The nurse is continuing to care for the child.

Exhibits

After reviewing the discharge instructions with the family, which of the following statements by a parent indicate an understanding of the teaching?
For each statement by the parent, click to specify if the statement reflects an understanding or indicates a need for reinforcement of the discharge teaching.

Rationale for correct choices

• Limb immobilization: Immobilization is the primary treatment for a nondisplaced fracture to maintain bone alignment, promote healing, and prevent further injury. Splints, casts, or braces may be used depending on the fracture location and stability. Proper immobilization also helps reduce pain and swelling by limiting movement of the injured extremity.

• Pain medication: Pain management is essential to ensure comfort and facilitate cooperation with care. Mild to moderate pain from a nondisplaced fracture can be managed with acetaminophen or ibuprofen. Effective analgesia also helps the child maintain mobility of unaffected areas and reduces stress associated with the injury.

Rationale for incorrect choices

• Antibiotics: Antibiotics are not routinely prescribed for closed fractures unless there is an open wound or risk of infection. The child’s abrasion on the knee may require topical care, but systemic antibiotics are not indicated for the fracture itself.

• Bed rest: Strict bed rest is not necessary for a nondisplaced upper extremity fracture. The child can usually participate in age-appropriate activities while the limb is immobilized, as long as the extremity is protected.

• Surgical consultation: Surgical intervention is typically reserved for displaced fractures, open fractures, or fractures with neurovascular compromise. This child’s fracture is nondisplaced and stable, so surgery is not anticipated at this stage.

• Skin traction: Skin traction is generally used for lower extremity fractures or severe fractures requiring alignment before surgical intervention. It is not indicated for a stable, nondisplaced forearm fracture in a child.

Rationale:

A. Check the client for indications of bleeding: The priority action following a heparin overdose is to assess the client for signs of active or internal bleeding, such as hematuria, melena, bruising, or hypotension. Immediate assessment guides urgent interventions to prevent life-threatening complications.

B. Monitor the client's aPTT levels: Monitoring aPTT is important to evaluate the anticoagulant effect and guide treatment, but it is secondary to assessing for actual bleeding. Assessment of clinical signs takes precedence over laboratory monitoring in urgent situations.

C. Complete an incident report: Documenting the medication error is necessary for legal and quality improvement purposes, but it is not the first action. Patient safety and immediate clinical assessment come before reporting.

D. Notify the risk manager: Informing the risk manager is part of the incident reporting process, but addressing the client’s immediate safety needs comes first. Notification can occur after urgent assessment and stabilization.