. Teaching is important, but not as important as preventing injury from complications.
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