The nurse is assigned to care for a client who has had an open reduction and internal fixation of a fractured right femur 2 days ago
The nurse is listening to the client's lungs and, when moving the gown, observes petechial hemorrhages on the skin of the chest. What is the first action by the nurse? A) Call the physician to inform them of the findings.
B) Administer pain medication.
C) Request an antihistamine for the allergic reaction.
D) Increase the intravenous fluids for hemorrhage.
A
Feedback:
The findings of the nurse indicate that the client may have a fat embolus, and the physician should be informed immediately. Administration of pain medication is not indicated at this time. The rash is not indicative of an allergic reaction. There is no indication that the rash is related to hemorrhage, and there is no need to increase the IV fluids.
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a. "Ambulating in the hallway twice a day will help." b. "I will apply a cold compress to the painful area on your back." c. "Drinking a warm beverage can relieve this referred pain." d. "You should cough and deep breathe every hour."
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a. Give syrup of ipecac b. Contact the poison control center c. Give milk to coat the stomach d. Observe for symptoms
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