A child has an injured wrist and will not allow the nurse to exam the injured arm. Both parents and child are upset. What is a priority nursing intervention?
1. Tell the parents to hold the child down, so the arm can be examined.
2. In a soothing voice, ask the child to point to the "ouchie" or pain and move fingers.
3. Obtain an order for pain analgesic and then examine the arm.
4. Call radiology and have them come to the emergency room to obtain x-ray films.
Answer: 2
Before any measures (obtaining x-rays and administration of analgesics) are started, an initial assessment is the priority. It will be important to calm the child and gain the child's trust. Inspection and observation are important, so asking the child to point to the painful part and moving the fingers, along with noting any pallor or abnormal position would be part of the initial assessment. Parents are not to be asked to restrain their child. If restraint is necessary, then the parents need to leave the room and the nurse needs to obtain assistance from other personnel. (Hockenberry, Wilson, 9 ed., p. 1639.)
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