A nurse is planning care for an older adult client who has a history of dementia and is admitted following surgical repair of a hip fracture. Which of the following actions should the nurse plan to take?

Rationale for Correct Choices

• Blood glucose: A blood glucose level of 250 mg/dL is critically elevated and puts the client at risk for complications such as delayed wound healing, infection, dehydration, and diabetic ketoacidosis (DKA) if unmanaged. Hyperglycemia impairs immune function and must be addressed promptly to stabilize the client's condition and support healing.
• Wound : The draining, non-healing foot ulcer with purulent discharge indicates infection. However, uncontrolled glucose is a major contributing factor to poor wound healing and increased infection risk. Once glucose levels are addressed, wound care becomes the next critical focus to prevent systemic infection and further tissue damage.

Rationale for Incorrect Choices

• Temperature: While the client has a low-grade fever (38.3°C), which may be related to the infected wound, treating the source of infection and controlling glucose will have a greater and more direct impact on resolving the fever.
• Blood pressure: The blood pressure of 98/74 mm Hg is slightly low but not emergent and does not pose immediate risk. It can be monitored while more pressing concerns—like glucose and wound infection—are managed.
• WBC count: The WBC count of 9,500/mm³ is within normal limits. Although it helps in evaluating infection, it does not require direct intervention and is not a clinical priority compared to glucose control and wound care.

A. Ketorolac 30 mg IV: Ketorolac is a NSAID that can be administered intravenously for postoperative pain relief. Since the client is only 2 hours postoperative and reports severe pain (10/10), this prescription is appropriate for managing acute pain effectively.

B. Oxycodone 10 mg PO: Oxycodone is an opioid but it is taken orally, which may not be appropriate in the immediate postoperative period when the client is still recovering from anesthesia and may have nausea or difficulty swallowing.

C. Acetaminophen 1,000 mg PO: Acetaminophen is an appropriate medication for mild to moderate pain, but given the client's severe pain (10/10), a stronger analgesic such as an NSAID (ketorolac) or opioid would likely be prescribed in this situation.

D. Fentanyl 12.5 mcg/hr transdermal: Fentanyl transdermal patches are used for long-term, chronic pain management and are not suitable for immediate postoperative pain. The onset of action is slow, and it would not provide adequate pain relief in the immediate postoperative period.