A nurse is assessing a client who is in skeletal traction. Which of the following findings should the nurse identify as an indication of infection at the pin sites?
Mild erythema
Serosanguineous drainage
Fever
Warmth
The Correct Answer is C
A. Mild erythema (redness) at the pin sites can be a normal finding due to the body's response to the presence of foreign objects. It may not necessarily indicate infection.
B. Serosanguineous drainage (a mixture of clear and bloody fluid) can also be a normal finding initially after the insertion of pins. It may not necessarily indicate infection.
C. Fever is a systemic response to infection. In a client with skeletal traction, fever can be an indication of an infection at the pin sites or a more systemic infection related to the traction device.
D. Warmth around the pin sites can be a normal finding due to the inflammatory response that occurs after pin insertion. It may not necessarily indicate infection.
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Related Questions
Correct Answer is B
Explanation
A. Increasing the client's protein intake is important for overall healing, but it is not the top priority in the acute phase of osteomyelitis. The immediate priority is to administer antibiotics to address the infection.
B. This is the correct answer. Administering antibiotics is the top priority in the treatment of acute osteomyelitis. Timely administration of appropriate antibiotics is crucial in eradicating the infection and preventing further complications.
C. Providing the client with antipyretic therapy (to reduce fever) is important, but it is secondary to administering antibiotics. The underlying infection must be addressed first and foremost.
D. Teaching relaxation breathing to reduce pain may be beneficial for the client's comfort, but it is not the priority intervention. Controlling the infection with antibiotics takes precedence.
Correct Answer is D
Explanation
A. Rowing - This activity can put strain on the lower back and may exacerbate low back pain.
B. Tennis - This sport involves a lot of twisting and sudden movements, which can potentially worsen low back pain.
C. Canoeing - While generally a low-impact activity, it still requires core stability which could potentially aggravate low back pain.
D. Swimming - Swimming is a highly recommended exercise for individuals with low back pain. It is a low-impact activity that helps strengthen the muscles in the back, as well as other parts of the body, without putting excessive strain on the spine. Additionally, the buoyancy of water provides support, reducing the impact on the joints.
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