A client with a broken arm has had ice placed on it for 20 ...

[newbem]

A client with a broken arm has had ice placed on it for 20 minutes. A short time after the ice was removed, the client reports that the effect has worn off and requests pain medication, which cannot be given yet.
 
  What actions by the nurse are most appropriate? (Select all that apply.)
 
  a.
  Ask for a physical therapy consult.
  b.
  Educate the client on cold therapy.
  c.
  Offer to provide a heating pad.
  d.
  Repeat the ice application.
  e.
  Teach the client relaxation techniques.

Question 2

A postoperative client has an epidural infusion of morphine and bupivacaine (Marcaine). What actions does the nurse delegate to the unlicensed assistive personnel (UAP)? (Select all that apply.)
 
  a. Ask the client to point out any areas of numbness or tingling.
  b. Determine how many people are needed to ambulate the client.
  c. Perform a bladder scan if the client is unable to void after 4 hours.
  d. Remind the client to use the incentive spirometer every hour.
  e. Take and record the client's vital signs per agency protocol.

[HandsomeMarc]

Answer to Question 1

ANS: B, D, E
Nonpharmacologic pain management can be very effective. These modalities include ice, heat, pressure, massage, vibration, and transcutaneous electrical stimulation. Since the client is unable to have more pain medication at this time, the nurse should focus on nonpharmacologic modalities. First the client must be educated; the effects of ice wear off quickly once it is removed, and the client may have had unrealistic expectations. The nurse can repeat the ice application and teach relaxation techniques if the client is open to them. A physical therapy consult will not help relieve acute pain. Heat would not be a good choice for this type of injury.

Answer to Question 2

ANS: C, D, E
The UAP can assess and record vital signs, perform a bladder scan and report the results to the nurse, and remind the client to use the spirometer. The nurse is legally responsible for assessments and should ask the client about areas of numbness or tingling, and assess if the client is able to bear weight and walk.