A 7-year-old girl is receiving IV antibiotics for osteomyelitis in the left femur.
After 72 hours of treatment, she continues to have fever, elevated WBC, and increased pain at the infection site. What is the nurse's priority action?
Notify the provider of the lack of therapeutic response.
Request an order for oral analgesics to reduce discomfort.
Encourage intake of calcium-rich foods to support bone healing.
Reassure the family that antibiotic therapy can take several days to show improvement.
The Correct Answer is A
Choice A rationale
Persistent fever, elevated white blood cell count (normal range: 4,000-11,000 cells/µL), and increased pain after 72 hours of antibiotic treatment for osteomyelitis indicate a lack of therapeutic response. This suggests the current antibiotic regimen may be ineffective, or the infection is not responding as expected. Prompt notification of the provider is crucial for re-evaluation of the treatment plan, potential antibiotic adjustment, or further diagnostic investigation to prevent complications like sepsis or chronic osteomyelitis.
Choice B rationale
While pain management is important, requesting only oral analgesics addresses a symptom without addressing the underlying lack of improvement in the infection. Untreated or inadequately treated osteomyelitis can lead to significant morbidity. Prioritizing symptomatic relief over addressing the root cause can delay appropriate medical intervention and worsen the patient's condition.
Choice C rationale
While calcium (normal range: 8.5-10.5 mg/dL) is vital for bone health, encouraging calcium-rich foods is a long-term supportive measure for bone healing. It does not address the immediate and concerning signs of ongoing, uncontrolled infection. Addressing the active infection takes precedence over nutritional support for healing at this stage.
Choice D rationale
While antibiotic therapy does take time to show full effect, 72 hours with worsening symptoms, including elevated WBC, suggests the current therapy is failing. Reassuring the family without addressing these objective signs of non-improvement can delay necessary medical intervention and potentially harm the patient by allowing the infection to progress further.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale
When bone fragments remain partially joined, this describes an incomplete fracture, such as a greenstick fracture often seen in children, where the bone bends and cracks but does not break completely through. This is distinct from a complete fracture where there is full separation of the bone.
Choice B rationale
A complete fracture is scientifically defined as a break in a bone where the bone fragments are entirely separated from each other. This total discontinuity interrupts the structural integrity of the bone, distinguishing it from partial breaks where some bone continuity is maintained.
Choice C rationale
When the bone penetrates the skin, this describes an open (or compound) fracture. While an open fracture is also a complete fracture, the defining characteristic of a *complete* fracture itself is the full separation of the bone fragments, irrespective of whether the skin is breached.
Choice D rationale
When the bone bends but does not break, this is characteristic of a bent bone deformity or an incomplete fracture, specifically a greenstick fracture common in pediatric patients due to the higher flexibility of their bones. This is not a complete fracture, where the bone's continuity is fully disrupted.
Correct Answer is ["A","B"]
Explanation
Choice A rationale
Reporting any change in the color or temperature of the toes on the casted extremity is crucial for detecting potential neurovascular compromise. Changes like pallor, cyanosis, coolness, or increased warmth can indicate impaired circulation, nerve compression, or infection, requiring immediate medical attention to prevent permanent tissue damage or complications.
Choice B rationale
Keeping the cast dry and avoiding submersion in water is essential to maintain the cast's integrity and prevent skin maceration. A wet cast can soften, lose its supportive capabilities, and become a breeding ground for bacteria or mold, leading to skin irritation, infection, or breakdown. Special covers are available for showering.
Choice C rationale
Applying lotion or powder to relieve itching under the cast is contraindicated. Lotions can soften the skin, promoting maceration and fungal growth, while powders can cake and irritate the skin. Inserting objects under the cast can also lead to skin abrasions, infections, or foreign body reactions, compromising skin integrity.
Choice D rationale
Using a warm hair dryer to dry the cast if it gets wet is generally discouraged. While a cool setting might be acceptable for some fiberglass casts, warm or hot air can cause burns to the underlying skin, especially if sensation is impaired or if the cast material is plaster, which can retain heat. Air drying or a fan on a cool setting is preferred.
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