A nurse is planning care for a client who has acute glomerulonephritis. Which of the following interventions should the nurse include in the plan?

Choice A reason:
Phenytoin is an antiepileptic drug that can be used to treat and prevent seizures. Headache and restlessness could be signs of neurological irritation or an impending seizure, which phenytoin can help to manage. It is important to monitor the client's neurological status closely following hemodialysis, as changes in electrolyte balance can affect neuronal activity.

Choice B reason:
Decreased blood pressure and rapid pulse are not typical indications for administering phenytoin. These symptoms could indicate hypovolemia or other cardiovascular issues that may occur after hemodialysis, which would require different interventions.

Choice C reason:
Muscle cramps and chest heaviness are not indications for phenytoin administration. Muscle cramps can be a common side effect of hemodialysis due to electrolyte shifts, and chest heaviness may indicate cardiovascular strain or other complications.

Choice D reason:
Pain and tingling at the access site are typically related to the vascular access itself and are not treated with phenytoin. These symptoms may require assessment for potential complications such as infection or thrombosis at the access site.

Choice A reason:

Pneumothorax, a collapsed lung, can indeed cause shortness of breath and dyspnea. However, it is typically associated with a sudden onset of these symptoms following a chest injury or spontaneously in the case of a ruptured air blister. In the context of a femoral head fracture, pneumothorax is less likely unless there was additional trauma to the chest area.

Choice B reason:

Pneumonia is an infection of the lungs that leads to inflammation of the air sacs, causing them to fill with fluid or pus. Symptoms include cough with phlegm, fever, chills, and difficulty breathing. While pneumonia could cause dyspnea, it usually develops due to an infectious process rather than directly from a femoral head fracture.

Choice C reason:

Airway obstruction involves a blockage that prevents air from passing freely to the lungs. It can be caused by foreign objects, swelling due to allergic reactions, or other medical conditions. The symptoms of airway obstruction include difficulty breathing, wheezing, and potential changes in skin color. However, airway obstruction is not commonly a direct complication of a femoral head fracture.

Choice D reason:

Fat embolism syndrome is a serious condition that occurs when fat globules enter the bloodstream and lodge within the pulmonary vasculature, leading to respiratory distress. It is a known complication following long bone fractures, such as the femur, and presents with symptoms like shortness of breath, hypoxemia, and neurological manifestations. Given the recent femoral head fracture and the symptoms reported, fat embolism syndrome is the most likely diagnosis.