A nurse is assessing a client who has an abdominal incision. Which of the following findings should the nurse report to the provider?

Rationale:

A. Explain the cast application procedure to the child: Preparing the child for a future procedure is helpful but not immediately necessary. At this point, pain control and reduction of swelling take precedence to prevent complications and stabilize the injury.

B. Review cast care instructions with the child's parents: While parent education is important, it is secondary to immediate interventions that address pain, swelling, and preparation for the procedure. Priority actions focus first on the child’s current needs and safety.

C. Elevate the affected forearm with pillows: Elevation helps reduce edema and pain in the fractured extremity and prevents further swelling. This is a critical nursing intervention for acute fracture management before and after casting.

D. Apply ice packs to the fingers and along the right forearm: Ice helps manage pain and inflammation by vasoconstriction, limiting fluid accumulation in tissues. Applying it early post-injury is crucial to controlling swelling in a fractured limb.

E. Place a nonadherent dressing on the right knee abrasion: Caring for minor abrasions is important but is not a priority compared with interventions addressing fracture management, pain, and preparation for cast application.

F. Administer Ibuprofen 200 mg PO: Pain management is a priority in fracture care to maintain comfort and reduce distress. Administering analgesics before cast application helps the child tolerate the procedure and facilitates cooperation.

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.