A nurse is completing a home care visit for a 75-year-old client who began enoxaparin sodium (Lovenox) therapy 2 weeks ago.

The nurse is providing teaching regarding managing a bleeding episode in the event of an accidental injury with the client and his spouse.

Which of the following statements by the spouse indicates a need for further teaching?

Choice A rationale

While optimal nutrition and hydration are essential for bone matrix formation and overall cellular metabolism to support the healing process, involving components like calcium and Vitamin D, this physiological support is secondary to the immediate mechanical stability required for functional healing. Nutrition and hydration primarily provide the building blocks and medium.

Choice B rationale

Maintaining immobilization and alignment is the highest priority because bone healing fundamentally relies on minimizing movement at the fracture site to prevent displacement and shearing forces. Immobilization facilitates the stable formation of the fracture hematoma, which then differentiates into soft and hard callus, leading to bony union and functional restoration.

Choice C rationale

Pain relief, although crucial for patient comfort and compliance with the care plan, does not directly influence the physiological mechanism of bone union. Pain management focuses on symptom control by interrupting nociceptive signaling, which is supportive but not the primary driver for achieving a stable, healed fracture.

Choice D rationale

Promoting independence in activities of daily living is an important goal for rehabilitation and psychological well-being but is a long-term outcome dependent upon successful functional healing. Premature or excessive activity can disrupt the callus formation, hindering the primary biological repair process.

Choice A rationale

Immobility generally leads to a decreased metabolic rate due to the reduced expenditure of energy for physical activity and muscle contraction. This lowered metabolic demand results in an overall reduction in oxygen consumption and nutrient utilization, often contributing to a negative nitrogen balance and weight loss, but it is not a direct increase.

Choice B rationale

Immobility significantly impairs the skeletal muscle pump mechanism, which normally assists venous return in the lower extremities. This failure results in venous pooling, or stasis, increasing hydrostatic pressure within the capillaries. This stasis elevates the risk for thrombus formation, commonly referred to as deep vein thrombosis (DVT), a potentially fatal complication.

Choice C rationale

Prolonged immobility, particularly in a supine position, hinders the complete emptying of the bladder due to the lack of gravity and ineffective detrusor muscle function. This leads to urinary stasis, where residual urine harbors bacteria, significantly increasing the risk of urinary tract infections (UTIs) and the potential for renal calculi formation due to calcium reabsorption.

Choice D rationale

Immobility, especially in a supine position, restricts the chest wall's excursion and the functional capacity of the diaphragm and intercostal muscles. This leads to decreased depth of respirations, or hypoventilation, which causes the pooling of secretions in the dependent lung fields and elevates the risk for atelectasis and pneumonia.

Choice E rationale

The absence of weight-bearing and regular muscle contraction stimuli due to immobility results in a rapid breakdown of muscle protein, exceeding the rate of synthesis. This physiological response causes muscle atrophy, characterized by a reduction in muscle mass and strength, leading to significant weakness and functional decline over time. 80mm.5pt.