The nurse is providing care for a patient following an open reduction surgery of a fracture. Which finding should the nurse report immediately to the HCP?

There is numbness and tingling sensations in the surgical limb.

Surgical pain is a 4 on a scale 0-10.

The foot on the surgical limb is slightly cooler that the other limb.

There are +2 pulses and the surgical limb is pink in color.

Answer and Explanation

The Correct Answer is A

A. There is numbness and tingling sensations in the surgical limb. Numbness and tingling may indicate neurovascular compromise, such as compartment syndrome or nerve damage, requiring immediate medical attention.

B. Surgical pain is a 4 on a scale 0-10. Pain at a level 4 postoperatively is generally manageable and expected. It does not indicate an immediate complication.

C. The foot on the surgical limb is slightly cooler than the other limb. While a slightly cooler foot could be a concern, it is less urgent than numbness and tingling. Monitoring and comparing with other symptoms are necessary.

D. There are +2 pulses and the surgical limb is pink in color. This indicates good circulation and is a positive sign, not requiring immediate reporting.

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Correct Answer is A

Explanation

A. Monitoring pin and wound sites for signs of infection. Correct. Infection at the pin and wound sites is a major risk with external fixation and requires vigilant monitoring and care.

B. Being aware that the patient may experience issues with body image. While body image concerns are important, they are not the primary priority in care.

C. Helping the patient achieve a desired level of mobility. Mobility is important, but the primary concern with external fixation is preventing and managing infections.

D. Providing a caring and supportive attitude during a challenging time. While providing emotional support is important, it is not the primary priority of care for external fixation.

A. Provide an elevated toilet seat. B. Assist of bed immediately following surgery. C. Medicate with pain medications. D. Maintain weight bearing as prescribed.

Correct Answer is D

Explanation

A. Provide an elevated toilet seat: This is important for preventing hip dislocation but is not the immediate priority.
B. Assist out of bed immediately following surgery: Mobilizing the patient is important to prevent complications such as deep vein thrombosis (DVT) and pneumonia, but this should be done safely and as prescribed.
C. Medicate with pain medications: Pain management is crucial for postoperative recovery but is part of comprehensive care rather than the single priority.
D. Maintain weight bearing as prescribed: Following weight-bearing restrictions is critical to ensure proper healing and prevent complications such as dislocation or prosthetic failure. This is the immediate priority in terms of preventing harm and ensuring recovery.

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The nurse is providing care for a patient following an open reduction surgery of a fracture. Which finding should the nurse report immediately to the HCP?

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