The nurse working on an orthopedic unit is receiving report on 4 clients with recent fractures. Which client should the nurse assess first?

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11ecbb05_ca1f_6b43_b433_19e950e9965d_MD0009_00 Clients with orthopedic injuries, particularly pelvic and long bone injuries (eg, femoral fracture), may develop a fat embolus. Fat emboli are thought to occur from the release of fat globules (lipids) from bone marrow or the systemic release of triglycerides into the bloodstream following a mechanical insult. The circulating lipids can occlude small vessels in the lungs (similar to pulmonary embolism), brain, and skin, which impair circulation and oxygenation, leading to: Respiratory distress syndrome (eg, dyspnea, tachycardia, sudden and worsening chest pain, hypoxemia, restlessness, anxiety) Altered mental status (eg, confusion, memory loss) Petechial hemorrhages in the arms, chest, and/or neck (Option A) (Option B) Purulent (eg, yellow, foul-smelling) drainage from skeletal pins and fever may indicate infection that could progress to osteomyelitis. Treatment with antibiotics is required, but this infection is not emergently life threatening. (Option C) Pitting edema may occur in clients with impaired mobility (eg, hip fracture) and often relates to fluid volume excess. Hypertension may also be related to fluid volume excess in clients receiving IV fluids. This client should be assessed next. (Option D) Clients with rib fractures often take frequent, shallow breaths as they experience intense pain with inspiration. Adequate pain control allows for deep breathing, which prevents buildup of secretions, atelectasis, and pneumonia. Educational objective: Clients with pelvic and long bone injuries are at risk for fat emboli, which can occlude small vessels in the lungs, brain, and skin. Sign and symptoms include altered mental status (eg, restlessness), chest pain, respiratory distress, and petechial hemorrhage.

The Nurse Working on an Orthopedic Unit Is Receiving Report