Which nursing intervention would the nurse avoid when providing care for a client with a fractured extremity?

1, 2, 3

(Rationale:
A plaster cast takes 24 to 72 hours to dry (synthetic casts dry in 20 minutes). The cast and extremity may be elevated to reduce edema. A wet cast is handled with the palms of the hands until it is dry, and the extremity is turned (unless contraindicated) so that all sides of the wet cast will dry. A cool setting on the hair dryer can be used to dry a plaster cast (heat cannot be used because the cast heats up and burns the skin). The cast needs to be kept clean and dry, and the client is instructed not to stick anything under the cast because of the risk of breaking skin integrity. The client is instructed to monitor the extremity for circulatory impairment such as pain, swelling, discoloration, tingling, numbness, coolness, or diminished pulse. The PHCP is notified immediately if circulatory impairment occurs.)

2

(Rationale:
The client with pallor, slow capillary refill, weakened or lost pulse, and absence of sensation or motion to the distal limb may have arterial damage from a lacerated, contused, thrombosed, or severed artery. Regardless of the cause, the LPN notifies the registered nurse immediately, who will contact the primary health care provider. These signs can occur with constriction from a tight cast as well. Emergency intervention is needed, which could include removal of the constricting bandage, fracture reduction, or surgery to repair the area.)

2, 4, 5

(Rationale:
The earliest manifestations of FES are a low arterial oxygen level (hypoxemia), dyspnea, and tachypnea (increased respirations). FES is a serious complication that usually results from fractures or fracture repair. In this syndrome, fat globules are released from the yellow bone marrow into the bloodstream within 12 to 48 hours after an injury or other illness (mechanical theory). Headache, lethargy, agitation, confusion, decreased level of consciousness, seizures, and vision changes may follow. Petechiae may appear over the neck, upper arms, and/or chest. Although this rash is a classic manifestation, it is usually the last sign to develop.)

1,3,4,6

(Rationale:
The four cardinal signs/symptoms of Parkinson's disease (PD) are tremor, muscle rigidity, bradykinesia or akinesia (slow movement/no movement), and postural instability. In addition to changes in voluntary movement, many clients experience autonomic nervous system symptoms, such as excessive perspiration, not dry skin, and orthostatic hypotension, not hypertension. Orthostatic hypotension is likely related to loss of sympathetic innervation in the heart and blood vessel response. PD is a progressive neurodegenerative disease that is the one of the most common neurologic disorders of older adults.)

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