The nurse in an orthopedic outpatient clinic expects to see several clients with fractures for follow-up. After reviewing the clients' medical records, which client is at the highest risk of a delayed union?
A) 20-year-old college student with type I diabetes mellitus who sustained a fractured tibia in a bicycle accident. Nutrition recall tool completed during the last visit was consistent with American Diabetic Association (ADA) guidelines.
B) 62-year-old bartender with a history of peptic ulcer who sustained a fractured clavicle breaking up a fight at work. He was upset about abstaining from upper body resistance training.
C) 49-year-old teacher with osteoporosis who sustained an open ulnar fracture in a motor vehicle accident. Reports that she has cut down smoking to 10 cigarettes per day.
D) 55-year-old accountant who sustained fractures to the 4th and 5th right metatarsals. He has a history of hypertension under good control with medication.
Answer: C
Evaluating risk of delayed union requires knowledge of the factors that impact bone healing. The client at greatest risk of delayed union had the risks of an open fracture and osteoporosis. The client also used tobacco, which decreases blood supply to the healing bone. Although diabetes does increase risk of delayed union, this client is young and exercised on a bicycle prior to the accident. If the client is following an ADA diet, there is adequate intake of vitamin D and calcium, which fosters bone healing. Peptic ulcer or controlled hypertension are not risks for delayed bone healing.
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