A nurse is assisting in the care of a 6 year old child who preoperative for repair of a fractured femur.

Exhibits

For each finding click to specify whether the finding indicates no change in the child's condition or is a sign of potential worsening condition.

A. Pain following range-of-motion exercises is incorrect. Mild discomfort during movement can be expected in a healing fracture. However, severe pain unrelieved by medication or worsening pain should be reported as it could indicate compartment syndrome.

B. Coolness of the toes is correct. Cool or pale toes may indicate compromised circulation, which is a sign of compartment syndrome or impaired perfusion. This is a medical emergency and should be reported immediately.

C. Pruritus under the cast is incorrect. Itching is a common, non-emergent issue with casts and can be managed with safe interventions such as blowing cool air inside the cast. However, inserting objects to scratch the skin should be avoided.

D. Presence of swelling while the extremity is dependent is incorrect. Some degree of swelling is expected when the limb is in a dependent position. Elevating the extremity can help reduce swelling, but persistent swelling with other signs of neurovascular compromise should be reported.

A. Sitting the child in an upright position is not the best method for administering otic medications in a toddler. The preferred position is having the child lie on their side with the affected ear facing up to allow proper administration and absorption of the medication.

B. For children under 3 years old, the nurse or parent should pull the pinna downward and back, not upward, to straighten the ear canal for proper medication administration. Pulling upward is appropriate for children older than 3 years.

C. Allowing the otic medication to reach room temperature before administration is essential to prevent discomfort such as dizziness or nausea, which can occur if cold drops are introduced into the ear.

D. After administration, the child should remain in a side-lying position with the affected ear facing up, not down, for a few minutes to allow the medication to properly enter the ear canal. Placing the affected ear down may cause the medication to leak out.