A moderate amount of serous drainage from a recent surgical site is a sign of normal healing. Serous drainage is clear, thin, and watery. The production of serous drainage is a typical response from the body during the normal inflammatory healing stage.

Option A: Purulent drainage would indicate the presence of infection. Purulent drainage is milky, typically thicker in consistency, and can be gray, green, or yellow in appearance. If the fluid becomes very thick, this can be a sign of infection. Yet, if there is a large amount of serous drainage, it can be the result of a high bioburden count.
Option B: A soiled dressing should be changed to avoid bacterial growth and to examine the appearance of the wound. Overall, it should be noted that the dressing selection should be based on the individual patient and wound characteristics. If the wound is not in the normal inflammatory phase of healing, the clinician must investigate what is the root cause and how to manage the drainage.
Option C: The surgical site is typically covered by gauze dressings for a minimum of 48-72 hours to ensure that initial healing has begun. Changing the dressing less allows the wound bed to be left undisturbed, which allows for the migration of new cells. When wound beds are left undisturbed in an optimal moist environment, they are able to heal at a faster rate.

Impaired perfusion to the right lower arm as a result of a closed cast may cause neurovascular compromise and severe pain, requiring immediate cast removal. When there is an increase in compartmental pressure, there is a reduction in the venous outflow. This causes venous pressure and, thus, venous capillary pressure to increase. If the intracompartmental pressure becomes higher than arterial pressure, a decrease in arterial inflow will also occur. The reduction of venous outflow and arterial inflow result in decreased oxygenation of tissues causing ischemia.

Option A: Itching under the cast is common and fairly benign. A cast can cause the client’s underlying skin to feel itchy. To relieve itchy skin, turn a hair dryer on a cool setting and aim it under the cast.
Option B: Neurovascular compromise in the arm would not cause pain in the shoulder, as perfusion there would not be affected. Pain is typically severe, out of proportion to the injury. Early on, pain may only be present with passive stretching. However, this symptom may be absent in advanced acute compartment syndrome. In the initial stages, pain may be characterized as a burning sensation or as a deep ache of the involved compartment.
Option D: Impaired perfusion would cause the fingers to be cool and pale. Increased warmth would indicate increased blood flow or infection. Classically, the presentation of acute compartment syndrome has been remembered by “The Five P’s”: pain, pulselessness, paresthesia, paralysis, and pallor. However, aside from paresthesia, which may occur earlier in the course of the condition, these are typically late findings.

Physical activity and daily exercise can help to improve movement and decrease pain in osteoarthritis. Exercise programs that combine both aerobic and resistance training have been shown to decrease pain and improve physical function in multiple trials and should be encouraged by physicians regularly.

Option B: Joint pain and stiffness are often at their worst during the early morning after several hours of decreased movement. Evidence shows that water-based activities can help relieve symptoms and improve joint function, hence consultation with a physical therapist is recommended. Further, many of these patients may benefit from a walking aid.
Option C: Ibuprofen is a strong anti-inflammatory, but should always be taken with food to avoid GI distress. NSAIDs are usually prescribed orally or topically and initially, should be started as needed rather than scheduled. Due to gastrointestinal toxicity, and renal and cardiovascular side effects, oral NSAIDs should be used very cautiously and with close monitoring long term.
Option D: Acetaminophen is a pain reliever, but does not have anti-inflammatory activity. Pharmacotherapy of OA involves oral, topical, and/or intra-articular options. Acetaminophen and oral NSAIDs are the most popular and affordable options for OA and are usually the initial choice of pharmacologic treatment.

Alendronate can cause significant gastrointestinal side effects, such as esophageal irritation, so it should not be taken if a patient must stay in supine position. It should be taken upon rising in the morning with 8 ounces of water on an empty stomach to increase absorption. The patient should not eat or drink for 30 minutes after administration and should not lie down.

Option A: Contraindications to alendronate include patients with known hypersensitivity, esophageal abnormalities, delayed esophageal emptying, or achalasia. Severe risk of esophageal morbidity indicates avoidance in patients who are unable to sit or stand upright for at least 30 minutes. Avoid alendronate in patients with hypocalcemia.
Option B: ACE inhibitors are not contraindicated with alendronate and there is no iodine allergy relationship. Baseline concentrations of calcium and bone mineral density should be established before therapy begins, with follow-up testing at 6 to 12 months post-therapy. Calcium at baseline and continual monitoring is needed if hypocalcemia risk is recurring.
Option C: There is no restriction for alendronate on a patient taking a calorie restricted diet. The accumulation of alendronate in the kidney allows for persistent anti-fracture benefits even after cessation of treatment. Current recommendations suggest tailoring the drug holiday length to the individual patients. The average drug-holiday in low-risk patients is 3 to 5 years.

Prophylactic use of antibiotics is not indicated to prevent Lyme disease. Antibiotics are used only when symptoms develop following a tick bite. Specific treatment is dependent upon the age of the patient and stage of the disease. For patients older than 8 years of age with early, localized disease, doxycycline is recommended for 10 days. Patients under the age of 8 should receive amoxicillin or cefuroxime for 14 days to avoid the potential for tooth staining caused by tetracycline use in young children.

Option A: Insect repellant should be used on skin and clothing when exposure is anticipated. While there are many repellants on the market, it is best to avoid them as the risk of harm is greater than any benefit. If one is going to use a repellant, DEET is the one product that is safe, however, it is not 100% effective.
Option B: Clothing should be designed to cover as much exposed area as possible to provide an effective barrier. The outdoors person should be told to wear appropriate garments and be familiar with the skin features of the tick bite. The nurse should educate the patient on how to remove the tick from the skin and when to seek medical assistance.
Option D: Close examination of skin and hair can reveal the presence of a tick before a bite occurs. Nurses should educate parents on how to inspect their children for ticks at the end of an outdoor event, in an endemic area. Pets can also develop Lyme disease and carry the tick. Hence, pet owners should examine their pets on a regular basis and remove the tick. There is no risk of acquiring Lyme disease by removing the tick.