A school nurse notices a sudden drop in grades and increased absenteeism in a previously high-achieving student.
When approached, the student avoids eye contact and has flat affect. What is the nurse's next best action?

Choice A rationale

This describes an incomplete fracture, where the bone's continuity is not completely disrupted. The periosteum and some bone matrix remain intact, providing some structural continuity. This type of fracture often involves a "greenstick" injury in children, where one side of the bone fractures and the other side bends.

Choice B rationale

A complete fracture involves a full break through the bone, resulting in two or more distinct bone fragments that are no longer connected. This disruption compromises the structural integrity of the bone, leading to instability and potential displacement of the fragments.

Choice C rationale

This describes an open or compound fracture, where the fractured bone fragments penetrate the skin, creating an open wound. While often a complete fracture, the defining characteristic here is the skin penetration and increased risk of infection, not just the separation of fragments.

Choice D rationale

This describes a bend deformity or an incomplete fracture, often seen in children due to the greater flexibility of their bones compared to adults. The bone's plastic deformation allows it to bend without a complete break, preserving some structural continuity.

Choice A rationale

Providing a high-protein diet is beneficial for tissue repair and overall healing, as proteins are essential building blocks for cells and enzymes involved in the inflammatory and reparative processes. However, this intervention is secondary to addressing the underlying infection. Nutritional support optimizes recovery but does not directly eliminate the bacterial pathogen.

Choice B rationale

Encouraging weight-bearing on the affected limb is contraindicated in acute osteomyelitis. This action could exacerbate inflammation, increase pain, and potentially lead to pathological fractures or further dissemination of the infection within the bone, compromising structural integrity and delaying healing. Rest is crucial for minimizing stress on the compromised bone.

Choice C rationale

Administering IV antibiotics as prescribed is the priority intervention because osteomyelitis is a severe bacterial infection of the bone. Intravenous administration ensures high systemic concentrations of antibiotics, reaching the infected bone tissue efficiently to eradicate the pathogen, prevent further bone destruction, and reduce the risk of systemic complications like sepsis.

Choice D rationale

Applying heat packs to the affected area might provide some symptomatic relief from pain by increasing blood flow, but it is not a primary intervention for osteomyelitis. Heat can potentially increase swelling and may not be effective in reaching the deep-seated infection within the bone. Direct antimicrobial therapy is paramount for resolution.