A nurse is caring for a client who is receiving oxygen when a fire starts in an adjacent room. Identify the sequence of actions the nurse should take. (Move the steps into the box on the right, placing them in the order of performance. Use all the steps.)

Rationale for correct choices:

• Compartment syndrome: The client demonstrates classic neurovascular compromise: severe escalating pain, numbness, inability to move toes, cool extremity, absent distal pulses, delayed capillary refill, and increasing edema. These findings reflect increased intracompartmental pressure compromising circulation and nerve function. This is a limb-threatening postoperative emergency following fractures and splinting.

• Osteomyelitis: The client has an open fracture with internal fixation, drainage at the surgical site, fever, and a marked rise in WBC count. Open fractures significantly increase the risk of bone infection due to direct contamination. Persistent fever and leukocytosis support developing osteomyelitis rather than normal postoperative inflammation.

Rationale for incorrect choices:

• Fat embolism syndrome: Fat embolism typically presents with acute respiratory distress, hypoxemia, altered mental status, and petechial rash. This client maintains adequate oxygen saturation and denies shortness of breath, making this condition less likely at this time.

• Deep vein thrombosis: DVT commonly presents with unilateral calf pain, warmth, erythema, and swelling, but does not cause absent pulses, motor loss, or sensory deficits. The acute neurovascular changes seen here point to arterial compromise rather than venous obstruction.

A. Droplet precautions: Droplet precautions are used for infections transmitted by large respiratory droplets, such as influenza or pertussis. Herpes simplex is not spread through respiratory droplets, so droplet precautions are not necessary.

B. Protective environment: A protective environment is designed to protect immunocompromised clients from acquiring infections. It is not used for clients who are infectious, such as those with herpes simplex.

C. Contact precautions: Herpes simplex virus is transmitted via direct contact with lesions or infected bodily fluids. Contact precautions, including wearing gloves and gowns and proper hand hygiene, prevent transmission to healthcare workers and other clients.

D. Airborne precautions: Airborne precautions are reserved for infections transmitted via small droplet nuclei, such as tuberculosis or measles. Herpes simplex does not spread through the airborne route, so these precautions are unnecessary.