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Global Rationale: Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Physiological AdaptationNursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 50-4Question 7Type: MCSAA patient wearing a long leg cast has assessment findings of compartment syndrome in the extremity. The nurse demonstrates understanding of the complication and its specific treatment by gathering which equipment?1. Pillows to elevate the leg2. A percussion hammer3. Buck’s traction equipment4. Ace bandagesCorrect Answer: Rationale 1: Elevating the leg above the heart would compromise circulation.Rationale 2: At this point the diagnosis has been made; further assessment is not indicated and would waste time.Rationale 3: Buck’s traction is not a priority in the current care of this patient.Rationale 4: Compartment syndrome occurs when excess pressure in a limited space constricts the structures within a compartment, reducing circulation to muscles and nerves. With increased edema, this event threatens the viability of the limb and increases the risk of sepsis. Treatment can include removing the cast entirely or bivalving it (splitting it apart with a cast cutter) and securing the two sides with Ace wraps, tape, or Velcro straps.4Global Rationale: Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Physiological AdaptationNursing/Integrated Concepts: Nursing Process: PlanningLearning Outcome: 50-4Question 8Type: MCSAA committee of musculoskeletal care nurses has been meeting to formulate policy changes regarding the proper method for providing pin site care. Based on current research findings, the nurses come to which conclusion?
3Global Rationale: Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Reduction of Risk PotentialNursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 50-4
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Nursing, Orthopedic surgery, Global Rationale, Bone fracture, callus, Compartment syndrome