The nurse receives a report on 4 clients. Which client should the nurse assess first?

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11ecbb05_cbd2_4bb6_b433_49d08433f386_MD0009_00 A fat embolism is life-threatening; therefore, the client with the femur fracture is the priority. There is a risk for the formation of fat emboli following certain fractures, typically those of the long bones and pelvis. Globules of fat leave the bone and travel through the bloodstream to the lungs, skin, and brain where they cause damage by occluding small vessels. Altered mental status will result from blocked blood vessels in the brain. An embolism to the lung would result in respiratory distress. A hallmark sign of fat emboli is the presence of petechiae (pin-sized red/purple spots) that result from small-vessel clotting and appear across the chest, in the axillae, and in the soft palate. (Option A) This hospitalized heroin user is likely experiencing heroin withdrawal, which manifests with vomiting, abdominal cramping, and diarrhea; restlessness and diaphoresis; frequent yawning; rhinorrhea and lacrimation; and myalgias and arthralgias. This client needs treatment, but this condition is not life-threatening. (Option C) Moderate hyponatremia (normal sodium 135-145 mEq/L [135-145 mmol/L]) can cause altered mental status and can lead to seizures if it becomes severe. This client needs treatment and should be the second priority after the client with fat embolism. (Option D) Infections can cause altered mental status, especially in elderly clients. As the infection resolves, mental status improves. Educational objective: Clients with pelvic or long-bone fractures are at risk for the development of life-threatening fat embolism syndrome. Respiratory distress, mental status changes, and petechiae (on chest, axillae, and soft palate) are the classic manifestations.

The Nurse Receives a Report on 4 Clients