Which should cause a nurse to suspect that an infection has ...

[lunatika]

Which should cause a nurse to suspect that an infection has developed under a cast?
 
  a. Complaint of paresthesia
  b. Cold toes
  c. Increased respirations
  d. Hot spots felt on cast surface

Question 2

An adolescent with a fractured femur is in Russell's traction. Surgical intervention to correct the fracture is scheduled for the morning. Nursing actions should include which action?
 
  a. Maintaining continuous traction until 1 hour before the scheduled surgery
  b. Maintaining continuous traction and checking position of traction frequently
  c. Releasing traction every hour to perform skin care
  d. Releasing traction once every 8 hours to check circulation

[zogaridan]

Answer to Question 1

ANS: D
If hot spots are felt on the cast surface, they usually indicate infection beneath the area. This should be reported so that a window can be made in the cast to observe the site. The five Ps of ischemia from a vascular injury are pain, pallor, pulselessness, paresthesia, and paralysis. Paresthesia is an indication of vascular injury, not infection. Cold toes may be indicative of too tight a cast and need further evaluation. Increased respirations may be indicative of a respiratory tract infection or pulmonary emboli. This should be reported, and child should be evaluated.

Answer to Question 2

ANS: B
When the muscles are stretched, muscle spasm ceases and permits realignment of the bone ends. The continued maintenance of traction is important during this phase because releasing the traction allows the muscle's normal contracting ability to again cause malpositioning of the bone ends. Continuous traction must be maintained to keep the bone ends in satisfactory realignment. Releasing at any time, either 1 hour before surgery, once every hour for skin care, or once every 8 hours would not keep the fracture in satisfactory alignment.