An older adult client is admitted to the hospital following a fall in which they sustained a fractured pelvis. What would be priority nursing care?
1. Determine the activity before the fall
2. Assess urine and stool for presence of blood.
3. Determine hemoglobin and hematocrit
4. Assist the client to turn every 2 hour
Answer: 2
Puncture of the bladder or bowel and vascular bleeding are a priority in the initial period after the fracture. The client also should be assessed for abdominal bruising and increasing abdominal distention and rigidity. Activity before the fall can be determined later; physiologic needs are a priority. The hemoglobin and hematocrit will be evaluated, but it would not be indicative of immediate bleeding. The client should remain in the supine position with the head slightly elevated and no turning until the stability of the fracture has been determined.
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