A client with a history of a T2 spinal cord injury tells the nurse, "I feel awful today. My head is throbbing and I feel sick to my stomach." Which action should the nurse take first?

A. acute glomerulonephritis: Acute glomerulonephritis typically presents with hematuria, proteinuria, and edema, but it is not directly related to crush injuries. It is an immune-mediated condition rather than a consequence of muscle trauma.

B. myoglobinuria: Crush injuries release myoglobin from damaged muscle into the bloodstream, which can accumulate in the kidneys and cause acute tubular necrosis. Dark, cola-colored urine is characteristic of myoglobinuria. This is a common cause of acute kidney injury following severe trauma.

C. embolus in a renal artery: A renal artery embolus can cause sudden flank pain and oliguria, but it is less likely in the context of a crush injury. It does not typically produce dark-colored urine.

D. bilirubinemia: Bilirubinemia causes jaundice and dark urine from liver dysfunction, not directly from muscle trauma. The client’s history and urine color are more consistent with myoglobinuria than liver-related causes.

A. Dress lightly during the day and stay in an air conditioned environment: Clients with T4 spinal cord injuries have impaired thermoregulation and are at high risk for heat-related illness. Light clothing and air conditioning help prevent hyperthermia and heat stroke. Staying in a cool environment is the safest strategy during extreme heat.

B. Drink at least 3000 mL of cold liquids daily in hot weather: While hydration is important, drinking excessive cold liquids does not fully prevent heat-related complications in clients with impaired thermoregulation. Cooling the environment is more effective in controlling core temperature.

C. Dress lightly during the heat of the day and stay on the screened porch: Even with light clothing, exposure to outdoor heat, such as on a porch, can lead to dangerous hyperthermia in someone with a high spinal cord injury. Indoor cooling is safer.

D. Sit outside for a limited time (one hour) in the morning only: Morning temperatures may still be high, and direct sun exposure poses a risk for hyperthermia. Limiting outdoor activity alone does not adequately protect thermoregulation. Air conditioning and minimal heat exposure are preferred.