The nurse in the emergency department (ED) is caring for a 17-year-old male client.
Item 1 of 1
- History and Physical
1722: The client has had an external fixation on the left wrist for the past two weeks. Today, he noticed swelling, increased pain, fever, and reports purulent drainage from the pin sites. The client reports poor adherence to performing pin care at home. On exam, the client is febrile and has an oral temperature of 103.4° F (39.7° C). The left wrist is erythemic, swollen, and tender to the touch.
The nurse has reviewed the history and physical.
For each potential intervention, click to specify whether the intervention is indicated or not indicated for the client.
The nurse has reviewed the history and physical.
For each potential intervention, click to specify whether the intervention is indicated or not indicated for the client.
| Potential Interventions | Indicated | Not Indicated |
|---|---|---|
Obtain a prescription for an antibiotic | ||
Culture the pin sites | ||
Apply a pressure dressing over the pins | ||
Obtain a prescription for analgesia | ||
Position the client's wrist so it is extended |
Statistics
Subject/Lesson
Subject
Adult Health
Lesson
Musculoskeletal
Client Need
Test Plan
Reduction of Risk Potential
Related Topic
Potential for Complications from Surgical Procedures and Health Alterations
Item Type
Item Type
GenerateSolutions
Explanation
Osteomyelitis is a significant complication of external fixations. A key preventative measure is pin care.
Interventions Indicated
- The nurse should obtain a prescription for antibiotics. Staphylococcus aureus is the most common pathogen causing osteomyelitis, particularly the methicillin-resistant strain (MRSA). This bacterium is responsible for the majority of both acute and chronic osteomyelitis cases.
- The nurse should culture the pin sites. Culturing the pin sites will assist the physician in determining the most appropriate antibiotic.
- The nurse should obtain a prescription for analgesia. Osteomyelitis is a painful condition, and the client may benefit from analgesia such as prescribed oxycodone.
Interventions Not Indicated
- The nurse should not apply a pressure dressing over the pin sites. Covering them too tightly can create a warm, moist environment that fosters bacterial growth.
- The nurse should not position the client's wrist, so it should be extended. The extremity should be in a neutral position, as flexion and extension will defeat the purpose of external fixation. This also will cause the client excessive pain.
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2 Key Topics
Osteomyelitis
22.6 Major Fracture-Related Complications
Additional Info
