A nurse in the emergency department cares for 4 clients with orthopedic injuries. Which client should the nurse assess first?

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11ecbb05_ca1c_5e01_b433_e5b2c7179ca4_MD0009_00 Joint dislocations may become orthopedic emergencies because articular bone may compress surrounding vasculature, causing limb-threatening distal ischemia (Option D). When a joint is dislocated, the articular tissues, blood vessels, and nerves are often traumatized by stretching. Signs of joint dislocation include pain, deformity, decreased range of motion, and extremity paresthesia. The nurse should frequently assess neurovascular status and provide analgesics until the dislocation can be reduced and immobilized. (Option A) In incomplete greenstick fractures, the bone bends and cracks but remains in one piece. These fractures are most common in children, as their bones are soft and flexible. The nurse should provide analgesics and offer reassurance; however, the client with neurovascular impairment should be assessed first. (Option B) Fractures of the bones of the hand (ie, metacarpals) are common in fall injuries, when the brunt of the fall is borne against the hands and fingers, resulting in hyperflexion or hyperextension. The nurse should provide analgesics; however, the client with neurovascular impairment should be assessed first. (Option C) Pathologic vertebral compression fractures and pain are expected in clients with multiple myeloma. These clients commonly experience fractures of the vertebral column and spinal processes as the cancer weakens and decalcifies the vertebrae. This client should be evaluated next to rule out spinal cord involvement. Educational objective: Joint dislocations may constitute an orthopedic emergency. Because articular tissues, blood vessels, and nerves are stretched and compressed, neurovascular compromise may occur. Prolonged disruption of the vasculature and nerves may cause permanent injury and even loss of the distal extremity.

A Nurse in the Emergency Department Cares for 4 Clients