A nurse is preparing to provide morning hygiene care for a client who has Alzheimer's disease.
The client becomes agitated and combative when the nurse approaches him.
Which of the following actions should the nurse plan to take?

Choice A rationale:

This is the correct answer. Older adults often experience decreased kidney function as a normal part of aging. Medications that are excreted primarily by the kidneys may require dosage adjustments to prevent potential toxicity.

Choice B rationale:

Increased liver function is not a typical physiological change in older adults. Liver function tends to decrease with age, which can affect the metabolism and clearance of certain medications.

Choice C rationale:

Increased metabolism is not a common physiological change in older adults. Metabolic rate tends to decrease with age, which can affect the metabolism of drugs.

Choice D rationale:

While pulmonary function may decrease with age, it is not the primary physiological change to consider when administering medications to older adults. Kidney function is a more critical factor in medication dosing for this population.

The correct answer is choice A: Fat embolism syndrome.

Choice A rationale:

The client with an open fracture to the right femur is at risk for developing Fat Embolism Syndrome (FES) FES occurs when fat globules from the bone marrow or other tissues enter the bloodstream, leading to systemic complications. In this case, with an open fracture, there is a higher risk of fat emboli entering the circulation. The clinical manifestations of FES include respiratory distress, altered mental status, and petechial rash. These symptoms typically occur within 24-72 hours after the injury, which aligns with the timeline mentioned in the progress report on Day 1 of admission.

Choice B rationale:

Osteomyelitis is less likely to develop within the first 24 hours following a motor vehicle crash. It is an infection of the bone and typically takes more time to manifest. The early concerns in an open fracture involve the risk of infection, but osteomyelitis is not an immediate threat in this scenario.

Choice C rationale:

Compartment syndrome is a potential concern in orthopedic injuries, but it primarily arises due to increased pressure within a muscle compartment, causing reduced blood flow. While it is a valid concern, it is not typically associated with fat embolism syndrome, which is more specific to the release of fat globules into the bloodstream.

Choice D rationale:

Deep vein thrombosis (DVT) is a concern in immobile patients or those with significant trauma, but it is not the most immediate concern in this case. DVT usually develops over time and is more associated with prolonged immobilization rather than the early stages of admission.