Femur and Head injury

[2017]

Hi all!

I have tried to answer these questions multiple times and seem to be missing something and was wondering if you guys could help!

KB. is a 16 year old who fell while skiing. She briefly lost consciousness but is now alert and oriented. She was transported down the hill by ski patrol after being stabilized and then was flown to the hospital. She has a fractured right femur and humerus. She will be admitted to your unit after an open reduction and internal fixation (ORIF) of the femur fracture and casting of her leg and arm.

1) You are taking report from the PACU nurse. KB is awake and taking ice chips. What information will you document on the patient admission form?

- Parenternal access

-Medications previously given

-insurance information

- pain assessment

- vitals

[so for this one I had answered insurance, pain, and vitals and it's saying that it is only a percentage right]

2) In order from least important (1) to most important (7) prioritize the physicians orders:

-Vital signs per routine

-Neurological checks q2h

-turn, cough, deep breathe and incentive spirometer q2h while awake

-ice pack and elevate right lower extremity and right upper extremity

-IV fluids D5 1/2NS at 100ml/hr

-Morphine sulfate 5mg IV q4-6h prn

[my confusion is whether pain and fluids are prioritized above or below the ice packs and elevation]

[Rose_Queen, BSN, MSN, RN]

Question1: will the insurance status affect the way you provide care for the patient? How will you know what medication effects to be watching for?

[traumaRUs, MSN, APRN]

Moved to nursing student assistance

[NICUismylife, ADN, BSN, RN]

You will pretty much never deal with insurance info as a nurse, FYI.

What is your reasoning for not wanting to know if the pt has IV access or what meds the patient has been receiving up to this point?

Also, consider that TCDB and IS are to prevent a complication, whereas some of the other orders you listed below it are to treat the current problem. While all of these interventions are important, the ones that treat the actual problem are usually considered higher priority.

[AliNajaCat]

Also, consider that many such questions can have more than one answer. Part of the point of them is to get you to do some digging so you can understand completely what each one is for and why so you can make better decisions, and to demonstrate to your faculty that you can therefore make a cogent argument for your choices.

[Lev, MSN, RN, NP]

For prioritization, think about your ABCs and then pain and everything else.

Airway/

Breathing - anything respiratory related

Circulation - anything having to do with circulation - including IV fluids to support circulation/ or elevated an extremity to support circulation

Assessment always comes before intervention - ie. neurochecks before giving narcotic pain medication (morphine)