A nurse is assessing the skin turgor of an older adult client. In which of the following areas should the nurse lift the skin?

Rationale for correct choices

• Osteomyelitis: The client has an open fracture, which increases the risk of infection in the bone due to direct exposure to pathogens. The rising temperature (36.8 → 38.9°C) and elevated heart rate indicate a possible inflammatory response, making monitoring for osteomyelitis essential. Early detection allows prompt initiation of antibiotics and prevents chronic bone infection.

• Fat embolism syndrome: The client sustained a long-bone fracture (right femur), which is a known risk factor for fat embolism syndrome. Signs such as tachycardia, tachypnea, and decreased oxygen saturation (96% → 94%) may indicate early fat emboli. Prompt recognition and supportive interventions, including oxygen therapy and monitoring respiratory status, are critical.

Rationale for incorrect choices

• Deep vein thrombosis (DVT): While immobility and trauma increase the risk of DVT, there is no evidence of unilateral leg swelling, redness, or pain reported in this client. Although preventive measures are important, current findings suggest infection and respiratory complications are more immediate risks.

• Compartment syndrome: Compartment syndrome typically presents with severe pain unrelieved by medication, tense swelling, and neurovascular compromise in the affected limb. The client’s report and vital signs do not indicate these specific signs, so it is not the most immediate concern at this time.

Rationale:

A. "Taking disulfiram is an alternate therapy instead of joining Alcoholics Anonymous.": Disulfiram is a pharmacologic aid and should be used in combination with counseling or support groups like Alcoholics Anonymous. It is not a standalone treatment and does not replace behavioral therapies.

B. "I should avoid products containing alcohol, like mouthwash, while taking this medication.": Disulfiram causes a severe reaction when alcohol is ingested, even in small amounts found in products like mouthwash or cough syrup. Avoiding all alcohol-containing products demonstrates correct understanding of safety precautions while taking this medication.

C. "Disulfiram is mainly used for people who are at a high risk for a relapse of drinking alcohol.": Disulfiram is primarily used to maintain abstinence by causing unpleasant reactions with alcohol, but it is not limited to clients at high risk of relapse. It is important for all clients on disulfiram to understand adherence and alcohol avoidance.

D. "My sensitivity to alcohol will go away 24 hours after I stop taking this medication.": Disulfiram’s effects persist for up to 14 days after discontinuation, not just 24 hours. The client must continue to avoid alcohol for a longer period even after stopping the medication to prevent adverse reactions.