The nurse is caring for a patient who sustained a fractured femur from a motor vehicle accident 1 day ago. The patient is anxious, restless, appears short of breath, and requests pain medication for chest discomfort
The most appropriate nursing action(s) would be to 1. increase intravenous fluids
2. assess the patient, obtain vital signs and spo2, and phone the physician.
3. administer pain medication as ordered.
4. institute relaxation techniques.
Correct
2
Rationale: The patient may be experiencing a fat embolism from the previous long bone fracture. The nurse should do a thorough assessment noting lung sounds, conjunctivae and pulse oximetry before calling the physician. Anticipate orders for supplemental oxygen, arterial blood gases, serum laboratory values, chest x-rays, electrocardiogram, a V/Q scan, and angiography. Pain medication and relaxation techniques may be instituted after speaking to the physician if the patient's condition warrants it. Increasing intravenous fluids might be indicated after the patient's status has been thoroughly assessed by the physician.
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