The practical nurse (PN) is caring for a client with type 1 diabetes mellitus. Which intervention should the PN implement immediately after a below-the-knee (BKA) amputation due to gangrene?

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: Suction equipment is essential for a client who has undergone fixation of a mandible fracture. Due to the nature of the surgery and the presence of wiring, the client may have difficulty managing oral secretions. Suction equipment ensures that any secretions can be promptly and effectively removed, preventing aspiration and maintaining a clear airway. This equipment is vital for managing the client's immediate postoperative needs and ensuring their safety.
Choice B reason: A crash cart, while critical in emergency situations, is not specifically required to be present in the client's room following mandible fracture fixation. Crash carts are typically available on the unit and can be quickly brought to the room if needed. The practical nurse should be familiar with the location of the crash cart and how to access it, but it does not need to be permanently stationed in the client's room.
Choice C reason: A non-rebreather mask is used to deliver high concentrations of oxygen to clients experiencing severe respiratory distress or hypoxemia. While it is an important piece of equipment for respiratory emergencies, it is not specifically necessary to have in the room of a client with a mandible fracture fixation. The priority is to have suction equipment and wire cutters immediately available, while other oxygen delivery devices can be accessed as needed.
Choice D reason: A nasogastric tube is used for decompression of the stomach or for feeding clients who are unable to take oral nutrition. It is not specifically required for a client with a mandible fracture fixation unless there are additional complications or indications for its use. The practical nurse should focus on equipment directly related to managing the fixation and maintaining the client's airway.
Choice E reason: Wire cutters are a critical item to have in the room of a client with a mandible fracture fixation. In the event of an emergency, such as vomiting or respiratory distress, the wires securing the mandible may need to be quickly cut to ensure the client's airway is not compromised. Having wire cutters immediately available ensures that the practical nurse can respond swiftly and effectively to any urgent situations, maintaining the client's safety and airway patency.