A nurse case manager is caring for a population of clients in the community. Which of the following demonstrates the role of a liaison?

Rationale for correct choices

• Compartment syndrome: The child has a nondisplaced fracture of the radius and ulna, which can lead to swelling and increased pressure within the forearm compartments. Compartment syndrome is a serious complication that can compromise circulation and nerve function if not identified and treated promptly. Early recognition is critical to prevent permanent muscle and nerve damage.

• Paresthesia: The child reports mild tingling in the fingers, indicating early sensory nerve involvement. Paresthesia is a key early sign of neurovascular compromise in compartment syndrome. Monitoring for worsening tingling, numbness, or pain is essential for timely intervention, such as fasciotomy if needed.

Rationale for incorrect choices

• Deep vein thrombosis: DVT is uncommon in pediatric patients, especially in the absence of immobility, central lines, or hypercoagulable conditions. While fractures increase risk in adults, it is not the highest-priority risk in this 9-year-old child with an acute upper extremity fracture.

• Malunion: Malunion refers to healing of a fracture in an abnormal position. While possible, this risk develops over time and is not the immediate concern in the acute phase. Neurovascular compromise and compartment syndrome are more urgent.

• Type of fracture: While the fracture type (nondisplaced radius and ulna) informs management, it does not by itself represent the complication risk. The clinical symptoms of tingling are more directly indicative of acute neurovascular compromise.

• Ecchymosis: Bruising reflects local tissue trauma but is not a definitive indicator of compartment syndrome. Ecchymosis should be monitored but does not provide the highest-priority evidence of risk.

• Location of fracture: The midshaft location guides treatment, such as splinting, but the presence of paresthesia is more directly associated with risk for compartment syndrome. Location alone does not indicate imminent neurovascular compromise.

Rationale for correct choices

• Limb immobilization: Immobilization is the primary treatment for a nondisplaced fracture to maintain bone alignment, promote healing, and prevent further injury. Splints, casts, or braces may be used depending on the fracture location and stability. Proper immobilization also helps reduce pain and swelling by limiting movement of the injured extremity.

• Pain medication: Pain management is essential to ensure comfort and facilitate cooperation with care. Mild to moderate pain from a nondisplaced fracture can be managed with acetaminophen or ibuprofen. Effective analgesia also helps the child maintain mobility of unaffected areas and reduces stress associated with the injury.

Rationale for incorrect choices

• Antibiotics: Antibiotics are not routinely prescribed for closed fractures unless there is an open wound or risk of infection. The child’s abrasion on the knee may require topical care, but systemic antibiotics are not indicated for the fracture itself.

• Bed rest: Strict bed rest is not necessary for a nondisplaced upper extremity fracture. The child can usually participate in age-appropriate activities while the limb is immobilized, as long as the extremity is protected.

• Surgical consultation: Surgical intervention is typically reserved for displaced fractures, open fractures, or fractures with neurovascular compromise. This child’s fracture is nondisplaced and stable, so surgery is not anticipated at this stage.

• Skin traction: Skin traction is generally used for lower extremity fractures or severe fractures requiring alignment before surgical intervention. It is not indicated for a stable, nondisplaced forearm fracture in a child.