A client with a history of a right radical mastectomy arrives on the postoperative unit following surgical repair of a fractured left radius and application of a short arm cast. Which action should the practical nurse implement while obtaining the client's blood pressure (BP)?

Choice A reason: Fat embolism syndrome (FES) is a serious complication that can occur after a long bone fracture. It happens when fat droplets from the bone marrow enter the bloodstream and travel to the lungs, brain, or other organs, causing a range of symptoms. These can include respiratory distress, cerebral symptoms like confusion or agitation, and petechial rash. The practical nurse must be vigilant for early signs of fat embolism, such as changes in mental status, tachypnea, and hypoxia, as timely intervention is critical to prevent severe outcomes. Monitoring the client's oxygen saturation, respiratory rate, and level of consciousness is essential in detecting this potentially life-threatening condition.
Choice B reason: Urinary retention can be a concern postoperatively due to anesthesia and immobility. While it is important to monitor urinary output and ensure the client is voiding adequately, urinary retention is not as immediately life-threatening as a fat embolism. The practical nurse should still assess bladder function and encourage measures to promote voiding, such as adequate hydration and mobility. However, this complication does not take precedence over the potential for a fat embolism in the early postoperative period following a long bone fracture repair.
Choice C reason: Nonunion refers to the failure of the fracture to heal properly, which can lead to chronic pain and functional impairment. It is a significant complication that requires attention, but it typically develops over a longer period rather than immediately postoperatively. The practical nurse should monitor for signs of nonunion, such as persistent pain and lack of healing on follow-up X-rays. However, this is not the most urgent concern in the immediate postoperative period when compared to the risk of a fat embolism.
Choice D reason: Muscular spasms can occur after a fracture as the muscles around the injury site contract to protect and stabilize the affected area. While muscle spasms can be painful and affect the client's comfort and mobility, they are generally not life-threatening. The practical nurse should address muscle spasms through pain management strategies and physical therapy, but this complication is not as critical as the potential for a fat embolism in the immediate postoperative period.

Choice A reason: Providing reassurance that hair loss is not usually permanent offers the client some comfort during a challenging time. Informing her that the color and texture may change when it grows back prepares her for potential differences in her hair's appearance post-chemotherapy. This response acknowledges the temporary nature of chemotherapy-induced hair loss while also being honest about the possibility of changes, which helps manage the client's expectations effectively.
Choice B reason: Stating that "people with cancer react differently to chemotherapy" is true, but it is not the most supportive or informative response. It may leave the client feeling uncertain and anxious about the outcome. Providing more specific information about hair regrowth, as in choice A, is more helpful in addressing the client's concerns and providing reassurance.
Choice C reason: While acknowledging that wigs are available is practical, focusing on the possibility that hair might not grow back can be disheartening for the client. It is important to offer hope and positivity where possible, and emphasizing the usual pattern of hair regrowth, as in choice A, is a more supportive approach. If the client does have concerns about wigs, this can be discussed separately.
Choice D reason: Indicating that hair regrowth depends on the amount of drug received is somewhat accurate but lacks the reassurance and positivity provided in choice A. It is important to give the client a clearer understanding that, in most cases, hair loss from chemotherapy is temporary, and hair will generally grow back. This helps alleviate some of the stress associated with the treatment.